CPT Billing & Coding

Developed in 1966 by the American Medical Association (AMA), Current Procedural Terminology (CPT) serves as a universal language within the health-care arena. In addition to depicting medical data, procedures, diagnoses and treatments concerning a patient, CPT codes are a vital part of the billing process.

Features

• During the CPT billing and coding process, the verbal description of diseases, injuries and procedures are converted into numeric/alphanumeric terms. Billers and coders assess medical documents and then assign the corresponding CPT code.

Function

• CPT codes dictate the monetary fee for the services rendered, along with the monetary compensation/reimbursement a practitioner will receive. The codes are submitted via claims to the patient and his insurance provider; the specific amount of money to which a practitioner is entitled may vary among different types of insurance policies.

CPT Sections

• The CPT system/manual comprises eight sections: Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine (Category I, Category II--Performance Measurement and Category III--Emerging Technology).

Identification

• In addition to subsections, subcategories, symbols, colon and semicolon modifiers, appendices, indices, supplementary codes and examples, each section has its own range of codes: Evaluation & Management (99201-99499), Anesthesiology (00100-99140), Surgery (10021-69990), Radiology (70010-79999), Pathology and Laboratory (80048-89356) and Medicine (90281-99602).

Considerations

• All CPT coding procedures must abide by federal, legal and insurance guidelines. Organizations such as the American Medical Association (AMA), Center for Medicare-Medicaid Services (CMS), Institute for Safe Medication Practices (ISMP) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) monitor CPT guidelines and implementation.