Correct CPT Coding Procedures

Current procedural terminology (CPT) is a system of assigning numerical codes to medical services, treatments and procedures for tracking and billing purposes.

CPT codes are assigned and then submitted to payers for reimbursement to physicians and providers.

Understanding CPT

• CPT codes are Level I codes within the Healthcare Common Procedure Coding System (HCPCS) classification system. The codes are copyrighted and published exclusively by the American Medical Association (AMA). They are updated annually to depict changes in treatments and procedures, delete unused codes and provide more detail for existing codes.

  CPT codes are five digits that represent physician services. For example, treatment of an arm fracture may be coded "24500, closed treatment of humeral shaft fracture; without manipulation."

  CPT codes do not code for "... medical items or services that are regularly billed by suppliers other than physicians." There is an additional level of codes -- HCPCS Level II -- set up to cover medical services and goods used by other providers.

Goal of CPT Coding

• The goal of CPT is to assign an appropriate numerical code to a treatment or procedure description so that the insurer can reimburse the provider for the services provided.

  As a coder, you should assign codes that are as inclusive as possible within that five digit code. This means that, in some instances, one code will include several procedures.

Where is CPT Used?

• CPT codes are procedure (or service) codes used mainly in outpatient and physician settings.

  Some payers, such as Medicare and Medicaid, require the reporting of CPT codes on all bills.

Organization of CPT Codes

• CPT codes are organized by medical field, like anesthesia, surgery, radiology, medicine and pathology. There is also a specific code set for the evaluation and management of patients.

  A CPT coding book has an alphabetic index that is organized by main terms like procedure or service, anatomic site and condition. Under the main terms are indented terms that provide additional information such as the anatomical site and the range of codes for that site.

  For example, under the term laparoscopy, you will see indented terms like abdominal, adrenal glands, adrenalectomy and so on. You will then choose the anatomical site for the laparoscopy in order to locate the appropriate CPT code.

Reviewing Documentation for CPT Code Assignment

• To appropriately assign CPT codes to services rendered, a thorough review of the provider documentation must be performed.

  The coder/biller should review physician treatment and procedure documentation within the patient's health record.

Coding with CPT Codes

• Once the coder/biller has identified the appropriate services provided through a documentation review, then codes are ready to be assigned.

  Most healthcare providers have software systems that help to assign the CPT codes. However, the coder/biller must still be aware of coding practices to insure that the appropriate codes are being assigned.

  When coding with a CPT book, never code only from the alphabetic index. Instead, look up the term in the alphabetic index, locate the code range for that service or procedure and then review the code ranges within the body of the coding book. Often, there are notes on specific codes within the book text to help determine the appropriate CPT assignment.

  For example, a CT scan of the lower arm shows a code range of 73200-73206 in a coding book index. Refer to that code range within the body of the coding book for exact code assignment. The codes will allow you to assign a more specific code based on whether contrast material was or was not used, and if the imaging included any "post processing."

  Assignment of incorrect or incomplete CPT codes will result in denial from the insurer or payer.