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CPT Codes – Medical Coding

CPT codes

Current Procedural Terminology (CPT) codes

CPT code is an essential part of the billing process. According to medical billing services and procedures, CPT codes are the language spoken between providers and payers.

CPT code

This article will see many details about CPT codes like CPT codes, different categories, mostly used CPT codes, their importance, and more.

What is a CPT code?

Current Procedural Terminology (CPT) is a set of codes, descriptions, and guidelines created to describe procedures and services used by physicians, allied health professionals, non-physician practitioners, hospitals, outpatient facilities, laboratories, and other health care providers.

Mainly, CPT codes report tests, surgical processes, assessments, and report medical procedures and services a medical care provider performs on a patient. As you might presume, this code set is extensive and includes the codes for more than thousands of medical procedures.

CPT codes are also used for management works like claims preparing and making rules for clinical care analysis.

CPT is the most widely accepted medical terminology used worldwide to report clinical, surgical, radioscopy, research lab, genomic sequencing, evaluation, and management (E/M) services under public and private health insurance programs.

CPT codes ICD-9-CM or ICD-10-CM digital codes can be integrated with electronic medicine encoding electronic medical billing process.

The CPT codes work in sequence with the ICD codes to create a complete picture of the medical process for the payer. Here is a simple example.”Mr. David arrived with these symptoms, and we performed these procedures.” In this, ICD codes represent symptoms, and CPT codes represent procedures.

Who developed, managed, and updated the CPT Codes?

CPT codes are developed, managed, and copyrighted by the American Medical Association (AMA).

In the 1960s, the American Medical Association created CPT codes to standardize medical reporting. Each CPT code represents a procedure or service’s written information that eliminates the subjective explanation of what the patient had.

The AMA updates the CPT code set annually by releasing new, revised, and deleted codes and changing the CPT coding guidelines. It assists in keeping updated with the latest services and procedures of the medical care field and identify the currently outdated services.

Additionally, the AMA updates CPT codification of medical language to have more benefits in medicine. While the AMA can do the copyright of CPT, AMA invites providers and organizations to work with the maintenance of the code set. The workers can make suggestions for changes of codes and code details to earn a better outcome.

Recognizing & Understanding CPT Codes

Let’s take a closer look at the CPT codes and how they’re organized. Every CPT code has five characters. Most of the codes are digits, but some codes have a fifth alpha character like F, T, or U. Examples include

  • 11102 – Tangential biopsy of skin
  • 0500F – Initial Prenatal care visit
  • 0510T – Removal of sinus tarsi implant

There are uniquely assigned CPT Codes to different activities. Thus, some can be used occasionally (or not at all), while others are used regularly (e.g., 99213 or 99214 for general check-ups).

Generally, the medical care field is constantly updated. So, new codes are created for new services and can unused codes discard. Annually, more than of thousand principles are updated and used.

Consistency in understanding the service and the reimbursement that practitioners get will not necessarily be the same. The contracts decide that between individual providers and insurers.

For example, Doctor David will do a physical check-up and be compensated $120 by the patient’s insurance company. However, if a patient went to Doctor Robert, his reimbursement by the patient’s insurance company for that same check-up with the same CPT code will only be $110.

Understanding the Types of CPT Codes

In ICD codes, ‘category’ refers to the first three letters describing a trauma or illness reported by a medical service provider. The ‘Category’ of the CPT codes means the division of the code set. In general, there are three categories of CPT codes.

The difference between ICD and CPT codes is that every number of the CPT code doesn’t relate to a particular technology or procedure.

All the time, Coders allocate a code for each service or procedure a provider performs. CPT also includes unlisted codes for those services and systems not named explicitly in another defined CPT code.

Given many service and operational procedures, AMA has logically organized CPT codes and categorized them into three categories.

  • CPT Category I – Largest code structure that contains code commonly used by providers to record their services and access
  • CPT Category II – emphasize tracking codes used for executive management.
  • CPT Category III – temporary codes used to report come out and preliminary services and approaches.

Introducing Category I Codes – Procedures, services, devices, and drugs, including vaccines

Category 1 Covers commonly used procedures and contemporary medical practices. Coders primarily identify CPT codes in Category 1. Five-digit number CPT codes recognize a procedure or service with the Food and Drug Administration (FDA). FDA is conducted by medical care professionals worldwide, and they demonstrate and document each CPT code.

Category 1 of CPT codes divides into six main sections:

  1. evaluation and management Services (99202 – 99499)
  2. anesthesiology Services (01000 – 01999)
  3. Surgery (10021 – 69990) – further divided into body area or system within this code range.
  4. Radiology Services (70010 – 79999)
  5. Pathology and Laboratory Services (80047 – 89398)
  6. Medicine and Procedures (90281 – 99607) 

Introducing Category II Codes – Clinical Laboratory Services

The Category 2 CPT medical code set includes the performance measurement codes used to measure the performance and help collect details about the quality of patient care delivered.

This CPT code set is not a replacement for Category 1 codes, and the usage of the category 2 CPT medical code set is optional.

Category II codes are also five-digit codes, including four numbers and ending with the letter F, which are increase tracking and performance measurement codes that providers can allocate in addition to Category I codes. However, category II codes don’t connect with repayments like Category I CPT codes.

Providers use coding in their category to search for specific information about patients, such as tobacco use, to help provide better medical care and better patient outcomes.

You can find Category II codes directly after the Category I codes in the CPT codebook. Below is the arrangement of these codes.

1. Composite Measures (0001F – 0015F)

2. Patient Management (0500F – 0584F)

3. Patient History (1000F – 1505F)

4. Physical Examination (2000F – 2060F)

5. Diagnostic Processes or Results (3006F – 3776F)

6. . Therapeutic, preventive, or other interventions (4000F – 4563F)

7. Follow-up or other results (5005F-5250F)

8. Patient Safety (6005F – 6150F)

9. Structural Measures (7010F – 7025F)

10. Nonmeasure Code Listing (9001F – 9007F)

Introducing Category III Codes – new technologies, services, and procedures

Category III codes are five-digit codes with four numbers, and the letter T follows Category II codes in the coding manual. For example, code 0644T is for transcutaneous intradermal removal or removal of internal cardiac vegetation.

The Category III CPT codes list, includes temporary codes representing the new technologies, services, and procedures. They are different from the Category 1 medical CPT code list. They identify services that not be widely performed by healthcare professionals, do not have the approval of the FDA, and do not have proven clinical effectiveness.

Appropriately, the medical service or procedure is always involved in the proceeding and planned research works. The purpose of category III CPT codes is to help researchers track emerging technologies and services.

Temporary codes can keep up in Category III for up to five years. However, services and Procedures that represent Quick Code related to Category I standards, which have the FDA approval, evidence that many providers perform the processes, and proof that the systems have proven effective, will be reassigned Category I codes.

And also, if providers do not use Category III codes, they can remove these codes.

AMA announces new or updated batch III codes twice a year through its website but announces batch III deletions once a year with the full set of temporary codes.

Typically, payers require a valid Category I and Category III code(s) for payment consideration.

Commonly used CPT codes.

Here are the most frequently used CPT codes for medical billing:

  • New patient office visit codes – make use to charge patients who have never been seen by any doctor in a similar specialty within the same group over the most recent three years.
  • Traditional patient office visit codes – used to bill for patients seen by a physician in a similar specialty within the same group over the last three years.
  • Starting emergency medical care for new or traditional patients codes: used to bill for patients admitted to a hospital.
  • Upcoming hospital care codes.
  • Emergency department visit codes.
  • Office consultation codes- used for patients visiting for a doctor’s opinion at the request of another doctor. 

Where you can found CPT Codes

CPT codes can be found and used in various documentation related to the medical care field.

Discharge Paperwork

When a patient has a doctor’s consultation or discharge from a hospital or other medical facility, he receives paperwork that consists of a numeric summary of the services they provided to the patient.

There can be codes with letters or numbers and mostly have decimal points, usually ICD codes and the five-character codes, traditionally CPT codes.

Bills

When a patient receives a bill from a doctor, there may be a list of services with a five-digit code. Those five-digit codes are the CPT codes.

Explanation of Benefits

The Explanation of Benefits (EOB) form shows how much of each service’s cost have to pay on the patient’s behalf. Like the doctor’s bill, it will align each service with a CPT code.

What is the primary importance of CPT codes?

Insurers use CPT codes to calculate how much repayment a physician will receive by the patient’s health insurance coverage. And also how much of the bill the patient will be left for responsible.

1. And also, insurers used CPT codes to identify whether a particular procedure is a wellness or illness-related – significant if you have a high deductible plan.

2. CPT codes help to identify medical billing errors. Having a good understanding of CPT codes helps read a hospital bill and catch any billing errors. Some patient support groups recognize that nearly 80% of accounts have minor errors.

These simple mistakes can have a significant impact on money. Wrong code means that insurance does not cover any expenses.

3. Patients can use CPT codes essential to determine what type of diagnostic, medical, or surgical work physician has requested for the patient.

 What are the new 2021 CPT codes?

American Medical Association (AMA) 2021 Current Procedural Terminology (CPT) code set, effective January 1. There are 329 modifications to the CPT code for 2021, 206 codes have been added, 54 have been deleted, and 69 have been revised. The table below indicates an abstract of the changes for each CPT code section. 

Added Deleted Revised
Evaluation and Management Services 2 1 17
Anesthesia 0 0 0
Surgery 11 11 28
Radiology Procedures 2 2 6
Pathology and Laboratory Procedures 43 1 9
Medicine Services and Procedures 18 9 4
Category II Codes 0 0 1
Category III Codes 45 23 1
PLA Codes 85 7 3
TOTAL 206 54 69

 

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