What is CPT? An Overview:

Current Procedural Terminology (CPT) is a standardized medical code set used to report medical, surgical, and diagnostic procedures and services. It is vital in facilitating accurate documentation, billing, and reimbursement for healthcare providers, health insurance companies, and accreditation organizations. During electronic medical billing, CPT codes are utilized alongside ICD-9-CM or ICD-10-CM numerical diagnostic codes.

History and Development of CPT Codes:

CPT codes have evolved to meet the changing needs of the healthcare industry. The AMA first introduced CPT in 1966 and has since undergone multiple revisions and updates. The development of CPT codes involved collaboration among healthcare professionals, industry experts, and organizations to create a comprehensive and standardized coding system.

How to Navigate CPT Codes:

Healthcare professionals can effectively utilize CPT codes in their daily practice by following these guidelines:

  • Code Selection: Select the most appropriate CPT code that accurately represents the specific procedure or service performed. Ensure adherence to coding guidelines, including documentation requirements and code modifiers when necessary.
  • Coding Resources: Use reliable coding resources such as CPT codebooks, online coding tools, and professional coding organizations' guidelines to stay up-to-date with the latest coding changes and ensure accurate code selection.
  • Documentation: Maintain thorough and accurate documentation to support the services provided and the associated CPT codes assigned. Clear and detailed documentation helps justify the medical necessity of procedures and supports proper reimbursement.
  • Ongoing Education: Stay abreast of coding updates and changes through continuous education and training. Attend coding seminars, webinars, and workshops to enhance coding skills and stay informed about evolving coding guidelines.

CPT codes are categorized into Category 1, Category 2, and Category 3.

Category 1: Procedures and contemporary medical practices

Category 1 codes cover widely performed procedures and contemporary medical practices. These five-digit numeric codes are FDA-approved, performed by healthcare professionals nationwide, and extensively documented. The six sections under Category 1 include evaluation and management, anesthesiology, surgery, radiology, pathology and laboratory, and medicine.

Category 2: Clinical Laboratory Services

Category 2 consists of supplementary tracking codes known as clinical Laboratory Services. These codes are optional and aim to gather information about the quality of care delivered, but they do not substitute Category 1 codes.

Category 3: Emerging technologies, services, and procedures

Category 3 codes represent Emerging Technologies, Services, and Procedures. These temporary codes are assigned to services that are not widely performed, may need more FDA approval, and require ongoing research. Their purpose is to assist researchers in monitoring emerging technologies and services.

It is important to distinguish CPT codes from ICD codes. CPT codes are associated with procedures, while ICD codes pertain to diagnoses. CPT codes describe the procedures performed, whereas ICD codes specify the diseases, illnesses, or injuries diagnosed.

Commonly used CPT codes.

Some commonly used CPT codes for medical billing include:

  • New patient office visit codes
  • Established patient office visit codes
  • Initial hospital care for new or established patients
  • Subsequent hospital care codes
  • Emergency department visit codes
  • Office consultation codes

These codes facilitate appropriate billing based on patient status and the type of medical service provided.

CPT codes consist of five characters and can be numeric or alphanumeric, depending on the category. Unlike ICD codes, each number or character in a CPT code does not correspond to a specific procedure or technology. This flexibility allows for ongoing revision and adaptation of the codes to meet evolving healthcare needs.