CPT coding – What it is?
CPT stands for Current Procedural Terminology. CPT codes are used to describe the medical procedures that are performed to diagnose or treat a patient while submitting claims to health insurance companies. The American Medical Association (AMA) developed the CPT codes and first published it in 1966. The AMA maintains and annually updates the CPT. The current technology and common medical practices are reviewed by the AMA CPT Editorial Board to assign codes to describe specific medical procedures. CPT has been established to produce a uniform language for precisely describing medical services. It provides a powerful means of communication within the healthcare industry nationwide. The first edition of CPT contained surgical procedures, limited sections on medicine, radiology and laboratory procedures. The second edition which was published in 1970 contained an elaborate system of terms and codes to describe surgical and medical procedures. It also contained a list of procedures related to internal medicine.
The fourth edition was published in 1977 which presented important updates in medical terminology. CPT was adopted as part of the Centers for Medicare & Medicaid Services (CMS) in 1983. With this, CMS commanded the use of Healthcare Common Procedure Coding System (HCPCS) to report services for Medicare Part B. CPT is also known as HCPCS Level I. In July 1987, as part of the Omnibus Budget Reconciliation Act, CMS commanded the use of CPT for reporting outpatient hospital surgical procedures.
The structure of CPT
The CPT comprises of many chapters with each chapter beginning with a general introduction to the code set being described for a specialty. It explains how evaluation and management services, codes 99201-99499, should be used along with the codes with in each specific set. Each introduction also contains instructions for medical coders and billers on how to report follow-up care, follow-up, therapy, materials supplied by a healthcare provider, and how to report separate procedures.
Some CPT procedures consist of a technical component, the actual performance of a procedure, and a professional component, the elucidation of the results of a procedure by a qualified professional. Some codes combine both the technical and professional components.
CPT contains appendices that includes the possible modifiers acceptable as per the AMA’s coding methodology. CPT also provides place-of-service codes to describe where procedures and patient encounters happen.
CPT coding format
The format of the CPT code is five characters long, numeric or alphanumeric, based on the category of the CPT code. Category points to the division of the code set. CPT codes fall into three Categories. Category I CPT codes illustrates most of the procedures executed by healthcare providers in inpatient and outpatient offices and hospitals. Category II CPT codes are supplemental tracking alphanumeric codes used mainly for performance management. Category III codes are temporary codes for new, emerging and experimental technologies, services, and procedures. An example of a CPT code is 99213 which means an “office or other outpatient visit for the evaluation and management of an established patent which requires at least 2 of 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity.” Thus, five numbers contain a plethora of specific information for medical billers and coders and others in the healthcare industry who follow the CPT codes. Although CPT codes have five digits, there are not 99,000-plus codes. CPT has been developed for flexibility and emendation, and therefore lot of gap is left between the codes.