CPT code stands for Current Procedure Terminology. This code is used to identify in-patient and out-patient medical procedures the patient receives during their visit. If you have healthcare providers laying hands on patients for treatment purposes, CPT code is 9/10 involved at some point in that process. CPT code is further broken down into 3 subdivisions. One, numeric codes. Two, alphanumeric codes, and finally the third, which is related to medical technology used. Alphanumeric codes relate to the performance measurement as well as potential laboratory or radiology test results. Numeric codes are utilized heavily in radiology, surgery, and anesthesia.
ICD code and CPT code work hand-in-hand and help create a picture of what occurred during a patient’s visit. ICD code justifies any measures taken by a physician or medical provider in order to treat the patient. Although that is very important, CPT code outlines what work was actually done for/on the patient. CPT code directly correlates to the pay out by the insurance company.
CPT stands for current procedural terminology. It’s a classification of treatment and services provided by a licensed MD. There are requirements to be met by the physician and treatment team to qualify for certain codes. Certain codes have criteria that must be met in order to file a claim under that specific code. All of this information can be identified in the CPT code handbook. By doing this it allows easier communication between physician-physician, it allows insurance companies to compare reimbursable amounts, and finally it speeds up the processing of claims.
ICD code and CPT code work hand-in-hand and help create a picture of what occurred during a patient’s visit. ICD code justifies any measures taken by a physician or medical provider in order to treat the patient. Although that is very important, CPT code outlines what work was actually done for/on the patient. CPT code directly correlates to the pay out by the insurance company.
CPT stands for current procedural terminology. It’s a classification of treatment and services provided by a licensed MD. There are requirements to be met by the physician and treatment team to qualify for certain codes. Certain codes have criteria that must be met in order to file a claim under that specific code. All of this information can be identified in the CPT code handbook. By doing this it allows easier communication between physician-physician, it allows insurance companies to compare reimbursable amounts, and finally it speeds up the processing of claims.
In general there are 6 sections of CPT
CPT code has expanded from 5 to 7 alpha numeric digits. The first letter of the sequence corresponds to the section that the code corresponds to. The sections are listed above for your convenience. It can be difficult piecing the puzzle together, that’s why modifiers and understanding the scope of practice and setting your healthcare facility operates within are useful to coders. For this reason our team ensures we open the lines of communication and interact regularly with the healthcare facility.
As comprehensive as CPT code is, it does not cover ALL necessary information requested by insurance companies for reimbursement. There are sometimes other details that the insurance company wants to have on file, such as mode of transportation for an emergency room. Was it via ambulance or another mode? Also how did the patient report to the facility, were they on a backboard unconscious? For these additional details HCPCS protocol is used to effectively report back to the insurance agency. HCPCS stands for healthcare common procedure coding system. This supplements and fills in any gaps not provided by CPT code such as cosmetic surgeries and dental procedures. HCPCS code is generally charge-master driven, meaning when used, a charge is usually instantly generated via internal software. This is the case for hospital supplies and other durable medical equipment. CPT is considered level 1 of HCPCS which is why they are so closely related with some overlap in code. For ambulance services, since treatments are rendered by EMTs who are not licensed doctors, there is no CPT code. However codes can be found within HCPCS because it is more comprehensive. This is one of many examples of why it’s imperative to be familiar with both systems as a medical coder, especially in settings where there is interdisciplinary medicine or a treatment team involved.
- Evaluation & management: this is when a patient walks through the doors of A healthcare facility in search of a solution to a medical issue.
- Anesthesia: The process of the patient being anesthetized for surgery
- Surgery
- Radiology
- Pathology & laboratory: this is where findings that aren’t obvious are evaluated and diagnosed.
- Medicine: this includes prescriptions, physical therapy, and other test like EKG, VBG, ultrasound, etc.
CPT code has expanded from 5 to 7 alpha numeric digits. The first letter of the sequence corresponds to the section that the code corresponds to. The sections are listed above for your convenience. It can be difficult piecing the puzzle together, that’s why modifiers and understanding the scope of practice and setting your healthcare facility operates within are useful to coders. For this reason our team ensures we open the lines of communication and interact regularly with the healthcare facility.
As comprehensive as CPT code is, it does not cover ALL necessary information requested by insurance companies for reimbursement. There are sometimes other details that the insurance company wants to have on file, such as mode of transportation for an emergency room. Was it via ambulance or another mode? Also how did the patient report to the facility, were they on a backboard unconscious? For these additional details HCPCS protocol is used to effectively report back to the insurance agency. HCPCS stands for healthcare common procedure coding system. This supplements and fills in any gaps not provided by CPT code such as cosmetic surgeries and dental procedures. HCPCS code is generally charge-master driven, meaning when used, a charge is usually instantly generated via internal software. This is the case for hospital supplies and other durable medical equipment. CPT is considered level 1 of HCPCS which is why they are so closely related with some overlap in code. For ambulance services, since treatments are rendered by EMTs who are not licensed doctors, there is no CPT code. However codes can be found within HCPCS because it is more comprehensive. This is one of many examples of why it’s imperative to be familiar with both systems as a medical coder, especially in settings where there is interdisciplinary medicine or a treatment team involved.