CPT codes are a vital component of healthcare billing and documentation. These 5-digit numeric codes, developed by the American Medical Association, provide a consistent way to accurately describe medical, surgical, and diagnostic services.
Uniformly categorized using a systematic approach, over 8,000 CPT codes now encompass the vast majority of services offered by providers. This standardized medical coding system enables appropriate communication, billing, and reporting across the complex healthcare industry.
This article will offer an informative overview that explains what CPT codes are, how users apply them, and their significance in streamlining today’s healthcare administration processes.
Key Takeaways
- CPT codes are used by healthcare providers, insurers, and facilities to report and bill medical procedures and services.
- The American Medical Association oversees the CPT code system and adds new codes annually as medical practices evolve.
- Understanding CPT codes can help patients navigate the healthcare billing process.
What is a CPT Code?
CPT, or Current Procedural Terminology, represents the language medical professionals, insurers, and facilities use for reporting and billing medical, surgical, and diagnostic procedures and services. CPT codes are 5-digit numeric codes that provide a uniform language to describe medical services and procedures by healthcare professionals.
The Role of CPT Codes
Healthcare providers use CPT codes to document which services and procedures were provided to patients. Healthcare providers report this information to health insurers, who use the codes to assess coverage under a patient’s insurance plan and determine reimbursement amounts to providers and facilities. CPT codes play a key role in healthcare billing and act as the common language for all parties involved.
Facilities like hospitals and doctor’s offices also use CPT code for internal tracking and cost accounting purposes. Assigning codes to each service provided allows facilities to analyze revenue, costs, and productivity. This information aids in budgeting, resource allocation, and ensuring the correct coding and billing of services.
What Do CPT Codes Describe?
CPT code describes medical, surgical, diagnostic, and therapeutic services like:
- Office visits
- Lab tests
- Imaging services (X-rays, CT scans)
- Surgeries
- Therapy services (physical therapy, occupational therapy)
There are over 8,000 CPT codes that cover the vast majority of services that a healthcare provider may offer. Each code has a plain language description associated with it that explains exactly what service the code refers to.
For example:
- 99203 – Office/outpatient visit, new patient, moderate severity, 30 minutes
- 82947 – Glucose blood test
- 70450 – CT scan of head/brain without contrast
Who Creates CPT Codes?
The American Medical Association (AMA) creates and maintains CPT codes through the CPT Editorial Panel. This panel consists of volunteers from various medical societies who meet regularly to update the codes annually.
As new medical services and procedures constantly emerge, the healthcare industry adds, revises, or deletes codes every year to keep up with these changes.
How Are CPT Codes Organized?
There are three main sections or code ranges in the CPT coding system:
Category I Codes
This category makes up the bulk of CPT codes. It covers medical services like:
- Evaluation and management (E/M) – 99201-99499
- Anesthesia – 00100-01999
- Surgery – 10000-69999
- Radiology – 70000-79999
- Pathology and Lab – 80000-89999
Category II Codes
Healthcare providers use these supplemental tracking codes for performance measurement. They help collect data on the quality of care, proper use of services, and patient safety.
Category III Codes
Assigning provisional Category III codes to emerging technologies, services, and procedures enables data collection while evaluating the service for the determination of creating a permanent Category I code.
Key Features of CPT Code
There are some important things to know about the makeup and use of CPT code:
- They are 5 digits long.
- The first digit refers to the category. 1 and 2 are for Category I codes, 3 are for Category II, and 4 and 5 are for Category III codes.
- They are numeric – no letters are used.
- The codes are organized into sections based on medical specialty.
- Within each section, codes are grouped by commonality – for instance, evaluation and management codes are all 99xxx.
- Modifiers can be appended to provide additional information about the service.
- Each year updated codes are released effective January 1.
How Are CPT Codes Used?
CPT codes have two main uses in healthcare:
- Billing: They provide a consistent way for providers to bill for their services across insurance companies. Healthcare providers include the appropriate CPT code on the claim to describe the service performed.
- Medical documentation: Medical records and procedure notes commonly reference CPT codes to specify the performed services.
Having a universal medical coding system is extremely important for the healthcare industry. It facilitates billing, reimbursement, record keeping, and reporting across the entire system.
CPT Codes vs. HCPCS Level II Codes
HCPCS (Healthcare Common Procedure Coding System) is another standardized code set used in healthcare, consisting of two levels:
- Level I: Corresponds to regular CPT codes for medical services and procedures.
- Level II: Used to describe products, supplies, and services not covered by CPT code:
- Durable medical equipment – canes, crutches, wheelchairs
- Ambulance services
- Medical supplies – bandages, casts, splints
- Certain drugs and injectables
HCPCS level II codes primarily begin with a letter, while CPT codes are only numeric.
Common CPT Code Lists
Here are some frequently used CPT codes and their descriptions:
| CPT Codes | Description |
|---|---|
| 20610 CPT Code | Drainage of abscess in soft tissue |
| 36415 CPT Code | Routine collection of blood samples from veins |
| 45378 CPT Code | Diagnostic examination of large bowel using the endoscope |
| 73721 CPT Code | MRI of the lower spinal column |
| 74177 CPT Code | CT scan of abdomen and pelvis |
| 78452 CPT Code | Imaging of heart using nuclear medicine |
| 85025 CPT Code | Complete blood cell count |
| 88305 CPT Code | Microscopic study of tissue sample |
| 90471 CPT Code | Vaccine administration |
| 90791 CPT Code | Evaluation and management of psychiatric patient |
| 90832 CPT Code | 16-30 minute psychotherapy session |
| 90834 CPT Code | 45-minute psychotherapy session |
| 90837 CPT Code | 60-minute psychotherapy session |
| 90847 CPT Code | Family psychotherapy session |
| 92507 CPT Code | Treatment of speech disorder |
| 93000 CPT Code | Electrocardiogram |
| 96127 CPT Code | Brief emotional/behavioral assessment |
| 96372 CPT Code | Medication injection administration |
| 97110 CPT Code | 15-minute physical therapy therapeutic procedure |
| 97112 CPT Code | 30-minute physical therapy therapeutic procedure |
| 97140 CPT Code | Manual therapy technique |
| 97530 CPT Code | 15-minute occupational therapy treatment |
| 99202 CPT Code | New patient office visit, straightforward complexity, 15 minutes |
| 99203 CPT Code | New patient office visit, low complexity, 30 minutes |
| 99204 CPT Code | New patient office visit, moderate complexity, 45 minutes |
| 99205 CPT Code | New patient office visit, high complexity, 60 minutes |
| 99211 CPT Code | Established patient office visits, minimal problems |
| 99212 CPT Code | Established patient office visit, straightforward problems, 10 minutes |
| 99213 CPT Code | Established patient office visit, low complexity, 15 minutes |
| 99214 CPT Code | Established patient office visit, moderate complexity, 25 minutes |
| 99215 CPT Code | Established patient office visit, high complexity, 40 minutes |
| 99222 CPT Code | Initial hospital care, straightforward complexity, 30 minutes |
| 99223 CPT Code | Initial hospital care, high complexity, 70 minutes |
| 99232 CPT Code | Subsequent hospital care, moderate complexity, 25 minutes |
| 99233 CPT Code | Subsequent hospital care, high complexity, 35 minutes |
| 99284 CPT Code | Emergency department visit, high complexity, and threat to life |
| 99285 CPT Code | Emergency department visits, high complexity, and significant threat to life |
| 99396 CPT Code | 60 minutes of prolonged physician service |
| 99213 CPT Code | Office visit for an established patient, low complexity, 15 minutes |
| 99214 CPT Code | Office visit for an established patient, moderate complexity, 25 minutes |
| 93306 CPT Code | Echocardiogram, complete heart scan |
| 80053 CPT Code | Comprehensive metabolic panel lab test |
| 99284 CPT Code | Emergency department visit, high complexity |
| G0463 CPT Code | Hospital outpatient clinic visit |
How to Look Up CPT Codes
If you ever need to look up a CPT code description, the AMA offers an online search tool called the CPT Code Lookup. You can search by code number or description keywords to find codes.
There are also coding manuals that provide a complete listing of codes along with long descriptions, guidelines, and illustrations. These are available in print and electronic formats.
Some online bill pay or EHR systems allow patients to look up codes listed on their statements as well.
Frequently Asked Questions – FAQs
CPT codes describe the actual services provided.
ICD codes specify medical diagnosis details.
Some services like office visits have multiple codes to account for various complexities, lengths of visit, or other factors.
No – HCPCS Level II codes cover different types of services not included in the CPT set.
No – Each CPT code has a very specific definition, so providers must select the most accurate code for each unique service.
Update it annually, adding new codes, revising, or deleting as needed. Release changes in the Fall for them to take effect on January 1.
Tips for Using CPT Codes
Here are some tips for both healthcare providers and patients when it comes to using CPT medical coding:
- Ensure that the selected CPT code accurately represents the performed service. Using the wrong code can lead to problems.
- Append modifiers when appropriate to add detail and specificity to the code. Common modifiers include -25, -50, -LT, -RT.
- Refer to current CPT coding manuals for guidelines and code descriptions. Coders must stay up-to-date on annual changes.
- If a bill contains codes you don’t understand, look at the descriptions using resources like the CPT Code Lookup tool.
- When documenting in medical records, reference the applicable CPT codes to accurately reflect services performed.
- If you notice errors on a medical bill containing CPT codes, contact the billing department to request correction and resubmission.
Development and Oversight
The American Medical Association owns and maintains the CPT code set. A CPT Editorial Panel evaluates requests throughout the year for new, revised, and deleted codes based on changes in medical practice and coding technology. The AMA releases major code revisions annually to maintain the currency of CPT codes.
Organize the CPT code set into several categories based on anatomy and medical specialty. Some of the main category sections include evaluation and management, anesthesia, surgery, radiology, pathology and laboratory, and medicine. These categories divide thousands of unique codes to offer granular detail on specific procedures.
The Purpose of CPT Coding
In summary, CPT codes serve an important purpose in the healthcare system. They provide a consistent, uniform language for describing medical, surgical, and diagnostic services.
This allows for accurate communication and billing between providers, patients, and insurance companies. It also enables gathering data for analysis of quality, costs, and patterns of care.
So whether you are a provider assigning codes or a patient trying to interpret them, understanding CPT coding is extremely useful.
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