What Are CPT Codes and Why Are They Important?

So what are CPT codes, how are they used, and why are they important? These are just a few of the frequently asked questions we will talk about in our today’s post.

According to Trisha Torey, a Patient Empowerment Expert at AboutHealth.com, CPT (Current Procedural Terminology) codes are five-digit numbers assigned to every task and service a medical practitioner may provide to a patient (although not a Medicare patient) including medical, surgical and diagnostic services. They are then used by insurers to determine the amount of reimbursement that a practitioner will receive by an insurer when he or she performs that service. Since everyone uses the same codes to mean the same thing, they ensure uniformity.

CPT codes are developed, maintained and copyrighted by the AMA (American Medical Association.) As the practice of health care changes, new codes are developed for new services, current codes may be revised, and old, unused codes are discarded. Thousands of codes are in use, and they are updated annually.

Why Are CPT codes Important?

The CPT coding system offers doctors across the country a uniform process for coding medical services that streamlines reporting and increases accuracy and efficiency and the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. CPT is also used for administrative management purposes such as claims processing and developing guidelines for medical care review.

The uniform language is also applicable to medical education and research by providing a useful basis for local, regional, and national utilization comparisons. Source: http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/cpt-process-faq/code-becomes-cpt.page

CPT Updates 2015 | CPT Coding Changes — Video
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CPT codes Fall Into Three Categories:

  • Category I CPT codes illustrate a procedure or service corresponding with a five-digit CPT code and descriptor classification.
  • Category II CPT codes are additional tracking alphanumeric codes used for execution measurement. Using Category II CPT codes is often optional.
  • Category III CPT codes are provisional codes for new and developing technology, procedures, and services. The codes were created for data collection and assessment of new services and procedures.

Modifiers are sometimes appended to CPT codes to report special circumstances. Source: https://www.aapc.com/resources/medical-coding/cpt.aspx

What Are Examples of CPT codes

  • 99201  a physical exam
  • 90658  flu vaccination
  • 90716  chicken pox vaccine (varicella)
  • 12002  laceration repair
  • 99214  may be used for an office visit
  • 99397  may be used for a preventive exam if you are over 65

To complete list of CPT codes, AAPC provided a link  http://coder.aapc.com/cpt-codes-range however details of codes are not available unless you are an AAPC coder subscriber.

CPT codes are revised annually in November with hundreds of codes added, changed or deleted each year.  If you are in the medical coding and billing field, it is strongly recommended that you have the most current edition of the CPT manual, which means you need a new book annually.  Professional additions, with illustrations are helpful to both new coders and frequent users alike. You can check out some of the medical coding books resources below:

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What Are CPT Codes and Why Are they Important

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