What is CPT Coding?

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December 21, 2016 | Aptus Associates

As a CPT medical billing specialist, you are responsible for transcribing and interpreting medical information for multiple reasons including filing insurance claims and monitoring patient care. To become a CPT coder, you will need to be certified in medical billing while some healthcare facilities will also require an Associates degree.

The American Medical Association (AMA) publishes and maintains the codes of the Current Procedure Terminology (better known as CPT) that are used among medical professions and services. These codes are the means of communication from one healthcare provider to another to help explain a procedure performed on a patient. These codes are used to communicate with insurance companies for a reimbursement to the healthcare provider or facility. CPT codes also allow government agencies to help maintain valuable procedures and efficiency of specific healthcare providers, divisions, and healthcare facilities.

There are three categories used in CPT coding. A coder should understand these three categories to help execute their job to the best of their abilities.

Category I

In this category, there are widely performed medical procedures that are given a five digit number and kept in numerical order to group them together in six sections: radiology, surgery, medicine, evaluation and management, pathology and laboratory, and anesthesiology. This is probably the most used category among medical coders. These codes are updated annually by the AMA.

Category II

These are made up of tracking codes that measure execution of performance. As HIPAA continues to regulate and make changes, these codes help provide regularly updated reports of measuring performance. These codes also help facilitate the quality of care through test results and the amount of services provided by the healthcare provider and/or facility. This category is made up of alphanumeric codes that include four digits and the letter F. Although these codes are optional, they do help provide important information that can help in management performance and the care of the patient. It’s important to be familiar with the coding of category II to help you be better prepared for a career in the field of medical coding.

Category III

This category consists of new and developing technologies. As new procedures and services come about, these codes help collect data and assess the changes. They’re used to help track upcoming technology that can be useful in the near future. These codes consist of four digits that are followed by the letter T. If these procedures are not accepted and used in Category I within five years, then the procedure will no longer be listed within the category III.

CPT coding allows healthcare providers and facilities to provide the best care for patients and assist other healthcare providers with the ability to improve their services. We have the skill and staff to know just what CPT code is right for every one of our (and your) patients.