An Introduction To Medical Billing Using CPT Codes

Are you new to medical coding and billing? If so, we understand how easy it is to be overwhelmed by all the information. For instance, you have over 100,000 billing codes to deal with. They include the Current Procedural Terminology (CPT) codes developed and maintained by the American Medical Association.

Most of your work as a medical billing specialist will involve a combination of CPT and ICD codes. This post will familiarize you with the former. As you get more comfortable with the CPT system, you will likely memorize the most commonly utilized codes. If you ever need to look something up, we invite you to use Find-A-Code.

What CPT Covers

Accurate billing requires healthcare providers to account for every procedure they offer. That is the purpose of CPT codes. Note that CPT codes are distinct and separate from ICD-10-CM and ICD-11 codes. The ICD system is designed to identify medical conditions, injuries, and diseases. CPT is all about describing diagnostic procedures, tests, and so forth.

Also be aware that the Medicare system uses a separate set of codes that are based on CPT. They are known as HCPCS codes. You need to be cognizant of the payer when deciding which codes to use on a particular claim.

How the Codes Work

Accuracy is paramount to medical billing in as much as it affects both reimbursements and the timeliness thereof. Payers expect the correct codes will be used on each and every claim. CPT codes always consist of five alphanumeric characters. Most are five digits; some consist of four digits and one letter.

The one downside to the CPT system is that it leaves plenty of room for different classifications. One physician may describe a procedure with one code, while another chooses a different code. This can create confusion among third party medical billers providing contract services.

Different Code Categories

The next thing to know is that CPT are divided into multiple categories for more efficient use. You will have to learn these categories and how to correctly apply them. They are as follows:

●    Category I – Pertains to medical services and devices. Drugs and vaccines are also included.
●    Category II – Pertains to the quality of care a patient receives.
●    Category III – Pertains to emerging technologies and medical procedures.
●    PLA – Pertains to lab tests and other similar procedures.

If you suspect there might be some overlap here, your suspicions are spot on. That is one of the reasons providers sometimes use different codes to describe the exact same procedure. You will get used to how different providers choose their codes with the more practice you get.

Why CPT Codes Are Used

A good way to close this post is to discuss why CPT codes are used. The answer is found within the billing code concept itself. Modern healthcare offers so many procedures, drugs, and medical devices that it is hard for providers and payers to keep up. Medical codes streamline the billing process by making sure everyone involved is on the same page. Codes are also more efficient than writing things out in longhand.

The purpose of the codes is to ensure that medical providers get paid for their services. They also ensure the correct amount is paid for each billed item. Without defined codes, providers and payers would likely find themselves arguing over payments.

You should now have a basic understanding of CPT codes. If you are feeling overwhelmed, try to relax; you’ll get the hang of it in time. Just remember the old proverb that says practice makes perfect. In the meantime, you can always look up codes here on our website.

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