When a healthcare service or procedure is given to a patient, an alphanumeric five-character code is assigned to it for documentation and data collection. This code is known as Current Procedure Terminology, or CPT, and this is used by insurers to help figure out the amount of reimbursement that should be given to a practitioner for their performance in your particular case. Understanding CPT codes can be difficult, but it's worth noting that they are regarded to be a nationwide standard for how professional medical individuals describe and communicate about various things, including surgery, radiology, anesthesiology, and more.
CPT codes first came into existence in 1966 and they are maintained and developed on a yearly basis by the AMA, or the American Medical Association. Today, thousands of CPT codes are used and updated across the US.
Understanding CPT Codes:
Understanding CPT codes also means recognizing that these codes fall into three different categories. The first category, or Category 1, includes five-digit codes that have descriptions which correspond with a particular service or procedure. On the other hand, the second category of codes include additional alphanumeric codes for tracking which are used for measuring value and the quality of the service that has been provided. Using category 2 codes is considered as optional, and should not be used as an alternative to category 1 codes. Finally, category 3 codes are provisional codes for developing technology and new services. These codes are created to help in the assessment and collection of new information.
In some circumstances, a two-digit modifier will be added to a CPT code to help represent very special circumstances and add clarification to the description of a particular procedure.
Assigning CPT Codes:
Understanding and assigning the appropriate CPT codes is incredibly complex. Although the CPT codes that are used across the United States are standardized, the amount of money that is given in reimbursements to practitioners across the country is not always the same. In fact, the amount paid out can actually differ for a wide range of different reasons, including the geographical location of the practitioner.
If the insurance payer is Medicare, the CPT codes may be used slightly differently, as the codes can be somewhat adjusted. Importantly, anatomy, insurance rules, medical terminology, procedural rules, and proper usage of modifiers are all essential information when reporting and using CPT codes, which is why the people who use these codes on a regular basis actually have to undergo a significant amount of training in earning the credentials they need to prove that they can use the codes accurately.
CPT codes remain to be a highly complicated, but very important part of the medical insurance world, particularly when it comes to determining how much a practitioner should be reimbursed for any procedure or service that he or she provides to a patient. A full list of CPT codes can be accessed through the AMA online. However, it's worth noting that individuals are only allowed to access these codes one at a time, and their access may be restricted if used too often.