Current Procedural Terminology, or CPT, is a term coined and trademarked by the American Medical Association (AMA) to describe a standardized compilation of medical codes. These codes allow doctors, insurance companies, health care professionals and patients to speak the same language when it comes to medical procedures, diagnostics and related tasks. If you’re working in health care, your life will be immeasurably easier if you develop a healthy relationship with CPT coding.
First Things First
CPT codes are divided into categories: Category I codes describe a procedure or service associated with five-digit codes. Category II are alphanumeric codes that can optionally be used in addition to Category I codes to measure performance. Category III codes designate new technologies and services. The three categories help to achieve the first consideration in assigning codes: To be as accurate as possible. There may be times when you’re faced with the temptation to assign a CPT code based on your assumptions of the patient’s condition, rather than taking the time to locate the correct code. Never assign codes based on anything other than what the physician’s notes or other source information provide. Read the doctor’s notes and determine the meaning of all terms. If you’re ever in doubt, double-check with the doctor to establish the services that were provided.
Maneuvering Through the Manual
In addition to the codes, the CPT manual provides you with descriptions and symbols to help you be exact in your coding. The back of the manual alphabetically lists medical terms for procedures, conditions and body organs, in addition to a list of equivalent terms. Find the procedure you need to code and use the tabular index to select a possible range of codes. Then make a note of the specific range pertaining to the procedure. For the most precision in coding, read the guidelines preceding the tabular index to help you find the correct range of codes.
Symbols and Modifiers
Symbols may accompany some of the CPT codes. For instance, three symbols you might see are: a small black triangle, indicating the code’s description has been changed considerably; a black dot labeling the code as being the first year it was added to the manual; and, a “plus” sign referring to a primary code that always requires an additional secondary code. Modifiers are numerical codes that can be attached to other codes as a way to describe an additional situation that might lengthen the specific service. For example, a physician might be setting a broken bone, which has a specific CPT code. During the procedure, he discovers a small laceration on the arm that should be treated before the bone is set. So he assigns a modifier code to indicate the additional treatment. Modifiers can ensure the doctor is paid for all the individual, yet associated, services provided during a procedure. Modifiers need to be backed up with the physician’s statement.
After you’ve found a range of appropriate codes for a specific procedure, read through the manual's information for each, looking for specific diagnoses and procedures connected to the code. Make sure these match the physician’s procedural notes. If required, add a modifier to the code you selected. To stay abreast of coding changes within the medical profession, you’ll need to have on hand at all times the most recent CPT manual. The AMA's editorial panel meets three times annually to update or revise CPT codes and guidelines.
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