Do random numbers in medical bills stop you and make you think? You’re not alone. The existing Healthcare complexity becomes even more mysterious when healthcare providers start using billing codes, which makes communication difficult for patients.
No need to get stressed, we will translate this matter to straightforward language. Healthcare providers commonly use CPT codes in medical billing.
Below, we will cover in details, their types, purpose and comparison to other medical coding methods.
What is a CPT Code?
CPT stands for Current Procedural Terminology. Doctors and hospitals, as well as insurance firms, use these five-digit labels to document medical, surgical, diagnostic, and operational services. The CPT coding is alphanumeric or can be numeric, which the billing staff use in preparing bills and claims.
The medical industry uses CPT codes as standardized labels to identify every treatment method. Medical procedures include routine services, X-rays, and minor surgical procedures, where there are different CPT codes in healthcare.
For example:
- Healthcare providers assign code 99213-99214 to standard patient office visits.
- Medical service 90658 functions as the code for a flu vaccination.
The coding system is a standard communication tool between medical service providers and insurance organizations. Medical personnel replace lengthy written descriptions with these codes to express their completed work succinctly.
Categories of CPT Codes
The CPT coding system presents itself in three different categories that serve separate purposes.
Category I: Common Medical Procedures
The majority of CPT codes appear in this category. They cover:
- Office visits
- Surgeries
- Lab tests
- Radiology procedures like X-rays and MRIs
Medical establishments need to perform regular reviews of each code to ensure their accuracy for new services and practices in this category.
Category II: Performance Tracking
Healthcare organizations have the choice to implement quality tracking measures by using these optional codes. These codes demonstrate medical processes such as patient vaccination delivery and doctor-patient follow-up activities. Performance improvement receives assistance from these codes, yet they do not influence billing processes.
Category III: Developing Technology
A temporary coding system exists for new treatments during their review period. The category contains new surgical techniques or high-tech procedures that must remain classified in this group until acceptance increases.
What Are CPT Codes Used For?
Numerous stages of healthcare services rely on CPT codes for classification. The use of CPT codes provides essential benefits for different stages in healthcare operations.
- The insurance company needs CPT codes to verify the procedures performed before determining payment amounts.
- Health facilities and doctors rely on CPT codes in healthcare to maintain organized medical records documenting all delivered services.
- Use of CPT codes enables healthcare institutions to monitor ongoing patterns as well as evaluate treatment effects. It gives continued healthcare improvement.
- The study of public health and future service planning for health organizations heavily relies on CPT data analysis.
Differences Between CPT Codes and ICD Codes
The reader might question the distinction between CPT and ICD code in medical billing at this point. The billing sector utilizes these codes for documentation, on the other hand, requiring ICD codes to explain the medical condition, like why the service is given.
In other words, you can say that the procedure and service activities are identified through CPT coding systems.
ICD codes indicate the underlying reason for medical procedures and treatment and the diagnosed health conditions.
For example:
For patients seeking medical treatment for lower back pain, the ICD code M54.5 will be used to diagnose the condition. Whereas, CPT code 97140 is used if he gets manual therapy. So basically, CPT coding tells what service is given to the patient.
However, these two coding systems work together to express what procedures the doctor conducted while ICD codes reveal the medical reasons behind those doctor actions.
CPT vs HCPCS Codes
Another coding system with which providers must be familiar is the Healthcare Common Procedure Coding System. It is also pronounced as “hick-picks.” This Coding System serves as a framework that is used specifically in Medicare and Medicaid billing systems.
Here’s how they compare:
- Among the healthcare codes that compose HCPCS (Level I) are CPT codes.
- The HCPCS Level II classification system covers medical products and supplies that fall outside the CPT code boundaries.
Like:
- Ambulance services
- Medical apparatus (like wheelchairs)
- Supplies (like bandages)
The Healthcare Common Procedure Coding System extends the procedural coverage system of CPT to include patient care activities.
Need Help with Medical Billing?
With a proper knowledge of CPT codes, it becomes easy to handle the complicated nature of medical billing. These codes act as shared communication tools between medical doctors, insurance providers, and treatment recipients about delivered medical services.
At DWP Medical, we are professionals in error-free coding and billing procedures. Our company provides special services for CPT codes in medical billing, claims management, and full billing support. It allows you to continue delivering patient care as our team manages financial transactions.
So, outsource your billing section to DWP Medical and see a visible improvement in your healthcare RCM.
FAQs
How many CPT codes are there?
According to current CPT updates the coding system contains more than 10,000 entries. Medical practices evolve annually, which drives the CPT coding system to undergo changes through new additions, code modifications and deletions.
Are CPT codes universal?
CPT codes maintain active usage across all parts of the United States under American Medical Association (AMA) control. Healthcare providers in all U.S. settings rely on CPT for their medical billing operations despite other countries using their particular coding frameworks.
How regularly are CPT codes updated?
The CPT coding system releases new updates on a yearly cycle, which begins normally on January 1st. However, the yearly update process guarantees that CPT codes remain relevant to the latest medical practices, new technologies and treatments.