CPT stands for current procedural terminology. It provides ervices and procedure codes reported on insurance claims.
CPT provides a list of identifying and descriptive codes for procedures and service. CPT coding is the uniform language that describes surgical procedures and services. CPT codes are used to report services and procedures. CPT codes are linked with ICD-9 codes. CPT codes are used to justify need for service or procedure.
Exchange (EDI), computer based patient. Record (CPR), electronic medical. Record (EMC), reference/research database.
Electronic Data Interchange.
Computer-based Patient Record.
Electronic Media Claims.
Category 1 Category 2 Category 3
Category 1 contains procedures and/or services identified by 5 digit codes.
Category 2 contains performance measurement tracking codes in an alphanumeric identifier with a letter in the last field. (EX: 4246C)
Category 3 contains emerging technology and temporary codes assigned for data purposes.
Evaluation and Management (E/M) Anesthesia Surgery Radiology Pathology and Laboratory Medicine
Bullets Triangles Horizontal Triangles Plus Sign Circle with line through it Bull's-Eye
Horizontal triangles are used to save space in CPT and code descriptions that are not printed in their entirety next to a code number. They surround revised guidelines and notes. They are NOT used for revised coding descriptions.
A plus signs identifies add-on codes, for procedures that are performed at the same time and by the same surgeon.
A circle with a line through it identifies codes that are not used with a modifier.
A bulls-eye indicates a procedure that includes moderate sedation.
Codes are assigned when a procedure or service is performed by a provider for which there is no CPT code.
When an unlisted procedure or service code is reported a special report is created.
A narrative document must accompany claim to describe nature and extent of the need of service or procedure.
CPT modifiers are used to clarify services and procedures performed by providers. A list of all CPT modifiers with a brief description is located insider the front cover of the coding manual.
Three questions must be asked: What body system was involved? What anatomic site was involved? What type of procedure was performed?
E/M codes are based on these three components: Extent of personal, family, and social history. Extent of examination. Complexity of medical decision making.
E/M is categorized according to these four types: Problem focused examinations. Expanded problem focused examination. Detailed examination. Comprehensive examination.
History and examination is determined by these 4 complexities: Straightforward. Low complexity. Moderate complexity. High complexity.
Each status modifier reported with an anesthesia code to indicate the patient's condition at the time anesthesia was administered.
NCCI was created to encourage national correct coding, methodologies, and manage the improper assignment of codes. NCCI was implemented by The Center for Medicare and Medicaid Services.
Incorrect coding results in inappropriate repayment of Medicare part B claims.