Medical Coding and Billing - CPT Coding

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CPT stands for current procedural terminology. It provides ervices and procedure codes reported on insurance claims.

Overview of CPT

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.

CPT Supports electronic data

Exchange (EDI), computer based patient. Record (CPR), electronic medical. Record (EMC), reference/research database.


Electronic Data Interchange.


Computer-based Patient Record.


Electronic Media Claims.

Categories of CPT

Category 1 Category 2 Category 3

Category 1

Category 1 contains procedures and/or services identified by 5 digit codes.

Category 2

Category 2 contains performance measurement tracking codes in an alphanumeric identifier with a letter in the last field. (EX: 4246C)

Category 3

Category 3 contains emerging technology and temporary codes assigned for data purposes.

CPT's 6 Sections

Evaluation and Management (E/M) Anesthesia Surgery Radiology Pathology and Laboratory Medicine

CPT Symbols

Bullets Triangles Horizontal Triangles Plus Sign Circle with line through it Bull's-Eye

Horizontal Triangles

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.

Plus Sign

A plus signs identifies add-on codes, for procedures that are performed at the same time and by the same surgeon.

Circle with Line Through It

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.

Unlisted procedures/services

Codes are assigned when a procedure or service is performed by a provider for which there is no CPT code.

Special report

When an unlisted procedure or service code is reported a special report is created.

Narrative document

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.

Coding Surgeries Correctly

Three questions must be asked: What body system was involved? What anatomic site was involved? What type of procedure was performed?

Coding E/M Correctly

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 categories

E/M is categorized according to these four types: Problem focused examinations. Expanded problem focused examination. Detailed examination. Comprehensive examination.

History and Examination

History and examination is determined by these 4 complexities: Straightforward. Low complexity. Moderate complexity. High complexity.

Physician Status Modifiers

Each status modifier reported with an anesthesia code to indicate the patient's condition at the time anesthesia was administered.

Nation Correct Coding Initiative (NCCI)

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

Incorrect coding results in inappropriate repayment of Medicare part B claims.

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