What Are CPT Codes And Why Do They Matter

As a medical coding specialist, there are a handful of healthcare related abbreviations that you need to know. While most medical assistant may be concerned with the mysterious language known as medical terminology that includes things like PERRLA, VS, HR, OD and OS—as an administrative medical assistant, you have a different language to deal with! 

Take some time to read on if you are ready to expand your medical coding vocabulary… 

What are CPT Codes?

Are CPT Codes and ICD-10 Codes the Same Thing? 

  • International Classification of Disease Codes-- ICD-10 codes are used to identify the symptoms, injuries, illnesses and medical conditions of patients and used between health care providers and health insurance companies.
  • Current Procedural Terminology-- CPT codes are used to describe procedures and services that medical professionals and other health care providers perform. 

CPT codes are used by medical professionals, hospitals, clinics and insurance offices to identify medical, surgical, radiological, laboratory and diagnostic services. This allows for standardized payment and reimbursement from health insurance companies.

The relationship between ICD-10 codes and CPT is important because the ICD-10 codes identifying the diagnosis support the necessity of the procedure completed. This allows the procedure to be covered and the provider to be reimbursed. 

stethoscope laying on papers with medical coding

Current Procedural Terminology codes were first developed by the American Medical Association in the 1960s as a means for the medical field to use standardized terms to document procedures and services in medical records.

There are just under 10,000 different 6-digit CPT codes ranging between 00100 and 99499. While the codes are comprised of six digits, two-digit modifying codes may also be added to provide more clarification on the specifics of a procedure or service.

Two or more codes are sometimes needed to describe an entire procedure or services, as one code may only describe part of a procedure. Often times, specially trained and educated professionals handle an office's medical coding and billing because the work is so precise and must be consistent across the nation. 

If you are interested in billing and coding, or want to get certified, you can find resources here

Another reason it is important for medical coders to be formally educated and trained in coding and billing procedures is that the CPT codes are ever-evolving. They sometimes change in order to keep up with advancing medical practices, as well as with changes in rules for reimbursement and new technologies.

The CPT Editorial Panel is responsible for monitoring changes in the medical field and adjusting CPT codes as needed. This panel meets three times a year to review changes and input from physicians, medical device manufacturing companies, researchers and senior professionals from across the nation.

A request to change or update a CPT code can be submitted by a medical professional and will be reviewed by the panel if the request was submitted within the identified deadline. Code change request forms can be found on the American Medical Association website.

The CPT Editorial Panel reviews approximately 350 requests each year, all of which result in one of the following four outcomes. The panel may decide to add the new code or revise an existing code, refer the suggestion to committee further evaluation, postpone the review to the next meeting or reject the item altogether. 

While it may seem complex at first, you can see that CPT codes are really meant to simplify the medical billing process. As an administrative medical assistant, you are an essential part of this process! Thanks for your hard work, and keep on coding…!

 

 


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