Medical Billing Basics – Current Procedural Terminology (CPT)
Basics of CPT Codes
Physicians’ Current Procedural Terminology (CPT), is developed, published, and copyrighted by the American Medical Association (AMA) annually. CPT codes predominantly describe medical services and procedures performed by physicians and non-physician professionals. Let’s understand the basics of CPT Codes: In general, whenever possible, providers should consider using CPT codes to describe their services for several reasons. Foremost, providers can evaluate patient care by reviewing the services and procedures coded. Secondly, procedural coding is a language understood in the provider and payer communities. Consequently, accurate coding can also help an insurer determine coverage eligibility for services provided.
Accurate coding consists of choosing the most appropriate code available for the service provided to the patient. However, the existence of a CPT or HCPCS code does not guarantee that a third-party payer will accept the code or that the service described by the code is covered. Investigate codes that are denied or down-coded on a claim by the third-party payer, and resubmit with the correct codes if necessary. The CPT coding system has an introduction, six main sections, five appendixes, and an index.
Category I Codes
- Evaluation and Management
- Anesthesia
- Surgery
- Radiology, Nuclear Medicine, and Diagnostic Ultrasound
- Pathology and Laboratory
- Medicine
Category II Codes
Category II codes, which are published January 1 and July 1 of each year, are supplemental tracking codes that are to be used for performance measurement only. They describe components usually included in an evaluation and management service or test results that are part of a laboratory test. The use of these codes is voluntary. However, they are not to be used in lieu of Category I codes.
Category III Codes
Category III codes, which are considered temporary, have been added for reporting the use of new technologies that are not available to report in the existing Category I CPT code set.
Unlisted Procedures
- Not all medical services or procedures are assigned CPT codes. The codebook does not contain codes for infrequently used, new, or experimental procedures. Each code section contains codes set aside specifically for reporting unlisted procedures.
- Before choosing an unlisted procedure code, carefully review the CPT code list to ensure that a more specific code is not available. Also, check for an HCPCS Level II code if these codes are acceptable to the third-party payer. These codes are found at the end of the section or subsection of codes and most often end in “99.” For example 90899 Unlisted psychiatric service or procedure
- Whenever an unlisted code is reported, it is necessary to include a descriptive narrative of the procedure performed in item 19 of the CMS-1500 claim form, as long as it can be adequately explained in the space provided. Payers generally require additional documentation (e.g., progress notes, operative notes, consultation reports, or history and physical) before considering claims with unlisted procedure codes.
- CPT codes are used by payers to determine the amount of reimbursement a practitioner will receive under health insurance coverage. Using correct CPT codes ensures timely payment with fewer chances of denials. While you are busy managing your patients, paying close attention to medical billing could be difficult as it’s a time-consuming process and needs expertise.
CPT © Copyright 2021 American Medical Association
We hope that this article has provided basic guidelines about the 99201 CPT code. If you are looking for overall billing and coding services you can refer to E2E Medical Billing Services. Our accurate and affordable billing services will eliminate billing and coding errors and will increase your practice collection. To know more about our medical billing and coding services, call us at 888-552-1290 or write to us at info@e2eMedicalBilling.com