Medical billing basic - What is CPT

What is CPT? 

CPT was developed by the American Medical Association (AMA) in 1966. The AMA revises and publishes CPT each year to keep pace with changes in medical practice. They delete obsolete procedures, modify existing procedures, and add newly developed procedures. 

Your physicians’ office should make it a policy to order the current book from the AMA each year. Begin using the new CPT codes on January 1. 

•  listing of descriptive terms and five-digit, numeric codes for reporting medical services and procedures performed by physicians. 

• provides a uniform language to accurately designate medical, surgical and diagnostic services. 

•serves as an effective means of reliable nationwide communication between physicians, patients and third-party payers. 

Each time you submit a claim, identify the service provided by using one of these five-digit CPT codes, plus a two-digit modifier when appropriate. 

HCPCS Levels of Codes

HCPCS is the acronym for the Healthcare Common Procedure Coding System. This system is a uniform method for health care providers and medical suppliers to report professional services, procedures, and supplies. 

There are three levels of codes within the HCPCS system: 

Level I. Level I is the largest component, made up of five-digit numeric CPT codes and two-digit modifiers. Both CPT codes and modifiers have descriptive terms for reporting services performed by health care providers. The first edition of CPT was published by the American Medical Association (AMA) in 1966 and it continues to release updates each year. 

Example: 10060 * Incision and drainage of abscess 

Level II. These national codes, created by The Centers for Medicare and Medicaid Services (CMS), were developed to cover services not specifically reported in CPT. Level II HCPCS codes consist of one alpha character (A through V), followed by four numbers. Level II HCPCS modifiers are two-digit codes which can be used with any level of codes. Level II codes are grouped by the type of service or supply they represent and are updated annually by CMS with input from private insurance companies. 

Example: A4580 Cast supplies 

Level III. Level III codes are used to report services and supplies that may be covered but not listed in the other two levels of HCPCS. These codes begin with a letter (W - Z) followed by four numeric digits. Wellmark has eliminated all Level III codes in accordance with HIPPA (Health Insurance Portability and Accountability Act of 1996) requirements. 

Remember: 

•     CPT* provides a uniform language to accurately designate medical, surgical and diagnos-tic services. 

•     CPT and HCPCS are updated annually to reflect medical practice changes. 

•     The AMA is responsible for revising CPT and CMS updates HCPCS Level II codes. 

•    CPT is used to report the medical services and procedures performed by physicians to insurance carriers. 

•    To assure that correct CPT codes are used for all procedures, a new CPT book should be purchased annually. 

•    Choose a procedure code that accurately identifies the service performed. Do not choose an approximate code (use an unlisted code if none exists to accurately describe it).