PROCEDURAL CODING – CPT

PROCEDURAL CODING – CPT Procedure Code - ANS-Code identifying medical treatment or diagnostic services. When a patient sees a physician, each procedure and service performed is reported on a health care claim using a standardized procedure code. Procedure codes represent medical procedures, such as surgery and diagnostic tests, and medical services, such as an examination to evaluate a patient's condition. Code Linkage - ANS-Connection between a service and a patient's condition or illness. On correct insurance claims, each reported service is connected to a diagnosis that supports the procedure as necessary to investigate or treat the patient's condition in that health care setting. Health plans analyze this connection between the diagnostic and procedural information, called code linkage, to evaluate the medical necessity of the reported charges. Procedure codes must be verified and then used to report physician's services. Physician, a medical coder, clearinghouse coder, or a medical administrative assistant may be responsible for the selection of procedure codes. Note that it is the physician's responsibility to report the correct CPT code. To be sure that the procedure codes, and the diagnosis codes, are correctly linked and valid, a medical administrative assistant, coder, or clearinghouse would review the documentation in the patient's medical record to be sure it supports the codes. A query may be communicated to the physician to resolve outstanding questions. By verifying all information and following the rules of correct coding, medical administrative assistants ensure that the provider receives the maximum appropriate reimbursement for procedures and services. Current Procedural Terminology (CPT) - ANS-Contains the standardized classification system for reporting medical procedures and services. The HIPAA-required set of procedure codes is the CPT, published by the American Medical Association (AMA) and is called the CPT. An updated edition of the CPT is available every year to reflect changes in medical practice. Newly developed procedures are added, some are changed, and old ones that have become obsolete are deleted. These changes are available in print and in an electronic file for medical offices that use a computer-based version of the CPT. New CPT codes are released on October 1 of each year and must be used for services dated the following January 1 or later. The CPT codes as of the date of service -- not the date of claim preparation - - are required by HIPAA. Encounter forms, the PMP, and any other computer systems that store CPT codes must also be updated. Category I Codes - ANS-Procedure codes found in the main body of the CPT. Category I codes -- which are most of the codes in the CPT -- are five-digit numbers with no decimals. They are organized into six sections: (1) Evaluation and Management (E/M); (2) Anesthesia; (3) Surgery; (4) Radiology; (5) Pathology and Laboratory; and (6) Medicine. Organization of CPT - ANS-With the exception of the first section, Evaluation and Management (E/M), the CPT is arranged in numerical order from start to end. Codes for E/M are listed first, out of numerical order, because they are used most often. The six primary sections of the CPT Category I codes are divided into subsections. The subsections are further divided into headings according to the type of test, service, or body system. Code number ranges included on a particular page are found in the upper-right corner. This makes locating a code faster after using the index. Section Guidelines - ANS-Usage