CPT Codes And How It’s Used in Medical Billing

The CPT codes are used by professional coders to assign them to certain medical services that a medical practitioner provides to a patient. It includes surgical, medical, and diagnostic services. The insurers use the CPT codes to determine the reimbursement amount that the practitioner receives for a specific service provided. So if you need a short review of what the CPT codes in medical billing are, then you have the right article.

Introduction to the CPT Codes

The Current Procedural Terminology or CPT code uses five-digit numbers without decimal marks. The codes are assigned for various tasks. Some are rarely used, but others are frequently utilized, as the CPT code 99203. These codes are developed, maintained, and copyrighted by the American Medical Association. The CPT codes are divided into different categories:

• Category I. The category for the codes for procedures, services, devices, and drugs, and other vaccines.
• Category II. For specific performance measures and care quality.
• Category III. Used for services and procedures that use emerging technology.
• PLA Codes used for lab testing.

Properly Using CPT Codes

A strict coding system is followed accordingly. And because of the complexity of the medical coding process, professional medical coders are employed. So if you want to know how coding works, then here’s a glimpse of what you should be aware of:

• Initial Coding. The healthcare practitioner or their staff starts the coding process manually or using an electronic health record system. If written manually on a form, they will note the information like the CPT code used during the visit.

• Verification and Submission. After the consultation or medical procedure, the medical coders and billers will check the patient records to correctly assign the right codes if none was written down during the visit. The billing department submits whatever provided services to the payer or the insurer.

• Claim Process. Using the codes, the payer or health plan will process the claim. This is when the amount to reimburse the doctor is determined and how much the payer owes for the services.

Now that you know which codes are used for various services you received, and how medical practitioners and their staff use them right, you now have a better understanding of how all this process works. You have to remember that in the medical field, the proper use of CPT codes can directly affect the amount or percentage of what every patient will pay for their medical care needs, clinic visits, and hospitalizations.