For now, just recognize that the CPT code set has a number of instructions that inform the medical coder on how to best code the procedure performed. Remember that you always need to code to the highest level of specificity, and a miscoded procedure can be the difference between an accepted and rejected claim.
Each of these sections has its own subdivisions, which correspond to what type of procedure, or what part of the body, that particular procedure relates to. The sections are grouped numerically, and, aside from Evaluation and Management, are in numerical order. Certain codes have related procedures indented below them. These indented codes are important variations on the code above them, and denote different methods, outcomes, or approaches to the same procedure.
For example, the code for the elevation of a simple, extradural depressed skull fracture is The code for the elevation of a compound or comminuted, extradural depressed skull fracture is There are a few important CPT Modifiers, which provide additional information about the procedure performed. Some codes have instructions for coders below them. These instructions are found in parentheses below the code, and they instruct the coder that there may be another, more accurate code to use.
These codes are five character-long, alphanumeric codes that provide additional information to the Category I codes. These codes are formatted to have four digits, followed by the character F. These codes are optional, but can provide important information that can be used in performance management and future patient care.
They are divided into numerical fields, each of which corresponds with a certain element of patient care. For a list of these fields in oder as well as examples, please refer to our ebook and powerpoints. Still, it is an important element of the CPT code set, and you should be familiar with the basics of Category II codes as you prepare for a career in the field.
The third category of CPT codes is made up of temporary codes that represent emergent or experimental services, technology, and procedures. In certain cases, you may find that a newer procedure does not have a Category I code. Category III codes allow for more specificity in coding, and they also help health facilities and government agencies track the efficacy of new, emergent medical techniques.
This Panel mandates that procedures or services must be performed by a number of different facilities in different locations, and that the procedure is approved by the FDA. Think of the sunset dates as expiration dates on the code. Like Category II, these codes are five characters long, and are comprised of four digits and a terminal letter. For example, the code for the fistulization of sclera for glaucoma, through ciliary body is T.
Evaluation and Management: — Anesthesia: — ; — Surgery: — Radiology: — Pathology and Laboratory: — Medicine: — ; — Within each of these code fields, there are subfields that correspond to how that topic—say, Anesthesia—applies to a particular field of healthcare. Category I CPT codes are numeric, and are five digits long. Each of these sections also has specific guidelines for how to use the codes in that section.
Category II These codes are five character-long, alphanumeric codes that provide additional information to the Category I codes. Composite codes These codes combine a number of procedures that typically occur in conjunction with one main procedure. Example: F: heart failure assessed includes all of the following : Blood pressure measured Level of activity assessed Clinical symptoms of volume overload assessed Weight recorded Clinical signs of volume overload assessed Patient Management Includes patient care provided for specific clinical purposes like pre- and postnatal care.
Category III The third category of CPT codes is made up of temporary codes that represent emergent or experimental services, technology, and procedures. Learn more about these invaluable codes in this video. If you have paperwork that has a CPT code on it and you want to figure out what that code represents, you can do so in a number of ways:. An important reason to try to understand CPT codes is so you can make sense of your hospital bill and catch any billing errors—which do happen often.
These seemingly simple mistakes can have a big impact on your wallet. The wrong code can mean that your insurance won't cover any of the costs. Try to take the time to sit down and slowly review your bill and compare it with your EOB to check for any possible errors. It is possible for your healthcare provider or the facility to make a typographical error, coding for the wrong type of visit or service. There are also fraudulent practices like upcoding charging you for a more expensive service and unbundling billing bundled services or procedures as separate charges that should be on your radar.
When in doubt, don't be shy to call your provider to discuss any possible discrepancies. There are two levels of codes:. Examples of items billed with level II codes are medical equipment, supplies, and ambulance services. They can have modifiers that are either two letters or a letter and a number. Being an informed patient is part of ensuring you receive the best medical care.
When you see something you don't understand in your medical record or bill, discuss it with your healthcare provider or insurer. You have a right to take an active role in ensuring your health care is accurately tracked. An encounter form is used to keep track of diagnosis and procedure codes recorded when a person visits a doctor's office.
It is maintained so that billing is correct and a receipt can be offered after the appointment. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life.
American Medical Association. HCPCS coding questions. Updated February 11, Centers for Disease Control and Prevention. Updated July 17, Kaiser Family Foundation. Studies find high rates of errors on medical billing. Published March 28, The importance of encounter form design. Health Care Manag Frederick.
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HCPCS codes are separated into two levels of codes. Level one: based on CPT codes, these are used for services or procedures often provided by healthcare providers Level two: these codes cover health care services or procedures that healthcare providers do not offer. Examples include medical equipment, supplies, and ambulance services. What is an encounter form?
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