What is CPT in Medical Coding Process
What is CPT®?
The Healthcare Common Procedure Coding System (HCPCS) consists of two main subsystems: HCPCS Level I and HCPCS Level II.
HCPCS Level I, also known as Current Procedural Terminology (CPT®), is a numeric coding system created and maintained by the American Medical Association (AMA). This system, which includes descriptive terms and codes, is primarily used for identifying medical, surgical, and diagnostic services provided by physicians and other healthcare professionals. These professionals utilize CPT® codes to document services and procedures for billing purposes, including insurance claims. However, CPT® codes do not cover certain medical items or services typically billed by non-physician suppliers.
HCPCS Level II, is a standardized system mainly for identifying products, supplies, and services not included in CPT® codes. This includes items like ambulance services, durable medical equipment, and other supplies used outside a physician’s office. Level II HCPCS codes are essential for Medicare and other insurers to cover a range of services and items not specified by CPT® codes. Medical Coder should have expert knowledge in CPT Coding Guidelines for accurate Medical Coding Billing Work
CPT®, owned and copyrighted by the AMA, was first published in 1966 focusing on surgical procedures. Over the years, it expanded to cover a broader range of medical services. The fourth edition was significant, introducing a system for regular updates and monitoring. In 1983, the Health Care Financing Administration (now CMS) adopted CPT® for reporting physician services for Medicare Part B Benefits, and in 1987 for outpatient surgical procedures.
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandated that the Department of Health & Human Services develop standards for electronic data. In 2000, they selected CPT® for reporting physician and other medical services, alongside the International Classification of Diseases (ICD-10-CM) for diagnosis codes.
CPT® codes are used to report services and procedures performed on patients:
- By providers in offices, clinics, and private homes.
- By providers in institutional settings such as hospitals, nursing facilities, and hospices.
- When the provider is employed by the healthcare facility (e.g., many of the physicians associated with Veterans Administration Medical Centers are employees of that organization).
- By a hospital outpatient department (e.g., ambulatory surgery, emergency department, and outpatient laboratory or radiographic procedures).