CPT codes, or Current Procedural Terminology codes, are a standardized set of codes used in medical billing and coding to describe medical, surgical, and diagnostic procedures and services provided by healthcare professionals. CPT codes were developed and are maintained by the American Medical Association (AMA).
CPT codes serve as a common language that allows healthcare providers, insurance companies, and other entities involved in the billing process to communicate and understand the specific services rendered during a patient’s visit. These codes provide a level of detail and specificity to accurately describe the procedures performed, enabling appropriate reimbursement and claims processing.
Each CPT code consists of five digits and is organized into three main categories:
- Evaluation and Management (E/M): These codes cover services related to patient visits, consultations, and medical decision-making, such as office visits, hospital visits, and preventive care.
- Procedures: This category includes codes for surgical procedures, diagnostic tests, therapeutic treatments, and other medical interventions.
- Ancillary Services: Ancillary codes encompass services such as laboratory tests, radiology procedures, and other diagnostic studies.
CPT codes are regularly updated and revised by the AMA to accommodate advances in medical technology and evolving healthcare practices. It is crucial for medical coders, billers, and healthcare providers to stay informed about the latest CPT code changes and use them accurately to ensure proper reimbursement and compliance with coding guidelines.
By assigning the appropriate CPT codes, healthcare providers can accurately document the services provided to patients, facilitate efficient claims processing, and support effective communication among healthcare professionals and insurance entities.
Please note that while CPT codes are used primarily in the United States, other countries may have their own coding systems, such as the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS).