CPT Coding Guidelines

Do you have questions about CPT coding guidelines? If so, we are here to help. Current Procedural Terminology, or CPT codes for short, were initially published in 1966 to assist in determining the amount of reimbursement that medical providers receive for the services they’ve provided.

CPT codes are maintained and copyrighted by the American Medical Association and are the United States standard for how medical professionals document and report medical services. All medical facilities and payers use thousands of CPT codes which are updated on an annual basis.

Three Categories of CPT Codes

CPT codes fall into three categories which include Category I, Category II, and Category III. Let’s take a closer look at what each of these categories are.

  • Category I: Category I codes are five digits and feature descriptors which correspond to a certain services or procedure. These codes range from 00100-99499. An example of a Category I code is 47350 which stands for “management of liver hemorrhage; simple suture of liver wound or injury.”
  • Category II: Category II codes are alphanumeric tracking codes which are optional and used to measure execution. An examples of a Category II code that stands for postpartum care visit is 0503F.
  • Category III: Category III codes are intended for new and ever-evolving technology, services, and procedures. These codes help collect data and assess new services and procedures. 0123T is a Category III code that stands for the fistulization of sclera for glaucoma through ciliary body.

There are two character modifiers that are added to CPT codes in order to report special circumstances. These two character modifiers are developed by the American Medical Association and the Centers for Medicare and Medicaid Services.

Medical Coders and CPT Coding Guidelines

When reporting CPT codes, medical terminology as well as insurance payer rules and correct modifier usage must be taken into consideration. Therefore, medical coders who determine and report CPT codes on medical claims must undergo a comprehensive training program and obtain special credentials.

You should ask yourself what the CPT coding guidelines and process is like in your medical facility. It is important to determine whether your staff has the credentials and training necessary to accurately and efficiently perform coding tasks.

Since the CPT coding process is often time consuming and complicated, you may find that outsourcing is right for your practice. By outsourcing, you won’t have to worry about accurate coding, rendering of any services provided, and yearly revising of CPT codes by the American Medical Association Panel.

Contact Applied Medical Systems Today

If you have questions regarding CPT coding guidelines, or if you’d like to ensure your medical billing is accurate and efficient, you should reach out to Applied Medical Systems (AMS) today. When you choose to work with us, we’ll allow you to focus on providing your patients with the highest quality of care and ensure you are paid properly and on time.