What are you being charged for when you use CPT codes?

 What are you being charged for when you use CPT codes?

We all need to see a doctor every once in a while, and for some of us, it's more of a habit than anything else. We normally wind up paying a pretty small co-pay for the services provided to us regardless of how often we go in for a checkup or treatment. Who then pays the difference and how is it paid? The doctors and nurses we see clearly don't live off of our co-pay; the question then becomes how they get the extra cash from our health insurance company. Learn the ins and outs of CPT Codes and their applications in this article.

Context of CPT Code

Doctors had to hand-write notes detailing a patient's symptoms, the most probable diagnosis, and the visits, treatments, and procedures they believed should be reimbursed for before CPT codes and ICD-9-CM codes were developed. Meanwhile, the American Medical Association developed Current Procedural Terminology (CPT) in 1966 to facilitate the use of codes by physicians when billing Medicare and other health providers. In order to get paid, doctors use the CPT Codes to specify the service they provided to other medical professionals. With 8,568 codes and descriptors available with the CPT 2005 Codes, it's easy to understand why doctors can occasionally get confused about which codes to use and for what purposes. But the overarching goal of the codes was to standardize Medicare and health provider payments and to assist doctors.

How are CPT Codes generated?

The seventeen-person CPT Editorial Panel meets four times yearly to review proposed revisions to the CPT Codes. These individuals are employed by the American Medical Association and are in charge of revising, adding, and removing CPT Codes. To further aid the Editorial Panel in its pursuit of maintaining the CPT Codes, there is furthermore a CPT Advisory Committee that comprises representatives from more than 90 healthcare organizations and medical associations.

Classification of CPT Codes: What are they?

There are three areas where CPT Codes are grouped. The bulk of CPT Codes are Category I codes, which are five digits long. It is common practice to refer to category I CPT codes while discussing medical terminology. Procedures that are congruent with modern medical practice and are performed often are included in category I codes. After that, there are six subcategories for Category I codes.Assessment and AdministrationIntensive CareMedical ProcedureDiagnostic imagingLaboratory and PathologyHealth care



Supplemental tracking codes utilized for performance measurement are known as Category II CPT Codes. In most cases, they will outline the components of an assessment and management service. These are not to be confused with category I codes; they are a four-digit code followed by a "F" that is optional.

Temporary codes for emerging technology are represented by Category III CPT Codes. They came into being so that new procedures and services could have their data collected and monitored. Category III CPT codes distinguish themselves from Category I codes by designating procedures that not all medical providers are likely to carry out. The rationale behind these codes is that they will allow researchers to monitor the progress of new services and technologies, which should lead to their wider adoption and better clinical outcomes. A four-digit number followed by the letter "T" is the format for Category III codes. The operation or service will no longer be recognized as a Category I code after five years, as these codes are meant to be temporary.

You may see for yourself how helpful CPT Codes are to the healthcare industry. They establish a nationally recognized and utilized standardized system of coding. To reflect the ever-evolving nature of medicine, these codes are revised and updated annually. With this new information, you can better understand how your healthcare provider calculates your charges for all of your medical procedures.

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