CPT for Medical Procedures
CPT stands for Current Procedural Terminology; they're the codes used to describe medical procedures, services and information about a patient. CPT for medical procedures is a standardized language within the medical arena. The assigned codes are used for reimbursement purposes, research, instruction and clinical care.
Significance
As noted by its site, The American Medical Association (AMA) developed CPT coding in 1966, and it's the most widely accepted medical nomenclature used to report medical procedures and services under public and private health insurance programs. Medical coders (and other health care professionals) review and interpret documents such as patients' charts or records to determine the CPT code that correctly reflects the medical procedure. Once the code is established, it gets entered into its database. Insurance companies and other health care institutes use the inputted code for billing purposes, as it dictates the specific fees and charges that will be paid for the services provided.
Human Anatomy & Physiology
Since CPT codes for medical procedures and services involve information regarding patients' symptoms, diagnoses, diseases, injuries and treatments, it's important for a coder to be familiar with basic human anatomy, physiology and medical terminology. That being said, you'll need to be familiar with basic human anatomy and physiology in order to assign codes. The ability to recognize anatomical structures and systems is crucial. They're typically grouped into the following: Body Structure/Functions, Cells/Tissues/Membranes, Skeletal System, Muscular System, Nervous System, Endocrine System, Cardiovascular System, Lymphatic System, Respiratory System, Digestive System, Urinary System and Reproductive System.
Medical Terminology
Medical terminology is rooted in the Greek and Latin languages and is used to classify parts of the body, medical practices, procedures and treatments. Medical terminology follows a specific structure much like any other language; the basic elements involve: the word root, combining form, prefix and suffix. Understanding medical terminology is also critical, because it's the language used in patient records and medical documents the codes are assigned to.
Features
The American Health Information Management Association (AHIMA) defines CPT coding procedures as "the transformation of verbal descriptions of diseases, injuries and procedures into numeric or alphanumeric designations." The "CPT Manual" (available online and in hard copy) is what's used to classify all codes and categories. The "CPT Manual" is broken down into various sections, section headings, subsections, categories, subcategories, guidelines, symbols, colons and semi-colons modifiers, appendices, indices and examples to help users find and identify the precise code.
Code Categories & Identification
Furthermore, CPT codes for medical procedures are comprised of three distinct categories: CPT I, CPT II and CPT III. As noted in "An Introduction to CPT Coding" from The College of American Pathologists, CPT I is a five-digit code with definitions used to report service/procedures. Within Category I, the code divisions are broken down into Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory and Medicine. Category II CPT Codes are constructed of four digits following the letter F; they're considered optional and are accompanying tracking codes employed for performance measures and data. Category III codes include four digits followed by the letter T; they serve as temporary codes to track new technology.
Considerations
CPT codes for medical procedures are required to abide by all federal and legal regulations, in addition to those put forth by individual insurance agencies and providers. The coding standards are overseen by the American Medical Association (AMA) and organizations such as The Joint Commission, Center for Medicare and Medicaid Services (CMS), and Institute for Safe Medication Practices (ISMP).
The ins and outs of CPT for medical procedures can be overwhelming at first. However, there are a number of online resources devoted to coding procedures and subsequent information. Reviewing medical terminology along with anatomy and physiology will help you to identify the numbers used within the primary code sections, and becoming familiar with medical terms will help you navigate the "CPT Manual" with a lot more ease.
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