What Are CPT Codes: An Overview
You’ve likely heard an assortment of complex terminology and lingo if you’ve spent much time in the field of medicine. As you become increasingly familiar with these domain-specific phrases, you may still be wondering: What are CPT codes?
Current Procedural Terminology (CPT) codes are essential for medical billing, so it’s crucial for facility leaders to understand how they’re applied in practice. We’ll provide an overview of what CPT codes are, how they’re used, and what you can do to ensure accuracy in your documentation.
What Are CPT Codes?
CPT codes are five-digit numerical codes assigned to the treatments and services delivered by healthcare providers. During the billing process, providers or medical billers will use these codes to notify insurers about the services received by their patients. Once insurers receive a list of CPT codes, they then use them to determine how much they owe providers.
Here are a few examples of commonly used CPT codes and their corresponding services:
- 99211 — Office/outpatient visit
- 36415 — Routine venipuncture
- 94040 — Electrocardiogram report
- 97530 — Therapeutic activities
- 80053 — Comprehensive metabolic panel
How Do CPT Codes Differ From ICD Codes?
While CPT codes and ICD codes are both used in the documentation and billing process, they convey different types of information. Unlike CPT codes, which represent different medical services, ICD codes signify the diagnoses for which these services are being used.
How Are CPT Codes Used?
Beyond wondering, what are CPT codes? You may be curious as to how CPT codes are actually used in practice. This process can be broken down into three simplified steps:
- Coding: After a facility sees a patient, that patient’s healthcare provider or a medical biller inputs corresponding CPT codes into their Electronic Health Record (EHR) or paper medical chart. EHRs are usually programmed to generate CPT codes automatically based on what services a provider inputs.
- Verification/Submission: Once CPT codes are documented, a facility’s billing department will double check these codes to make sure all services are accurately accounted for. The billing department will then submit the CPT codes to the patient’s insurance company.
- Claims Processing: If the insurance company deems that all documents look in order, they will approve the CPT codes and process claims to figure out exactly how they should pay the patient’s provider.
CPT codes are also used by the Centers for Medicare and Medicaid Services (CMS) to track healthcare utilization. This standardized categorization allows for easier data collection, which can contribute to decision-making and funding practices.
What Are the Three Categories of CPT Codes?
While all CPT codes have five-digits, some codes use only numbers while others use both numbers and letters. The specific attributes of a code depend on which of the three categories of CPT codes it falls under. We’ll describe and provide example codes from each of these categories below.
Category 1: Procedures and Services
The first group of codes corresponds to a procedure or service. As the most commonly used CPT codes, they’re used to identify services like office visits, drugs, laboratory tests, and surgical procedures. This is the only category of codes that providers are required to use.
These codes are further organized into six subcategories based on the type of service. These categories and their code ranges are outlined in the table below.
| Code Range | Category of Services |
|---|---|
| 99201 – 99499 | Evaluation and Management |
| 00100 – 01999;
99100 – 99140 |
Anesthesia |
| 10021 – 69990 | Surgery |
| 70010 – 79999 | Radiology |
| 80047 – 89398 | Pathology and Laboratory |
| 90281 – 99199;
99500 – 99607 |
Medicine |
Category 2: Performance Measurement
These CPT codes are used as optional, supplemental codes for performance measurement and quality improvement. While not mandatory, these codes can indicate the reason for the patient’s visit or the patient’s history, which may reduce the need for chart review.
Category 2 codes are alphanumeric — including both numbers and letters — with four numbers followed by one letter. They are also divided into subcategories, which are outlined below.
| Code Range | Category of Services |
|---|---|
| 00000-09999 | Anesthesia Services |
| 10000-19999 | Integumentary System |
| 20000-29999 | Musculoskeletal System |
| 30000-39999 | Respiratory, Cardiovascular, Hemic, and Lymphatic System |
| 40000-49999 | Digestive System |
| 50000-59999 | Urinary, Male Genital, Female Genital, Maternity Care, and Delivery System |
| 60000-69999 | Endocrine, Nervous, Eye and Ocular Adnexa, Auditory System |
| 70000-79999 | Radiology Services |
| 80000-89999 | Pathology and Laboratory Services |
| 90000-99999 | Evaluation & Management Services |
Category 3: Emerging Technology
The final group of CPT codes records the use of emerging technology, services, or procedures. These codes are temporarily assigned and allow for the collection of data, which helps researchers track the usage of services that aren’t yet widely used in clinical practice.
These alphanumeric codes are constantly changing, depending on the AMA’s yearly designation of codes. Emerging technology CPT codes are typically used for data collection, although some may be used in billing for new services that don’t yet qualify for a Category 1 code.
How Do You Match CPT Codes to Services?
Now that we’ve answered the question, What are CPT codes? you’re likely wondering where to find a list of CPT codes that you can reference to bill for services. To perform a CPT code lookup, you’ll need to purchase the annual list of CPT codes copyrighted by the AMA.
Another way providers can access the list of CPT codes is on the Centers for Medicare & Medicaid Services (CMS) website. You’ll be asked to verify a licensing agreement, affirm use within the U.S. solely by your organization, and attest to CPT code usage for CMS programming.
Once you gain access to the codes, you can search within the categories to choose the relevant CPT abbreviations: respiratory, digestive, anesthesia, and more. This will allow your organization to accurately record and bill for the care you’re providing to your patients.
How Can Facilities Prevent Coding Errors?
Ensuring the accuracy of CPT codes can help prevent delays in billing and keep your facility compliant with related CMS programming. Follow these three tips to minimize the risk of errors.
1. Keep up With AMA’s Updates
CPT codes are updated each year to ensure that new procedures and services are accounted for. It’s important to keep up with these updates to prevent errors in your billing process. The two most reliable sources for updates are the AMA’s CPT Resource Center and CMS’s Repository.
2. Automate Your Billing Procedures
Many EHR systems can be programmed to automatically link CPT codes to services. If your facility is using paper charts, consider upgrading to an electronic system to automate coding. If you have an EHR system, speak with your vendor to see if this function can be integrated.
3. Implement an Auditing Process
Consider implementing a system in which codes are double checked by administrative staff before being sent to insurers. If any errors are caught or claims are denied, it can also help to keep a log of these events to identify their causes and prevent them from happening again.
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Now that you know the answer to the question, What are CPT codes? you’ll be better prepared to accurately report and bill for your facility’s services. Stay connected with IntelyCare to get the latest free nursing care resources for your facility.