CPT Codes in Medical Offices That Employ

¶ … CPT codes in medical offices that employ Health Information Management professionals. Many current practices are using HIM professionals to help document patient visits and any treatments performed or offered to them. Having well trained HIM personnel can help the practice receive maximum reimbursement for the services that are performed there. This brief review will document the numerical system used for CPT codes that are detailed in billing literature as well as the appropriate methods for using them.

Coding professionals provide an invaluable service to physician practices and hospitals as they are truly the front line defense as far as ensuring reimbursements are near or even at maximum for their patients. The medical team works very hard for the patients they serve, and they should be reimbursed for it appropriately. Correct and appropriate medical codes will allow the office to recoup as much as possible from the services they provide.

Current procedural terminology (CPT) codes are Level I codes within the Healthcare Common Procedure Coding System (HCPCS) classification system. The codes are copyrighted and published exclusively by the American Medical Association (AMA). They are updated annually to depict changes in treatments and procedures, delete unused codes and provide more detail for existing codes. CPT codes are five digits that represent physician services. There is an additional level of codes -- HCPCS Level II -- set up to cover medical services and goods used by other providers. The goal of CPT is to assign an appropriate numerical code to a treatment or procedure description so that the insurer can reimburse the provider for the services provided. As a coder, you should assign codes that cover the service as accurately as possible within the given and correct five-digit code. CPT codes organize category one procedures and services within six sections. These sections are evaluation and management, anesthesia, surgery, radiology, pathology, and medicine. The numbers used to document these codes for billing purposes are: Evaluation and management 99201-99499; Anesthesia 00100-01999; Surgery 10021-69999; Radiology 70010-79999; Pathology and Laboratory 80047- 89398; and Medicine 90399-99607.

Some payers, such as Medicare and Medicaid, require the reporting of these CPT codes, as outlined above, on all bills. Because health records and bills include a wealth of information about a patient, they need to be carefully organized in a way that makes data easy to find. This is one important way that the CPT codes come in handy. If information in the record cannot be found or verified, the payment may be denied or reduced. The most important thing to remember is if it isn't in the record, it didn't happen. Here is where the coding team really shines because they are critical in ensuring the physician office is reimbursed for the work they do.

These five elements relate to evaluation and management (E/M) coding. The E/M codes all begin with the numbers 99. E/M codes describe the nature of the presenting problem (for example level of severity). E/M codes identify the place the treatment took place, such as the office, as well as the type, for example, initial visit, of service. E/M codes describe the content/extent/level of the service, for example a detailed history, and a detailed exam. E/M codes also describe how long it took to actually perform the service for the patient. E/M codes begin with the number 99201, and are found in the beginning of the CPT book (even though going strictly numerically they should be found at the end).