How long are cpt codes

That is determined by the contracts between individual providers and insurers. Some CPT codes indicate bundled services. That is, one code describes a number of aspects of care that are performed in combination.

Because CPT codes directly affect how much a patient will pay for medical care, offices, hospitals, and other medical facilities are very strict about how coding is done. They usually employ professional medical coders or coding services to ensure procedures are coded correctly. Your healthcare provider or her office staff will usually start the coding process.

If they use paper encounter forms, they will manually note which CPT codes apply to your visit. If they use an electronic health record EHR during your visit, it will be noted in that system; typically, systems allow staff to easily call up codes based on the service name. After you leave the healthcare provider's office, your records are examined by medical coders and billers so they can assign the correct codes, if not done already.

The billing department then submits a list of the services you were provided to your insurer or payer. Healthcare providers and facilities generally use electronic means to store and transfer this information, although some may still be done by mail or fax. Your health plan or payer then uses the codes to process the claim and determine how much to reimburse your healthcare provider and how much you may owe.

Health insurance companies and government statisticians use coding data to predict future health care costs for the patients in their systems. State and federal government analysts use data from coding to track trends in medical care and to determine their budget for Medicare and Medicaid.

CPT codes are found and used in various documentation as you transition through any health care experience. As you leave a healthcare provider's appointment or are discharged from a hospital or other medical facility, you are given paperwork that includes a numeric summary of the services they provided to you.

The five-character codes are usually CPT codes. There are other codes on that paperwork too, such as ICD codes , which may have numbers or letters and usually have decimal points. When you receive a bill from the healthcare provider, before or after it has been sent to your payer, it will have a list of services.

Next to each service will be a five-digit code. That's usually the CPT code. When you receive an explanation of benefits EOB from your payer, it will show how much of the cost of each service was paid for on your behalf. Like the healthcare provider's bill, each service will be aligned with a CPT code. Your interest in these codes is usually related to your healthcare providers' and insurance billings. The organization charges fees for the use of the codes and access to full listings, which means you won't find a comprehensive list online for free.

If the services and procedures they represent meet Category I criteria—which includes FDA approval, evidence that many providers perform the procedures, and evidence that the procedures have proven effective—they will be reassigned Category I codes. Conversely, Category III codes can be eliminated if providers do not use them. First, as you might imagine, procedural coding necessitates a solid grasp of anatomy and medical terminology.

One procedure might have numerous variations, differing only slightly, and selecting the right code will require an ability to comprehend the clinical documentation and code description—to understand what a given procedure is, how the physician performed it, and which code descriptor captures the highest specificity of the procedure performed.

They are not limited by the specialty in which they practice. For example, X-ray codes are listed under radiology, but a primary care coder will be required to assign an appropriate X-ray code if the primary care physician interprets an X-ray. This is the best way to ensure coding accuracy and optimal reimbursement for your employer. A modifier consists of two numbers, two letters, or a number and a letter. For example, some modifiers show that a procedure was performed on the right side of the body, versus the left side or both sides.

Other modifiers indicate that a physician took extra time and effort to perform a service or procedure. A short list of modifiers goes a long way in expanding the unique circumstances of services and procedures performed. In the CPT codebook, these codes are listed in mostly numerical order, except for the codes for Evaluation and Management. Note also that some codes appear out of numerical sequence but near similar procedures. This may seems slightly confusing, but having these codes clustered near similar procedures prevents having to delete and resequence codes, and so is seen as a sort of necessary evil.

Within each of these code fields, there are subfields that correspond to how that topic—say, Anesthesia—applies to a particular field of healthcare. For instance, the Surgery section, which is by far the largest, is organized by what part of the human body the surgery would be performed on.

Likewise, the Radiology section is organized into sections on diagnostic ultrasound, bone and joint studies, radiation oncology, and other fields.

Please refer to the eBook for a complete breakdown of the subfields used in each of the code fields. Each of these fields has its own particular guidelines when it comes to use.

For example, the Surgery section has a guideline for how to report extra materials used such as sterile trays or drugs and how to report follow-up care in the case of surgical procedures. If a procedure is indented below another code, the indented procedure is an important or noteworthy variation on the above procedure, and would replace the first code. The first, which comes before the semicolon, is the general procedure.

If we look in the CPT manual, we find the code below CPT codes also have a number of modifiers. These modifiers are two-digit additions to the CPT code that describe certain important facets of the procedure, like whether the procedure was bilateral or was one of multiple procedures performed at the same time. CPT modifiers are relatively straightforward, but are very important for coding accurately.

For now, just recognize that the CPT code set has a number of instructions that inform the medical coder on how to best code the procedure performed. CPT I codes are divided into 6 sections and are grouped, with the exception of Evaluation and Management, numerically. Here are the different Category One codes:. There are subgroups within these sections that indicate the type of procedure or what part of the body that procedure relates to.

For example, Radiology is categorized by type—ultrasound radiation, bone and joint studies, etc. The largest section, Surgery, is organized according to the body part s the surgery is meant to be performed on. Each section also has guidelines on use. For example, Surgery has a section on how to report extra materials used or how to report follow-up care.

Several CPT codes are arranged by indentation. These are supplemental performance tracking codes; these codes are also optional and not used for billing. Collecting such information allows healthcare providers to improve performance and quality of care and, as a result, provide better outcomes for patients. Here are the different Category Two Codes:. These codes are temporary codes that describe new and experimental technologies, services, and procedures; these codes can also be used for billing.

For example, T: Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on fluoroscopic images. Category Three codes are primarily used to gather data for FDA approval or indicate widespread usage that would turn the code into a permanent Category One code. After a period of five years, these codes either become a Category One code, get rejected, or reapply for Category Three status.