Current Procedural Terminology Flashcards, test questions and answers

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What is Current Procedural Terminology?

Current Procedural Terminology (CPT) is an important coding system used to classify and describe medical services, procedures and diagnostic tests. Developed by the American Medical Association, CPT helps standardize billing for health care providers across the United States. It is a five-digit coding system based on the type of service provided and its complexity. Since its introduction in 1966, CPT has become an integral part of medical coding and billing. It helps health care professionals accurately report services they provide as well as document complexity of procedures performed on patients. It also helps insurance companies verify that medical claims are appropriate and necessary while avoiding fraud or overbilling. CPT codes are divided into three major sections: Evaluation & Management (E); Anesthesia; Surgery; Radiology; Pathology/Laboratory; Medicine; Category II codes that track performance measures; Category III codes for emerging technologies and procedures not yet recognized by insurance companies; Healthcare Common Procedure Coding System (HCPCS) Level I codes for durable medical equipment, prosthetics, orthotics, supplies, etc.; HCPCS Level II codes for non-physician services such as ambulance transport or home health agency services. Health care providers use CPT to report their services to payers through electronic or paper claims forms. The accuracy of these claims is crucial to ensure payment from insurers in a timely manner. For this reason it is important that health care providers understand how to properly select the correct code for each service rendered when submitting a claim form with accurate patient information attached so that it can be processed without delay or rejection due to incorrect coding errors.