CPT Medical Billing Codes and their relationship to ICD-9 or 10 codes are described here. Where to find good CPT medical coding references for medical coders and medical billing specialists. Links below to quickly look up diagnosis and treatment codes for free.
CPT is an abbreviation for Current Procedural Terminology that is developed and maintained by the American Medical Association (AMA).
The CPT edition is designated by the year so you want to use the most current edition available. These codes can only be obtained from the AMA or one of their licensees. They are not like the ICD 9 and ICD 10 diagnosis codes which are publicly available.
This 5 digit CPT codes describe medical services performed by a physician or healthcare provider. They are also used for surgical and diagnostic services. All the major commercial and government insurance carriers require the use of CPT codes when submitting claims. For example CPT-4 code 99243 is used for an initial office consultation and examination.
For more comprehensive info on medical coding and billing related terms and abbreviations, checkout the Medical Billing Terms page.
Important For Reimbursement
CPT medical billing codes are assigned for every service that a provider performs on or for a patient. These are services such as the evaluation of a patients condition, surgical procedures, testing, or diagnostic services. CPT codes are used by health insurance companies to determine how much a provider is reimbursed based on the services or procedure performed. Depending on the providers agreement or contract with the insurance company, each provider may not be paid the same for the same procedure.
CPT codes correspond to an ICD-9-CM diagnostic code (soon to be ICD-10) which classifies a disease or condition. For an insurance claim to be paid by the insurer, the CPT medical billing codes must match the ICD 9 (or ICD 10) diagnostic code. For example, the ICD 9 code for high blood pressure cannot be assigned the CPT-4 treatment code for an unrelated treatment like an injection.
Where Can I Find CPT Medical Billing Codes?
The CPT medical billing codes are copyrighted by the AMA which prevents their free use and distribution without their permission and authorization.
However the AMA does allow a personal, non-commercial search of the Current Procedural Terminology (CPT) Codes on their website. The condition is that you that you can look up the codes ONLY for personal information and cannot sell the information.
If the AMA thinks you are using their free CPT search system too much, they can limit your searches and/or limit the number of CPT medical billing codes you look up at a time. You can look up these treatment codes from the AMA search link available on our CPT medical coding free references page.
One of the cheapest online coding references is from Find-A-Code. They offer access to the latest edition of CPT and ICD codes for only $4.95 a month.
Three Categories of Codes
CPT medical billing codes are part of the HCPCS coding system. HCPCS consists of three levels:
The AMA revises the CPT codes annually. CPT codes are sometimes accompanied by modifiers. These modifiers are two digit codes associated with a CPT code which indicate the procedure has been altered - or modified - or provide more specific treatment info. These modifiers are described in appendix A of the CPT publication.
CPT medical billing codes submitted on an insurance claim are associated with the diagnosis code to show the procedure is medically necessary. There may be more than one ICD code associated with each CPT code. The CMS 1500 form can accommodate up to four ICD codes in box 21 of the form as referenced by the diagnosis pointer in box 24E.
CPT Category I Code Organization
CPT codes are organized in sections as follows:
E/M Most Frequently Used
The Evaluation and Management codes, 99201 through 99499 are used by all specialties and facilities. These are listed first because they are the most commonly used. It's important that these codes are accurately assigned because the majority of a practices income is based on these procedures.
Of these codes, the 99201 thru 99205 are for different variations of new patient office visits. 99211 thru 99215 the CPT codes are for established patients. The different codes for each situation depends on the complexity of the providers decision making. For example the 99201/99211 depend on history, examination, and complexity of decision making for either the new or established patient. The 99205/99215 would be for more involved or comprehensive history, examination, and complex decision making.
The majority of E/M CPT medical billing codes require the provider to obtain information from the patient to access the necessary medical care. As such the E/M services are not significant procedures, but are important in determining the other procedures the patient needs.
Here are the symbols commonly used in CPT reference coding books:
Triangle - Located to the left of the code indicates the code description has been revised in the current edition of the CPT. Two Horizontal Triangles - These are around notes that have been revised. ; - Semi-colon in a CPT description denotes that everything to the left of the semi-colon is applicable to the indented shorter descriptions following. * - Asterisk or star shows after minor surgery codes to show preoperative and postoperative services are included and means the package or global surgery is not applicable. These procedures are usually paid as fee-for-service. + - Plus symbol identifies add-on codes usually performed at the same time and by the same provider as the primary procedure. There are usually notes in parenthesis to indicate the primary code(s) that these apply to. Circle with line through it - Means modifier -51 is not assigned to the code and are not add-on procedures. Lightning Bolt - Indicates product is pending FDA approval. Dot surrounded by Circle - Denotes moderate sedation.
Triangle - Located to the left of the code indicates the code description has been revised in the current edition of the CPT.
Two Horizontal Triangles - These are around notes that have been revised.
; - Semi-colon in a CPT description denotes that everything to the left of the semi-colon is applicable to the indented shorter descriptions following.
* - Asterisk or star shows after minor surgery codes to show preoperative and postoperative services are included and means the package or global surgery is not applicable. These procedures are usually paid as fee-for-service.
+ - Plus symbol identifies add-on codes usually performed at the same time and by the same provider as the primary procedure. There are usually notes in parenthesis to indicate the primary code(s) that these apply to.
Circle with line through it - Means modifier -51 is not assigned to the code and are not add-on procedures.
Lightning Bolt - Indicates product is pending FDA approval.
Dot surrounded by Circle - Denotes moderate sedation.
Free Billing Code Resources
Here are links to free references for CPT medical coding and ICD 9 codes from trustworthy websites. These can be very helpful if you're just trying to do a quick search for a treatment or diagnosis code.
There are several CPT coding handbooks available from the AMA bookstore or any authorized AMA publisher in an easy to navigate format that provide clarifications and make it easier to associate the code with the description.
If you're looking for an online coding resource, there are several popular sites to choose from; Find-A-Code, Supercoder, CodingItRightOnline, and Coding Today are a few. The great thing about online coding references is they are continuously updated with the latest codes and you can access from any browser.
The popular CPT Expert book (available at Amazon or at AMA) combines codes with billing and Medicare regulatory information in one volume and clarifies annual code changes and rules. These references are also a great help in insuring the correct modifiers are used as this can be a big source of coding inaccuracies - and unpaid claims.
We occasionally find our clients using out of date CPT medical billing codes or using ICD codes that don't match the treatment. Having good coding references is essential to resolving these issues.
Another excellent reference for medical billing specialists is Understanding Health Insurance. It's an excellent source for describing CPT and ICD coding systems, managed care, legal and regulatory issues, reimbursement methodologies, coding for medical necessity, and common health insurance plans. It's written in an easy to understand style for the complex issues in medical coding and billing and has several practical examples.
Medical Coding Software
This link discusses some of the options for Medical Coding Software and some of the major online resources available. Software references can be a real time saver in assigning the correct CPT medical billing codes.
CPT Codes and their associated modifiers and descriptions are owned, copyrighted, and trademarked by the AMA (American Medical Association). They can be purchased directly from the AMA Bookstore or from one of the licensed sellers such as SuperCoder.com, FindaCode.com, Amazon, etc.
Jan 09, 18 08:52 PM
Just starting out and need specific information on how to submit secondary claims. I understand you need EOB from primary. Do you send entire page with
Jan 09, 18 08:36 PM
What claim form would a Home Health Agency use to file a claim for telemonitoring? Response: We haven't had any experience billing for home health services
Jan 09, 18 08:24 PM
We've started a medical billing service and we want to understand best practices or the different ways in which we would get the information from our billing
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