What is CPT Coding?
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The CPT medical coding system, or Current Procedural Terminology, is a set of medical codes maintained and published by the American Medical Association (AMA). It is widely used in the United States and several other countries to report medical procedures and services provided by healthcare professionals. The CPT codes are used for billing purposes, medical documentation, and communication between healthcare providers, payers, and regulatory entities.
CPT codes are alphanumeric and are organized into three categories:
1. Category I codes: These codes represent a wide range of procedures and services, including medical, surgical, and diagnostic services. Category I codes are regularly updated to accommodate advances in medical technology and practices.
2. Category II codes: These codes are supplemental tracking codes used for performance measurement and quality improvement purposes. They provide additional data about specific services and procedures performed.
3. Category III codes: Also known as temporary codes, Category III codes are used for emerging technologies, services, and procedures that require further data collection. They are often used until sufficient evidence is available to support the creation of a permanent Category I code.
When a healthcare provider performs a medical service or procedure, they assign the appropriate CPT code(s) to the encounter. These codes are then used by insurance companies and other payers to determine reimbursement rates and process claims. Accurate and precise coding is crucial for proper payment and compliance with healthcare regulations.
It's important to note that the CPT coding system is distinct from the International Classification of Diseases (ICD) coding system, which is used to classify and code diagnoses and symptoms. Together, CPT and ICD codes form the foundation of medical billing and documentation in the healthcare industry.
