Medical coding is a very interesting field. The newly graduated professionals will only know about coding in information technology field, but they will not be aware of the coding in medical domain. Yes, Medical coding does not need any introduction now, because it has really come out as a very useful and stable career for healthcare professionals. CPT codes and ICD 10-CM (previously ICD 9 codes) are the main pillars of medical coding. CPT codes refer to the procedure code or exam and the ICD 10 codes refer to the diagnosis codes.
CPT stands for Current Procedural Terminology .There are three types of CPT codes: Category 1, Category 2 and Category 3. CPT is a registered trademark of the American Medical Association.
Each category codes consist of a particular service codes.
- CPT Category I—the largest body of codes consisting of those commonly used by providers to report their services and procedures
- CPTCategory II—supplemental tracking codes used for performance management
- CPT Category III—temporary codes used to report emerging and experimental services and procedures
Read also: New CPT codes changes for 2020 for Medical coders
CPT category I codes
This category of codes consists of 6 different section of codes. This will include a variety for codes from each department of the hospital. Below are the section which are included in CPT category I codes.
- Evaluation & Management Services (99201 – 99499)
- Anesthesia Services (01000 – 01999)
- Surgery (10021 – 69990) – further broken into body area or system within this code range
- Radiology Services (70010 – 79999)
- Pathology and Laboratory Services (80047 – 89398)
- Medical Services and Procedures (90281 – 99607)
CPT Category II codes
This category of codes are 5 digit alphanumeric codes , which has first 4 numeric letter followed by a F letter. While the CPT category I code include all the numerical codes. These codes are supplemental tracking and performance measurement codes that providers can assign in addition to Category I codes
CPT category II codes are located just after the Category I codes in CPT code books. Below are the list of codes includes in Category II.
- Composite Measures (0001F – 0015F)
- Patient Management (0500F – 0584F)
- Patient History (1000F – 1505F)
- Physical Examination (2000F – 2060F)
- Diagnostic/Screening Processes or Results (3006F – 3776F)
- Therapeutic, Preventive, or Other Interventions (4000F – 4563F)
- Follow-up or Other Outcomes (5005F – 5250F)
- Patient Safety (6005F – 6150F)
- Structural Measures (7010F – 7025F)
- Nonmeasure Code Listing (9001F – 9007F)
Read also: Best coding guide for Peripheral Angiography CPT codes
CPT category III codes
Category 3 CPT code list consists of temporary codes that cover emerging technologies, services and procedures. They differ from the Category 1 medical CPT codes list in that they identify services that may not be widely performed by healthcare professionals, may not have FDA approval and also may not have proven clinical efficacy. To be eligible, the service or procedure must be involved in ongoing and planned research. The purpose of these CPT codes is to help researchers track emerging technologies and services.
CPT codes versus ICD 10 CM codes
As I mentioned earlier ICD 10-CM codes represent the diagnosis codes. CPT codes are nothing without ICD 10-CM diagnosis codes. The Procedure or exam is performed only when there is a disorder or diagnosis to the patient. Hence, the diagnosis codes should also complement with the procedure or CPT code.
For example, if a patient visits a physician for a chest pain and the physician performs a chest X-ray. In this scenario the Chest x-ray will help to find any diagnosis or disorder causing the chest pain. Hence, the exam or procedure totally complement the symptom, which is chest pain.
But, in the same above scenario if the physician performs a leg x-ray for chest pain, then it will surely not support the medical diagnosis. Here, the procedure will not complement which the diagnosis and hence there will be possibility of claim denial from the payer, in short the payers will not pay for the exam or procedure performed.
Finally, the conclusion is always check the Chief complain (CC) for which patient has come and code the procedure which will support the medical diagnosis. So, both CPT and ICD 10-CM diagnosis should go hand in hand.
Who are Medical coders?
Medical coders are the professionals who are responsible for assigning CPT and ICD 10-CM codes after reading the medical charts. Yes, these professionals play a major role in Revenue Cycle Management (RCM). Also, Modifiers which play an important role in medical coding, should be used very carefully with CPT codes.
Modifiers are two digit numeric or alphanumeric codes which when added with procedure codes, modifies the definition of the exam and help in getting proper payment of the exam from the payer. To know some of the modifiers do refer the below post>
When to use 26 and TC Component
When to use 58 and 78 modifier
For example, if a complete abdominal ultrasound exam (CPT code 76700) is done twice in a day by same physician, then a 76 modifier is added to the second CPT code (76700, 76700-76) for getting paid for both exam. If the medical coder miss to assign 76 modifier, then it will be consider has duplicate exam and one procedure will be not paid by the payer or insurance company.
There are other codes as well which plays an important role in medical coding, the HCPCS level II codes & ICD 10-PCS codes.
HCPCS Level II —used to report procedures, services, supplies, drugs, and equipment
ICD-10-PCS —used to report inpatient procedures (hospitals)
HCPCS (pronounced “hick-picks”) stands for Healthcare Common Procedural Coding System. What we refer to as HCPCS codes is actually Level II of this system, or Level II HCPCS codes. Level I of the Healthcare Common Procedural Coding System consists of the CPT code set.
The Centers of Medicare and Medicaid Services (CMS) wanted a classification system for medical supplies, equipment, medications, and services not included in CPT—so, in 1980, the AMA worked with CMS to develop a new set of codes.
I have shared a lot about ICD 10 PCS codes, below are the related posts
Coding Guide for Root Operations
How to use CPT codes in Different Facilities?
Now, we have a CPT and ICD 10 codebook and we know how to find the codes as well. But the major question comes how to use these codes in live coding.
So, let us just try to understand how we use these codes in medical coding. I will try to make you understand in simple language and with some examples.
In Radiology facility, we get medical reports which consist of
Technique– the procedure or exam performed
Chief complaint or Reason for exam – problem for which patient came to the doctor or physician
Impression or Conclusion – finally what the physician concluded after the exam
Now, if you understand the above three section of the medical report, you can code a live medical report easily. You can refer some the sample coded medical charts which will help you to clear your doubts.
In surgery like interventional radiology, you will get lot of confusion for coding multiple procedure in a same report. Since surgery charts are very descriptive the coders take lot of time to understand the exam. But, with time you can achieve good coding skills in coding. I have shared some diagnostic and interventional radiology chart which will surely boost your coding knowledge. To get perfect will some the coding procedures, do refer the below posts.
This information will surely help to know most of the CPT codes used in medical coding.
Now, once you are aware of CPT codes most of the medical coders look seriously to have a good career in medical coding. Hence, then the medical coders look forward to get Credentials from AAPC and AHIMA exam. AAPC and AHIMA conducts yearly different medical coding certification exams which help in the professional growth of the medical coders.
CPC and CCS are the most common exam which medical coders apply for. I have cleared CPC exam in my first attempt. You can also clear CPC exam if you dedicatedly prepare for this exam. There is no negative marking in CPC exam and needs to get 70% or more to pass the exam. It has a extra free attempt to clear this exam, so you have totally two attempts to clear CPC exam. Hence, even if you fail in first attempt, you can prepare more nicely next time to clear the exam.
On the other hand, CCS is the toughest exam conducted by AHIMA. Generally, this exam consists of both objective as well as subjective questions, hence coders find it difficult to clear this exam. On top of that it has only 1 attempt and negative marking which makes it more difficult. Though I have some CCS exam preparation material which might help you in future.
The more you will code the more you will learn about medical coding. I have shared lot of information about CPT codes, do share the article if you liked it.
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