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Plugin-Introduction to CPT Medical Billing 101

Plugin-Introduction to CPT Medical Billing 101

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Published by: fiesty79 on Jun 14, 2010
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This course is designed for individuals working in medical coding, billing,medical fee contracting, insurance, auditing, or other positions related tomedical billing & coding. This course is a review of the basics of CPTcoding for medical services. The student will gain a fundamentalknowledge of the history, purpose, and utilization of CPT coding to receivepayment from insurance carriers.
Recommended Prerequisites:
Medical Terminology
Recommended Additional Resources:
Current year CPT manualMedical Dictionary and/or Medical Abbreviations
Rev 1.0October 2008
Page 1 of 47
National Center for Competency Testing7007 College Boulevard, Suite 705Overland Park, KS 66211
Upon completion of this continuing education course, the professionalshould be able to:1. Define CPT code.2. Describe the history of CPT codes.3. Identify the differences between CPT, HCPCS, and ICD-9 codes.4. Describe the purpose of CPT codes.5. Apply accurate CPT coding fundamentals to medical billing practicesin everyday medical office or insurance company operations.
The writers for NCCT continuing education courses attempt to provide factual information based onliterature review and current professional practice. However, NCCT does not guarantee that theinformation contained in the continuing education courses is free from all errors and omissions.
Page 2 of 47COURSE TITLE: Introduction to CPTAuthor: James D. Rigdon, CPC, NCICS, BS-HACoding AnalystUniversity Physicians, Inc.Aurora, ColoradoNumber of Clock Hours Credit: 4Course # 1220409P.A.C.E. ® Approved: Yes x No
Page 3 of 47
Medical coding is a complex but necessary task in medical billing offices used to report,track, and bill for services rendered by medical practitioners (e.g. physicians, nursepractitioners), ancillary providers (e.g. chiropractors, psychologists), or facilities (e.g.hospitals, nursing homes). Varieties of codes are used to consistently report medicalservices, procedures, supplies and equipment, and diagnoses. Codes are used toconvey complex medical language quickly and effectively to insurance companies, aswell as to other organizations such as Medicare, the American Medical Association, andthe World Health Organization. Many organizations utilize statistics mined from billinginformation for tracking purposes, such as frequency of office visits, severity of diseases, or even disease progression.
There are six basic types of medical codes used in various aspects of medical billing:
Current Procedural Terminology, Fourth Revision (CPT-4
) – identifiesservices and procedures
International Classification of Diseases, Ninth Revision (ICD-9)
– identifiesdiagnoses
Healthcare Common Procedure Coding System (HCPCS)
– identifiesadditional services and procedures not listed in CPT; drugs dispensed in thephysician’s office or other facility (including injectables, topicals, and orallyadministered); supplies and equipment dispensed to the patient
National Drug Codes (NDC)
– identifies pharmaceuticals dispensed to a patientvia a pharmacy
Revenue Codes
– identifies bundled facility and technical services (e.g. nursingcare, radiology or laboratory rendered in a facility setting, and room and board)
American Dental Association (ADA) Dental Billing Codes
– identifies servicesrendered by dental practitioners (usually bundled into the HCPCS ‘D’ section)The focus of this course is CPT codes.
The American Medical Association (AMA) developed the CPT manual in 1966. The firstedition contained a mere 3,534 codes. To this day, the AMA maintains the CPTmanual, and it has been revised and updated on a yearly basis since 1977. The HealthInsurance Portability & Accountability Act (HIPAA) and Centers for Medicare & MedicaidServices (CMS) require the use of standard code sets to be used when reporting anyservice rendered to a patient. CPT is one of those standard code sets.The 2008 CPT manual contains six sections with over 8,600 numeric, five-digit codes.To conserve space, some CPT codes are indented or cross-referenced. A coder usingthe CPT manual to report services should always look up the codes in the index first,and not rely on the structure of the manual to be ‘led’ to a code.

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