The 3 Most Frequently Asked Questions About CPT Codes

by  Find-A-Code™
Oct 16th, 2023

Medical coding and billing are challenging careers requiring a ton of knowledge and plenty of experience. Coders and billers need to be familiar with HIPAA regulations, medical terminology, NPI lookup and more. When it comes to the medical codes themselves, particularly CPT codes, there is more to know than any one person can possibly remember.

CPT (Common Procedural Terminology) codes are a set of medical codes designed for billing purposes. They cover the procedures and services provided by individual clinicians and healthcare facilities. They are among the most commonly utilized codes along with ICD-10 codes.

To give you a better idea of the CPT code set's reach, here are the three most frequently asked questions among current and future medical coders and billers:

1. Who is responsible for the codes?

The CPT code set was developed by the American Medical Association (AMA) back in the 1960s. Their goal was to streamline medical documentation and billing. In the decades since, the AMA has maintained ownership and management over the set.

CPT codes are updated by the AMA two times per year. Each proposed round of changes is released in advance of official adoption so that billers and coders have time to study them. Each year, outdated codes are dropped, existing codes are modified, and new codes are introduced.

2. What are the three classifications of CPT codes?

The thousands of codes in the CPT set are divided into three classifications. Each classification has its own purpose. Here is a brief description of each one:

• Category I – Category I CPT codes are the most frequently utilized codes within the CPT ecosystem. They are the codes used to bill payers for services and procedures covering everything from evaluation exams to surgical procedures and pathology services.
• Category II – Category II codes are not used for billing purposes. They are mainly supplemental codes intended to track clinical performance. They are utilized to help payers understand what clinicians and healthcare facilities are doing to improve patient outcomes.
• Category III – Within the healthcare environment, there are always emerging procedures, services, and technologies. Until such procedures, services, and technologies become mainstream, they are assigned temporary CPT codes. Such codes are part of Category III.

It goes without saying that medical coders and billers have an easier time doing what they do if they understand the three categories and their applications. Time and experience take care of that.

3. What makes CPT codes useful?

To the average consumer, the whole idea of medical billing codes seems obscure and unnecessary. No doubt some coders and billers feel the same way. They wonder what makes the CPT code set so useful.

It really boils down to the idea of translating clinical notes into some sort of shorthand that makes billing and documentation more efficient. If it helps, think of the CPT code set as being similar to the barcodes deployed for inventory tracking purposes. Rather than a big box retailer keeping track of individual products by brand, product type, and category, it is a lot more efficient to assign numbers. Medical codes are similar in that respect.

Medical coders and billers deserve a ton of respect for what they do. In addition to having to deal with tens of thousands of codes across multiple code sets, they also need to have a working knowledge of medical terminology, medical procedures, and legal compliance.

Understanding the CPT code set makes up just a small portion of what is required to be a proficient coder or biller. Mastering it is all in a day’s work for the certified professional.