CPT Code Basics: What You Need To Know

by  Find-A-Code™
Jan 23rd, 2023

It was 1966 when the American Medical Association (AMA) created what is known as the Current Procedural Terminology (CPT), the set of medical billing codes to be used by healthcare providers, facilities, insurance companies, and others to communicate regarding medical procedures and services. Today, CPT codes are not only still in use, but they are also among the most widely used in the industry.

Anyone hoping to get into medical billing or coding as a career will need to become familiar with CPT codes. They come with the territory. Fortunately, coders and billers do not have to memorize all the codes. With thousands to deal with, a coder or biller sometimes needs to look them up.

That being said, medical coders and billers at least have to be familiar with CPT structure. They need to be familiar with things like the fifth alpha characters some codes carry. Those extra characters are A, F, T, and U, and they mean something specific.

CPT Category Types

CPT codes are divided into three categories to make things a bit more organized. They are Categories I, II, and III. As you might expect, Category I is the largest group of the three. It is the most commonly used as well. It designates the most common services and procedures physicians, hospitals, and healthcare clinics bill for.

Category II is considered a supplemental category that is related to performance tracking. Finally, Category III is related to experimental and emerging services and procedures. The codes in this category are temporary by design. They are the least used of all three types.

Category I Sections

To organize things even further, all the codes in Category I have been divided into six sections. Each section relates to a particular type of procedure or healthcare service. Here they are:

●    Section 1 (99202–99499) – Evaluation and management services
●    Section 2 (00100–01999) – Anesthesiology services
●    Section 3 (10021–69990) – Surgical services
●    Section 4 (70010–79999) – Radiological services
●    Section 5 (80047–89398) – Pathology and lab services
●    Section 6 (90281–99607) – Medicine services.

Things can get somewhat confusing when you're dealing with surgical services. This particular section is further distilled into additional subsections or groupings. The idea is to make the codes as specific and detailed as possible so as to ensure that the right procedure or service is reported.

Knowledge and Training Are Key

It goes without saying that being a successful medical coder or biller requires both training and knowledge. As previously stated, coders and billers don't have to memorize all the CPT codes currently in use. Doing so would be nearly impossible anyway. However, it does help to have at least some knowledge outside of the codes themselves.

For example, it is often recommended that medical coders have a basic understanding of human anatomy. Why? Because the same procedure could have different codes for different anatomical features. The coder or biller needs to be able to take the notes recorded by a physician and code them correctly by body part. Not having a decent knowledge of anatomy makes this part of the job more difficult.

CPT codes were introduced by the AMA in order to standardize medical service and procedure reporting. On occasion, the AMA updates the codes or their nomenclature. As such, learning never ends for the professional coder or biller. Medical billing codes are constantly evolving to accommodate the current state of medicine.

If you have been thinking about getting into medical billing or coding as a career, bear in mind that you'll have to become familiar with CPT codes. But don't sweat it. You'll get used to them.