Current Procedural Coding, Research Paper Example

Abstract

The Current Procedural Coding manual is the technical procedural coding system used by physicians and health care providers such as hospitals, outpatient services that allows for proper classification in reporting medical services. It has six main sections that are divided into subsections with anatomic, procedural, conditions or descriptors. The procedures and services are identified by their numeric code which is a five digit number and are in numeric order with one exception Evaluation and Management.

Current Procedural Coding

The components of the Current Procedural Terminology (CPT) includes several sections. First is an introduction, which explains how to use the CPT system. This is followed by the main sections of the CPT, which consists of five-digit codes. There are then Category II codes, which apply primarily to performance measurement of the quality of care; these are optional codes. Category III codes are used for emerging technology, and tend to be temporary for services that have not yet been assigned a permanent codes. These codes are four numbers followed by a letter. Finally, the CPT has a series of appendixes for modifier descriptions, examples, and other useful information (CPT Manual, 2011; Smith, 2006).

In the main coding section, the Evaluation and Management section (99201-99499) appears at the beginning of the listed procedures in the CPT manual. The reason is that this section is the used most by physicians and other healthcare providers in reporting large portions of their services. The Evaluation and Management (E/M) section includes a wide range of categories such as office visits, hospital visits and consultations. These categories are then divided into two or more subcategories of E/M services (CPT Manual, 2011). In the E/M section an office visit for a new patient would be coded as 99203 and an established patient would be codes as 99213(Astro, 2011). A child’s preventive care visit would be 99393 (Hughes, 2011). These codes are always a five digit number with no alternative variation. This leads to more consistency when working with CPT diagnostic codes.

The next section in the CPT manual is Anesthesia (00100-01990, 99100-99140). This section has four main classifications, General, Regional, Local and Monitored Anesthesia. General Anesthesia is used when a patient needs to be put into a deep sleep, such as open heart surgery or abdominal surgery. Regional Anesthesia is used for such procedures as an epidural, spinal block, nerve block. It used when a specific area needs to be numbed and the patient is still conscious. Anesthesia is generally reported by location on the body, with anesthesia of the lower leg as a code 01462 to 01522 and anesthesia for burn excisions being 01951 to 01953.

The Surgery section is the largest section of the CPT manual. It is has several different subsections as it relates to the different body parts. Codes go from 10021-69990. For example, debridement of extensive eczematous or infected skin of up to 10% of the body surface is a code 11000; each additional 10% is a code of 11001. A colonoscopy might be coded as a 45378 (depending on specifics of the procedure).

Radiology (70010-7999) codes are used when tests such as ultrasounds, MRI, x-rays or any other diagnostic imaging tests are needed. Imaging of the digestive system is coded in the range of 74000 to 74363. A consult on an X-ray which does not charge for an office visit would be code 76140.

Pathology and Laboratory (80047-89398) are performed by a physician or technologist under the supervision of a responsible physician. These codes are used from tissue sampling to testing organs for disease. For example, drug testing codes are 80100 to 80103, and urinalysis testing ranges from 81000 to 81099.

The last section to discuss is Medicine (90281-99199, 99500-99607). These codes are used to identify serum globulins either extracted from human blood or genetic globulin products created in a laboratory. They are used for vaccines for immunization purposes, and psychiatry services. For example, a code for biofeedback might be either 90901 or 90911. Hypnotherapy would be covered by 90880. Initial patient assessments might be coded 96150 (Miyamoto, 2006). Vaccinating a girl for HPV involves a series of codes, including 90649 for the vaccine itself, and 90460 to administer it to the girl (Hughes, 2011).

For correct coding, the key steps are:

• Determine the category of the service and the subcategory, based on both the location of the service and the status of the patient;
• Determine the extent of the patient history that is available in the patient documentation;
• Determine the extent of the medical examination that is documented;
• Determine the complexity of the medical decision-making that is documented in the record;
• Analyze the requirements so the service level can be properly reported;
• Note the nature of the symptoms that the patient presents with and the amount of time spent with that patient;
• Confirm that the medical documentation is complete;
• Assign the appropriate CPT code.

Understanding how to properly code services is essential. Studies show that when proper coding has not been followed, mistakes as often under-report services as over-report them, and thus health care practices and centers that do not carefully monitor their CPT coding will be less competitive and less viable economically (Vonderheid, Pohl, Tanner, Newland & Gans, 2009; Martin, 2011)

References

Astro (2011). Evaluation and Management. Web. Retrieved from: http://www.astro.org/HealthPolicy/RadiationOncologyCoding/CodingFAQ/EvaluationAndManagement/index.aspx.

Abraham, M., Ahlman, J. T., Boudreau, A. J., Connelly, J. L., Evans, D. D. (2010). CPT 2011: Standard Edition. Chicago, IL: American Medical Association Press

Hughes, C. (2011). CPT update for 2011: Immunizations, observations and more. Family Practice Management, 18(1), 5-8.

Martin, V. (2011). 2011 coding changes. What you need to know to maximize reimbursement to your practice. Medical Economics, 88(1), 36-40.

Miyamoto, R. E. (2006). Billing effectively with the new health an dbehavior current procedural terminology codes in primary care and specialty clinics. Journal of Clinical Psychology, 62 (10), 1221-1229.

Smith, G. I. (2006). Basic CPT/HCPCS Coding, 2006 Edition. Chicago, IL: American Health Information Management Association. Retrieved from: http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_009346.pdf

Voonderheild, S. C., Pohl, J. M., Tanner, C., Newland, J. A., Gans, D. N. (2009). CPT coding patterns at nurse-managed health centers: Data from a national survey. Nursing Economic$, 27 (4), 211-220.