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Comprehensive Guide to CPT Codes in Medical Billing

Ronnie S

November 25, 2024

CPT Codes

What Are CPT Codes?

CPT (Current Procedural Terminology) codes are a standardized system used in the healthcare industry to describe medical, surgical, and diagnostic procedures and services. Created and maintained by the American Medical Association (AMA), these 5-digit numeric codes are essential for communicating medical services between healthcare providers, insurance companies, and government entities for billing and reporting purposes.

Why Are CPT Codes Important?

  • Standardization: Ensures uniform communication across healthcare systems.
  • Billing Accuracy: Helps healthcare providers and insurers determine appropriate reimbursements.
  • Efficiency: Speeds up claims processing and reduces billing errors.
  • Data Tracking: Useful for quality improvement, research, and healthcare statistics.

How to Look Up CPT Codes

To find a specific CPT code:

  • Use an online CPT Code Lookup Tool or the AMA CPT Codebook.
  • Check the coding software integrated with electronic medical records (EMR).
  • For specific searches, include modifiers and detailed documentation to narrow down results (e.g., “CPT code 99214 description“).

Most Frequently Used CPT Codes and Their Descriptions

Evaluation and Management (E/M) Codes

  1. 99213 CPT Code: A low-complexity visit for an established patient.
    • Usage: Often used for routine follow-ups or minor medical issues.
  2. 99214 CPT Code: A moderate-complexity visit for an established patient.
    • Usage: Includes medical decision-making of moderate complexity.
    • Lookup: “CPT code 99214 description” highlights its use in chronic disease management.
  3. 99203 CPT Code: Low-complexity visit for a new patient.
  4. 99204 CPT Code: Moderate-complexity visit for a new patient.

Mental and Behavioral Health Codes

  1. 90837 CPT Code: Psychotherapy session lasting 60 minutes.
    • Usage: For mental health services like cognitive behavioral therapy.
  2. 90791 CPT Code: Psychiatric diagnostic evaluation.
    • Usage: Initial assessment for mental health conditions.

Preventive Medicine and Vaccination

  1. 99396 CPT Code: Preventive visit for an established patient aged 40-64.
  2. 90471 CPT Code: Administration of a single vaccine (e.g., flu shots).
  3. Afluria Triv CPT Code: For influenza vaccines, specifically the Afluria Trivalent.

Diagnostic and Imaging Services

  1. 93306 CPT Code: Comprehensive transthoracic echocardiogram.
    • Usage: Includes imaging to evaluate heart function.
  2. Echocardiogram CPT Code: General term for heart ultrasound, includes 93306 and others.
  3. 36415 CPT Code: Collection of venous blood by venipuncture.
    • Commonly Used For: Routine blood tests.
  4. CPT Code for Colonoscopy (45378): Diagnostic colonoscopy without biopsy.

Physical Therapy and Rehabilitation

  1. 97110 CPT Code: Therapeutic exercises for strength, endurance, and balance.
  2. 97140 CPT Code: Manual therapy techniques like joint mobilization.
  3. 97530 CPT Code: Therapeutic activities focused on improving functional performance.

Miscellaneous and Emerging Codes

  1. 96372 CPT Code: Injection of drugs or therapeutic substances.
  2. G2211 CPT Code: For prolonged office visits; highlights additional time spent with complex patients.
  3. 96127 CPT Code: Brief emotional or behavioral assessment with scoring and documentation.
    • Usage: Often used in pediatric mental health screenings.
  4. 99205 CPT Code: High-complexity visit for new patients.

How to Use CPT Codes in Medical Billing

To ensure accurate billing:

  1. Verify Documentation: Ensure all procedures are documented in detail.
  2. Include Modifiers: Use modifiers to specify if a procedure was altered or performed under special circumstances (e.g., Modifier 25 for separate E/M services).
  3. Check Medical Necessity: Match the procedure to the diagnosis code (e.g., pairing 99406 CPT code with smoking cessation services).
  4. Stay Updated: Regularly review annual updates from AMA for changes.

Specialty-Specific CPT Code Insights

  • Cardiology:

    • Echocardiogram CPT Code: Critical for diagnosing heart conditions.
    • EKG CPT Code (93000): Used for routine cardiac monitoring.

  • Mental Health:

    • Combine codes like 90834 and 90837 for psychotherapy services.

  • Preventive Medicine:

    • 99396 and 99212 codes for annual wellness checks.

  • Physical Therapy:

    • PT CPT Codes (97110, 97112) are used for rehabilitation and mobility improvement.

How to Look Up Codes Online

  • Use professional resources like the AMA CPT Codebook or coding tools such as CMS Physician Fee Schedule.
  • Search for combinations like “CPT code 96372 description” for more targeted results.

Common Questions About CPT Codes

  • What is a CPT Code?
    • A universal language for documenting and billing healthcare services.
  • Can CPT Codes Be Combined?
    • Yes, but follow the rules for pairing services (e.g., CPT code 90839 can sometimes be used with 90837).

Why Staying Current on CPT Codes Matters

As healthcare evolves, new CPT codes are added, and outdated codes are removed. Understanding and properly using these codes can:

  • Prevent claim denials.
  • Improve revenue cycle management.
  • Ensure compliance with payer regulations.

How Quelin Billing Helps with CPT Codes

At Quelin Billing, we understand how challenging it can be to keep up with the ever-changing CPT codes and their billing requirements. Our team ensures:

  • Accurate Code Selection: We prevent under-coding or over-coding, which can lead to revenue losses or compliance risks.
  • Claims Optimization: Proper use of modifiers like CPT code 99214 with Modifier 25 ensures seamless claims processing.
  • Denial Management: If claims are denied due to incorrect coding, we quickly resolve the issue for you.
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