All about cpt medical coding and certification

CPT or Current Procedural Terminology coding is an expansive medical code set that is set forth and regulated by the American Medical Association. CPT codes are used by medical professionals to describe evaluations, tests, surgeries and other procedures that are done on patients. The code set is large and contains thousands of medical procedures. CPT codes are used in medical billing to explain to insurance companies which specific procedures patients have undergone. The codes are used by medical professionals to explain to insurance companies what procedures they should be reimbursed for. Medical facilities also use these codes to evaluate the efficiency of staff and departments within their jurisdiction.

CPT Medical Coding Categories:

CPT codes are five characters long, either numeric or alphanumeric. The specific letter or number of the code depends on the category that the code belongs into. There are three categories of CPT codes. Category I is the most commonly used set of codes and describes most of the procedures that a patient may undergo in a doctor’s office or hospital facility. Category II are tracking codes that are used to gauge and manage performance. Category III includes temporary codes that describe a number of experimental services and procedures.

Working As a Certified CPT Medical Coder:

The United States Bureau of Labor Statistics states that jobs pertaining to CPT medical coding are expected to increase over the next few years. In fact, the need for medical coders is expected to increase by at least 22 percent in the next six years. Those working in the field typically have some sort of higher education and must pass a certification test. Certified medical coders master not just CPT codes but also ICD-10-CM and HCPCS Level II. Those interested in pursuing a career in CPT medical coding are typically required to show strong evaluation and management skills, have some knowledge of surgical coding and are required to adhere to coding guidelines set forth by the American Medical Association. Many facilities prefer to hire certified coders, so having coding certification is a competitive edge.

Gaining CPT Certification:

Working in CPT medical coding can be as simple as gaining certification, although there are a few steps to being certified. There are however, several levels of certification. The AAPC or American Academy of Professional Coders offers certification in billing and coding for CPC, which is a Certified Professional Coder. The examination for this certification consists of CPT application, HCPCS procedure and diagnoses codes that are typically used in billing services. CPC applicants must possess at least two years of medical coding experience prior to certification and they must maintain yearly renewal requirements.

Specialty Coding Certification – CPC-H

Certified Professional Coder – Hospital certification is also available. A CPC-H applicant must successfully pass an examination that includes questions about CPT as well as ICD-10-CM diagnosis as well as procedure codes that are used in medical billing. Two years of experience in coding is required for certification, including yearly renewal requirements.

Specialty Certification – CPC-P

A CPC-P or Certified Professional Coder – Payer is someone who has successfully demonstrated that they can adjudicate provider claims properly. Certification in this field requires knowledge of the payer environment and the coder must possess no less than two years of coding experience which includes CPT, ICD-10-CM or HCPCS. Specialty credentials are also offered and include certification in dermatology, anesthesia, emergency room, cardiology, internal medicine, urology, orthopedics, cardiovascular and various specialties.

CCS-P Certification:

A CCS-P or Certified Coding Specialist – Physician based is a coder who possesses expertise in doctor’s offices, group practices or specialty centers. This medical coding specialist may review records for patients and typically has knowledge of numeric codes required for physician based diagnosis and procedures. The CCS-P typically also has knowledge of data integrity, health information documentation and quality.

CPT Codes From a Patient’s Perspective:

Patients may want to check the codes on their billing statements. Unfortunately, there is not a list of CPT codes available, as the American Medical Association owns the rights to those codes. There are a few third parties that offer lists of the codes, but there is typically a hefty charge to access that list. An insurance company’s benefits department may offer a list of preventive CPT codes that patients can use to ensure that they are being charged for the proper procedures. The AMA does offer a code search for CPT codes, although free registration is a requirement before accessing the code list.

Using Codes For Billing Disputes:

Sometimes, a patient may be billed for a procedure that was not performed. This is where having access to CPT codes can come in handy. If, for instance, a patient is charged for bloodwork that was never ordered or performed, and the CPT code for that bloodwork is on the billing statement, that patient may be able to dispute those charges with the medical facility or their health insurance company to avoid paying for a procedure that was not actually performed. Insurance companies also regularly use CPT codes to dispute billing from medical providers for patients in the event that those patients did not actually receive a specific test or treatment.

The Need For Codes:

Many argue that CPT medical coding is too complex and that the process may cause problems within the billing system. Most agree, however, that these codes are necessary to ensure that patients and insurance companies are not paying for procedures that have not been provided. There are literally thousands of codes in the system, and these codes make it much easier for healthcare providers and insurance companies to stay informed about what particular testing and diagnosis a patient has received. Without those codes, it would take much longer to update patient files and for insurance companies to verify that a particular procedure was performed and for that company to pay the medical facility for patient treatment. Medical coding is a process that has been years in the making and is something that will change as more and more medical procedures are developed.