Evaluation and management …,.What is the CPT coding Manuel and how it is used and it's importance in insurance billing?

Answer 1

CPT - Current Procedural Terminology - is a manual/ book, produced by the AMA, describing every medical procedure performed in the practice of Medicine, on humans, with an assigned code NUMBER for each.

A CPT code number then describes the procedure in detail: professional component (the part of the procedure that requires physician or provider interpretation) and the technical component (which pertains to the healthcare worker actually performing the procedure, whether it be a doctor or allied health person). These two parts can be billed under one global number, or broken down into two separate numbers pertaining to each part.

The insurance industry assigns a dollar value to each CPT code (a global reimbursement, a professional component reimbursement, or a technical component reimbursement rate), of which the reimbursement amount can vary depending upon the part of the country the test is being performed in - allowing for 'cost of living' [cost of medical care delivery] specific to a 'region' of the country.

And the AMA can change these codes, usually just a few (not all), each year - requiring that each provider purchase a new book each year - however, the internet has negated some of that requirement/expense.

CPT describes the procedure: ICD-10 describes the reason that the procedure is being performed. You can't have one without the other - the insurance claims form requires both - and they must make sense [in other words, you can't order a urinalysis (CPT 81000) with a cardiac arrhythmia code (ICD-10 I49.9).

The facility/provider must assign the codes; the coder merely inserts the codes into the computer billing/claims filing program.