Current Procedural Terminology (CPT) Codes

We as Coders and Billers should understand the interaction of the CPT procedural codes and the ICD diagnostic codes. The providers receive payment for their service, whether it is an office visit or an operation in the hospital. All services need to be coded for proper payment.

HCPCS (Healthcare Common Procedure Coding System) Level II codes are updated by the Centers for Medicare and Medicaid Services. HCPCS Level II codes are revised annually with implementation in Jaunary of each year. This means that coders have to stay up to date on all changes. Some of the ways coders can stay up to date include: getting updates from the CMS website; consulting with the ASCA website; network with other coders; and consulting local coverage determinations. There are also monthly newsletters published by the AMA called HCPCS Assistant that are considered an official coding resource by the CMS. The medical management software must be kept up to date to ensure the proper codes are being used. A coder should never use an older

There are two trends that I have learned about from UMA and TV. ICD-10 replacing IDC-9. ICD-10 will provide the medical billing/coder with more descriptions for describing encounters and hospital stay for patients. Where ICD-9 had 3,824 procedure codes and 14,025 diagnosis codes, ICD-10 on the other hand, has 71,924 procedure codes and 69,823 diagnosis codes that is a big difference. The affordable care act also made an impacted on billing/coding since more people are getting procedures done. These procedures will need to be coded and documented for doctors and hospitals to get paid.

This standardized dialect is also pertinent for medical schooling and teaching in addition to clinical research and studies conducted by scholars, scientists, and physicians by providing a valuable foundation for domestic and coast-to-coast operation evaluations. CPT is used to describe doctor’s services, a vast amount of administrative services in addition to operating services executed in medical facilities, treatment care centers, and outpatient divisions. Providing support for clerical duties and functions such as processing medical claims and initiating strategies and procedures for the evaluation of clinical care is another cause of relevance for CPT. The system also meets the need for tracking trends and identifying improvements, plus progression goals and scaling the value of healthcare services received by patients. The CPT coding system provides physicians throughout the United States with a consistent method for classifying and coding clinical procedures which in return provides a more efficient tool for recording and reporting task that were completed. Physicians, scholars and payors, have been dependent upon CPT to interconnect with other fellow associates, patients,

The Joint Commission defines the Periodic Performance Review as an assessment tool created to assist health organizations improve and monitor their performance throughout the year. This tool focuses on the processes that influence patient care and safety while providing the structure for unremitting standards fulfillment. Nightingale Community Hospital is compliant with most standards as set forth by the Joint Commission. However, upon inspection and in an effort to stay focused on compliance, our standards committee has located a few discrepancies that must be resolved to maintain our accreditation with the Joint Commission.

The Joint Commision (a not-for-profit) is known as a symbol of quality for performance standard in hospitals and organization in the United States. Their purpose is to accredit and certify that nearly 21,000 health care organization are providing safe and effective care. If a hospital or organization chooses to maintain their accreditation they are provided with a manual which includes a list of chapters such as, the environment of care, leadership, provision of care, treatment and services, life safety, and information management. In each chapter, it describes specific standards/requirements that must be met to maintain compliance. The Joint Commission also addresses health record documentation standards and elements that include, legibility,

The joint Commission is a united State established in 1998 as a division of Joint Commission resources. The foundation is a nonprofit tax, exempt it has 501 institutions. It assigns more than 20,000 health care organizations it improves health care for the public. Many states recognize Joint Commissions as a condition of licensure and the receipt of medical reimbursement. The Joint Commission came up with the “do not use list” to help reduce mistakes of getting the medicines mixed up. The special one day summit brought together members with more than 70 people certified in that field; they discussed medical error associated with the misuse and baffled abbreviations, acronyms and symbols. There are various reasons why health care professionals

Current Procedural Terminology (CPT) is published by the AMA and updated yearly. This terminology was devised to have a standard language of defining medical and surgical procedures for billing purposes. Insurances use this information to evaluate and decide on the proper amount of reimbursement (Wager et al., 2009).

P&T committee is a medical staff committee that is composed of physicians from various specialties. The committee has a family practice physician, cardiologist, hospitalist, pediatrician, obstetrician, nephrologist, orthopedist, an infectious disease physician, a nursing representative, microbiology representative, emergency room physician and a pharmacist.

An accurate and specific documentation of universally accepted set of codes are important for the protection of healthcare providers as well as increased reimbursement for services received. These codes are for the validation of which services the patient received from their health care provider ( (Page, 2009). Having the correct codes in place insures the provider with the information needed by the health insurance carrier. Maintained by the AMA (American Medical Association), this universal numeric assignment is also used for developing guidelines for medical care review as well as data collection for medical education and research (Scott, 2013).

When looking at the role of the Joint Commission their mission comes to mind; they state that their mission is to constantly improve health care for the masses, while considering connections with stakeholders, by looking at the health care organizations and compelling them to strive to give safe and effective care of the greatest quality. Though this is their overall mission they update their standards every year (The Joint Commission, 2016). These updates may add a new safety feature or amend a current safety feature or staffing problem or even looking at the sound system in a hospital (The Joint Commission, 2016). The whole role of the commission in giving these accreditations out is to ensure that hospitals are providing the utmost care

The Priority Focus Area of Communication includes 3 Joint Commission (JC) standards relative to Universal Protocol. These 3 standards, which are components of the National Patient Safety Goals, are aimed at ensuring the correct

The outmoded coding professional’s role was to describe and apportion diagnosis, procedure, and other medicinal service codes using ICD-9-CM and HCPCS/CPT coding classifications while referencing the Coding Clinic for ICD-9-CM, Coding Clinic for HCPCS,

For established patients receiving evaluation and management, providers may bill for these services using the CPT codes 99212, 99214. Choosing the correct code depends on the patient’s history, examination findings, and decision-making complexity. If complexity is found to be straightforward taking the provider less than 10 minutes, the billing code will be 99212 (Engle, 2014). If the history and examination findings result in moderate decision-making complexity, requiring more time from the practitioner and more diagnostic procedures the billing code will be 99214 (Engle, 2014). While, Ms. Trinidad does not encounter established patients in the emergency department, within my clinical hours, Ms. Rossow encountered several established patients of various levels of complexity. The billing code 99212 is appropriate to use for patients with low complexity, such as one of Ms. Rossow’s patients whose visit was due to elbow pain after a fall a week ago. Mrs. Rossow also managed the care of patients with a higher level of complexity such as a middle-aged male with a history of recent prostate cancer and a chief complaint of abdominal pain and fever.

specialist determine the ICD, CPT or HPCS coding. The coder or biller may have to communicate with the healthcare provider if there are any questions on any of the diagnoses, treatments or duration of the office visit (Dietsch, 2011). Because insurance companies are very strict on correct medical billing and coding, a small mistake can cause the insurance company to deny the claim and will then require the doctor to fix the error and the claim will need to be resubmitted (Cocchi & White, n.d.).