The Current Procedural Terminology (CPT) Codes

properly documented and can be billed to you in the correct manner. Also, another use for medical codes is to protect yourself from false

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.

"Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS." (Aapccom, 2015) It is very important that billing coders have a full understanding of how to properly use medical codes to prevent denial of claims submitted.

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 E/M code's is a big important part in this process. Being a health care professional, using the medical code's. like medicare, medicaid, other private insurance to be reimbursement. If not using the right code, the doctor office, hospital, and urgent care. Will lose a lot of money. So using the right cpt code's insurance companies, office, hospital, and urgent care can be reimbursement correct. Cause CPT code's are formed with 5 digits.

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.

One of the greatest milestones in the United States health system is the use of electronic health records codes to ensure consistency in diagnosis and treatment procedures provided by physicians (Romano & Stafford 2011). The purpose of the case scenario of the sixteen year old female who visits the emergency department is to show how electronic health record coding is done and its impact on health reimbursement. The International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT) codes are brought out well in the case study showing how they help in ensuring physician consistency in coding diagnosis and treatment procedures for the purpose of health reimbursement.

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).

To define the CPT procedural code which is different from the E/M CPT codes, the procedural codes are a type of medical classification that identifies specific surgical, medical, or diagnostic interventions. These are carried out at time of service by the provider.

The Centers for Medicare and Medicaid Services (CMS) requires all providers to implement ICD-10 coding system begin on October 1st, 2015 so the U.S. healthcare system can communicate in the same language as with other countries’ systems. The transition from ICD-9 to ICD-10 had big changes from 14,000 diagnostic codes to more than 68,000 and 4,000 procedure codes to 87,000. The transition affected the reimbursements of hospitals. Medicare requires all patients’ procedures and services to be coded using ICD-10 system while they are charged in CDM using CPT codes. However, there is no direct link between ICD and CPT codes (Jensen, Ward, & Starbuck, 2016). The CDM committee had to work together to prepare for this event. Switching from numerical

She or he also needs to be familiar with how to use the International Classification of Disease (ICD) codes, the Current Procedural Terminology (CPT) codes, and the Diagnosis Related Group (DRG), which is used to reimburse hospitals for inpatient stays. These stays are for patients who may have severe injuries, might need more extensive care, or may require admission for twenty four hours, or longer depending on how severe the severity of his or her diagnosis. The in-patient coder will then assign the accurate codes to the medical diagnoses and treatment plans for the in-patient facilities. Next, the coder will then continue to monitor the inpatient stay and must perform coding services for every day that the patient is in the hospital until being

Coding violations are one of the common ways that health care providers can defraud the Government. Health care provider must enter a numerical “Procedure Code” CPT (Current Procedural Terminology) code or HCPCS (Health Care Common Procedure Coding System) code that matches the specific type of care provided to the patient in order to bill either a government health care program such as Medicare, or Medicaid or private insurance company such as Blue Cross Blue Shield or a for payment.

HCPCs or Healthcare Common Procedure Coding System is used to represent procedures, supplies, products, and services that are provided to Medicare, Medicaid beneficiaries, and to individuals enrolled in a private insurance program. The setting I think you would use HCPCs codes in are Hospitals and in Doctor's Office. I think that would be a common setting in which you would use HCPCs codes because of everything that goes into each and every procedure. The doctor puts a lot of material into each and every procedure.

Coding violations is one of common ways that health care providers can defraud the Government. Health care provider must enter a numerical “Procedure Code” CPT (Current Procedural Terminology) code or HCPCS (Health Care Common Procedure Coding System) code that matches the specific type of care provided to the patient in order to bill either a government health care program such as Medicare, or Medicaid or private insurance company such as Blue Cross Blue Shield or a for payment.

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.).