How to Use CPT Codes

CPT codes (current procedural terminology) are designed to describe particular services provided to a patient at a medical facility. Use of CPT codes is part of a variety of practices followed by health care professionals to ensure payment by insurance companies. As coordinated billing has become a large part of a medical office's agenda, it pays to know the function of CPT codes and how to apply them to a bill.

Difficulty: Moderate

Instructions

Things You'll Need:

• Patient Bill/Chart
• Up-to-date CPT handbook

1. Get a list of performed services or procedures.

2. Look up each service or procedure in an up-to-date CPT reference book.

3. Enter each five-digit CPT code next to the relevant service or procedure in the specified part of the bill.

4. Send the bill along with an Explanation of Benefits to the insurer's offices.

5. Keep your own record of applicable CPT codes for the bill. Be prepared to offer these to an insurance representative if coverage must be verified.

Tips & Warnings

• CPTs also vary by type of medical service. It might be possible to narrow down your CPT reference materials to the kind of services your office provides, for example, psychological or pediatric. Keep in mind what area of medical services you are looking for when accumulating CPT resources.
• The AMA updates CPTs annually. Make sure your records reflect all current revisions.
• Not all insurance companies are compelled to cover service or procedures described by CPTs. The CPT codes were developed for procedures covered by Medicare. Other insurance companies have their own contracts. Make sure you know each insurer's contract to see if CPT use is relevant.

Resources

• Medical billing information website.
• DocOfficeRx Includes CPT information.

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