What is the CPT coding system? What is its purpose? 2. Who publishes the CPT manual? 3. How many digits make up a billable CPT code? 4. How many categories are in the CPT manual? What are the categories and what do they include? 5. How many appendices are in the CPT manual? List them and their special instructions. 6. What are the CPT guidelines? Where are they located? 7. What are Unlisted Procedures/Services? What are they used for? 8. What is the CPT index and how is it organized? What are the main terms present in the CPT index? 9. What are CPT modifiers? List and describe two modifiers from this chapter. 10. In evaluation and management, name and describe the two types of patients.
The Correct Answer and Explanation is:
- What is the CPT coding system? What is its purpose?
The CPT (Current Procedural Terminology) coding system is a standardized system used to document and categorize medical, surgical, and diagnostic services and procedures. Its primary purpose is to provide a universal language for healthcare professionals, enabling them to accurately report medical procedures for insurance billing, data collection, and ensuring proper reimbursement for services rendered. - Who publishes the CPT manual?
The CPT manual is published by the American Medical Association (AMA). They are responsible for updating and revising the codes regularly to keep pace with advances in medical practice. - How many digits make up a billable CPT code?
A standard CPT code consists of five digits. These codes are used to identify procedures or services provided by healthcare professionals. - How many categories are in the CPT manual? What are the categories and what do they include?
The CPT manual is divided into three categories:- Category I: These codes are used for procedures and services that are widely accepted by the medical community. They include most services such as surgeries, diagnostics, and evaluations.
- Category II: These codes are used for performance tracking and data collection purposes. They don’t affect reimbursement but help track the quality of care.
- Category III: These codes are temporary and used for emerging technologies, services, and procedures. They help track experimental or new treatments that are not widely used yet.
- How many appendices are in the CPT manual? List them and their special instructions.
There are seven appendices in the CPT manual:- Appendix A: Modifiers – Lists and explains modifiers.
- Appendix B: Summary of additions, deletions, and revisions – A list of changes made to the manual.
- Appendix C: Patient History Codes – Used for determining the patient’s history when coding.
- Appendix D: Maternity Care and Delivery Codes – Defines specific codes related to maternity.
- Appendix E: Electrodiagnostic Medicine – Codes for neurophysiology testing.
- Appendix F: 2000 ICD-9-CM Code Updates – For older code updates.
- Appendix G: Summary of CPT codes by age, sex, and type of procedure.
- What are the CPT guidelines? Where are they located?
CPT guidelines are specific instructions and notes that explain how to use certain codes. These guidelines help clarify the correct use of codes and modifiers. They are located at the beginning of each section in the CPT manual and are crucial for correct code selection. - What are Unlisted Procedures/Services? What are they used for?
Unlisted procedures or services are used when a specific CPT code does not exist for a procedure or service that a healthcare provider has performed. These are used to report services that are new or uncommon, for which no standardized code is available. They help ensure that the procedure is properly documented for insurance purposes. - What is the CPT index and how is it organized? What are the main terms present in the CPT index?
The CPT index is an alphabetical listing of terms and services covered in the CPT manual. It is organized by main terms such as diseases, procedures, and body systems. The index also includes subterms which further define the procedures. Main terms typically include specific procedures, organ systems, and treatment methods. - What are CPT modifiers? List and describe two modifiers from this chapter.
CPT modifiers provide additional information about a service or procedure, such as alterations to the standard procedure or special circumstances.- Modifier 22 (Increased Procedural Services): Indicates that a procedure required more effort than usual, often justifying an increase in reimbursement.
- Modifier 51 (Multiple Procedures): Used when multiple procedures are performed during a single session, often to indicate that multiple surgeries are done together.
- In evaluation and management, name and describe the two types of patients.
In evaluation and management (E/M) coding, patients are classified into two categories:
- New Patient: A patient who has not received any professional services from the physician or healthcare provider in the past three years.
- Established Patient: A patient who has previously received services from the physician or healthcare provider within the past three years.
