All about CPT Codes and Its Role in Medical Billing

Current Procedural Terminology (CPT) is a set of numbers assigned to certain tasks and services that a medical practitioner provides to a patient. And this includes medical, surgical, and various diagnostic services. The codes are important factors for tracking and billing purposes. They are specifically used in Radiology Billing by insurers to determine the amount of reimbursement that the practitioner involved should receive for the certain service provided.

Understanding the CPT Codes

The CPT code is a set of unique five-digit numbers that are assigned to various actions. Others may be alpha-numeric too, depending on which category they fall into. Some are used more frequently than the others. The CPT codes are developed, maintained, and copyrighted by the American Medical Association (AMA). These codes are designed in a way for it to be flexible for future revisions.

More and more codes are added to the list as newer medical and diagnostic services are introduced. Older codes are revised and some that were never used are discarded. To date, there are thousands of CPT codes in use and are updated regularly and many of them are for Radiology Billing Service.

Where CPT Codes Appear

The CPT codes are usually found on the discharge paperwork, hospital or medical services bills, as well as on the printout of the explanation of benefits (EOB) from the payor. CPT codes are assigned to different categories:

  • Category I – for procedures, services, devices, as well as drugs used.
  • Category II – for measuring the quality of care provided.
  • Category III – includes services and procedures that use emerging technology
  • PLA Codes – alpha-numeric codes used for lab testing.

How CPT Codes Are Used

The CPT codes greatly affect the processes of a Radiology Billing Company. It plays a huge factor in determining how much a patient will still be paying for the medical care received. The CPT codes are usually found in the different documents provided during your healthcare experience.

Why You Should Be Aware of CPT Codes

Some people are more interested to know about the CPT codes mainly because they got curious about it as seen on their doctors’ or insurance billings. If you want to know what the codes are in your medical paperwork, the easiest way is to get in touch with your doctors’ office. The clerk will be able to help you match the CPT codes with the services that you received. You can also contact the billing department of your payor and they can help look that up for you.