Healthcare Business DEMYSTIFIED

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What is a CPT code?

Very often on medical billing documents you will see something called a CPT code.  It often shows up on the Explanation of Benefits (EOBs) and many people wonder what it is.  CPT is short for Current Procedural Terminology.  Every office visit, procedure and lab test done in the doctor's office has a CPT code.  It is a way to standardize each service provided and make sure that we are all talking about the same thing.  Each CPT code has a brief description so that the doctor's office can properly identify the correct code for what they did for the patient.  The CPT code is how the doctor's office  communicates to the insurance company what was done for the patient.  As an example, most physician offices use a series of CPT codes for office visits.  There is one set for new patients and one set for established patients.  The office visit codes have multiple levels of service as some visits are straight forward and problem focused (99211) while others may be complicated and require a high level of attention and diagnosis (99215).  If a patient presents with a number of chronic diseases and has a variety of problems (as often seen with the elderly) the office visit will require a high level of decision making.  Often an extended list of medications need to be reviewed and adjusted.  These type of visits can often take an extended amount of time and are extremely complicated.

A Sampling of CPT codes used in the Physician's Office

99201 New Patient Level 1 Office Visit  
99202 New Patient Level 2 Office Visit  
99203 New Patient Level 3 Office Visit  
99211 Established Patient Level 1 Office Visit  
99212 Established Patient Level 2 Office Visit  
99213 Established Patient Level 3 Office Visit  
99386 New Patient Preventative Medicine Visit Age 40-64years  
99387 New Patient Preventative Medicine Visit Age 65 and over  
80061 Lipid Panel  
90471 Vaccine Administration  
90716 Varicella vaccine  
99381 New Patient Preventative Medicine under 1 year of age  
99382 New Patient Preventative Medicine Ages 1 to 4  
99393 Established Pt Preventative Medicine Ages 5-11  
99394 Established Patient Preventative Medicine Visit Age 12-17yrs  
93000 Routine ECG  
82948 Glucose, blood, reagent strip  
87086 Urine Culture  
86580 TB skin test  
94640 Inhalation treatment