Description of the CPT Coding System – Health System Example

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"Description of the CPT Coding System" is an interesting example of a paper on the health system.   Current Procedural Terminology (CPT) is a system of coded numbers that are allocated to medical practitioners. CPT helps insurers establish the amount of reimbursement to give to a practitioner. However, this does not mean that the amount of reimbursement is the same for each practitioner based on their CPT. When a physician fills the claim form, the insurance company is the one to decide on how much fee to reimburse. Insurance companies then calculate the reimbursement fee based on the physician’ s expertise, time, and risk involved in the medical procedure, based on the company’ s plan.                       In 1966, the association of medics in America first published CPT containing surgical codes, for physicians.

It is the responsibility of the association of medics in America to develop and maintain CPT codes. Initially, it was mainly for surgery, but today the scope of CPT has widened. CPT codes are usually revised on a yearly basis by editorial panels of physicians, to keep up with changes in the medical field.

This means the introduction of new codes and the elimination of those codes that are no longer in use (Falen, Noblin & Ziesemer, 2010). Currently, the CPT book has major six sections.                       Evaluation and management (E/M) deal with reporting of evaluation done by a physician on an outpatient. The physician fills a billing form indicating the time, skill, and knowledge applied in attending to the patient. The E/M section describes the location where the service was provided, the type of service rendered, type of patient, and the specific care given to the patient.                         On anesthesia, the physician in charge needs to describe the specific section of the body on which anesthesia was administered and the average time spent.

This time ranges from pre-anesthesia to post-anesthesia. The physician may be required to allocate modifiers to anesthesia codes, in order for the insurer to understand the patient’ s condition better. It also tells the time it took the physician to provide the service.                       Concerning surgery, the surgeon is required to fill the billing form explaining the exact services rendered to the patient right from pre-operative to post-operative care.

The surgeon fills in the amount of time spent in all these stages, the skills required and the risks faced.                       On radiology, a radiologist is required to file a report on all the activities they carried out, findings, and interpretations ( Lindh et. al, 2009). This may include information on the number of views, the type of view, and any difficulties experienced while conducting the test. This will make it easier for the insurer to understand the radiologist’ s work and reimburse them accordingly.                         Billing of laboratory and pathology repayment requires evidence to show the need for the medical procedure.

A pathologist is reimbursed based on how intensive the procedure was and on the amount of body that the procedure was performed. Both the laboratory technologist and the pathologist have to show the specimen on which they conducted the test.                       All patients at a health facility should have medical records. A physician attending a patient should have the latter’ s medical report in order to understand the patient's history. In order for a physician to be reimbursed, they need to show the patient’ s registration record or in its absence, a fact sheet.

This will prove to the insurer that the patient did in fact visit the health facility.        

References

Falen, T., Noblin, A., & Ziesemer, B. (2010). Learning to Code with CPT/HCPCS 2011. New York: Williams & Wilkins.

Lindh, W., Pooler, M., Tamparo, C., & Dahl, B. (2009). Delmar's Comprehensive Medical Assisting: Administrative and Clinical Competencies. New York: Cengage Learning.

Torrey, T. (2011). What Are CPT Codes? Retrieved 30th May 31, 2012, from about.com. Patient Empowerment.

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