How to use CPT Codes for medical billing? - I-conic Solutions

How to use CPT Codes for medical billing?

The American medical association has laid down various ways to simplify the tiring and complicated way of medical billing. These codes are updated every year by the association in collaboration with different medical specialties. These codes are very important when it comes to helping the payers identify the type of services they have been provided. It helps the users know of the exact amount they have to invest after their claim is taken under consideration. The updates provided by CPT Medical coding also help the facilities keep a track of the new services introduced every year.

What do you mean by CPT Codes?

Five digit numeric or alphanumeric modifiers which are also known as CPT codes keep a track of each and every task or service that healthcare services provide.The CPT codes are useful to both payers and providers to maintain a record of the services given and taken care of. Over the time, these codes have proved to be of great help to resolve disputes related to bill related problems amongst the payers and healthcare providers.

What are the various types of CPT codes?

  • There are a total of three categories of CPT codes which are further broken down into various sections.The first category includes codes given to medical procedures, services, vaccines, drugs,etc. The next category includes codes keeping a track of performance records and quality of care provided by healthcare facilities. The third category deals with the temporary codes that are assigned to new procedures or technologies. 

Is it easy to find a CPT code?

Keeping the codes for evaluation and management aside, other CPT codes are recorded in the CPT code book in mostly numerical order. These codes are updated yearly by the American medical association in collaboration with other healthcare service providers. The codes of evaluation and management are written in the front of the codebook for easy access. Usually, these codes are used in physician’s offices to maintain a report on the number of their services. So to sum up, it is not entirely difficult to find CPT Medical codes. The AMA has made sure that medical facilities as well as payers have a track of the codes to their services in case of need.

Procedure for submission of CPT Medical codes

If an office is using primitive methods then the CPT medical codebook comes in handy while jotting down the codes but if your organization uses various software then it is quite easy to type the services and get access to the codes assigned to them on click of a finger.

Even though these are the steps mostly included, the billing process might vary in several ways keeping the healthcare services in different slots.

Firstly, the CPT Medical coding staff is handed the medical documentation by the healthcare service providers. The coding staff rechecks the service provided and forwards the claims to the insurance company for further investigation. 

It then comes under the responsibility of the insurance company to review the services and claims to provide advice to their clients regarding the amount of payment to be done finally.

After going through all of these reviewing and testing processes, the insurance company moves forward with the claims and initiates the payment process.

How to prevent incorrect CPT Medical coding

It is essential that one keeps in mind that there is no substitute for coders except for reviewing all provider documentation related to coding and rechecking them before selecting the appropriate codes.

The CPT medical coding process can prove to be a tiring and difficult process unless the coders are experienced and qualified enough. They should be updated with the new codes and have a track of the changes to ensure a smooth billing process.

The place of service (POS) codes also play a crucial part in preparing the claims. It is quite important that the providers along with the insurance company are aware of the place of service as it becomes easy for them to maintain track of the services provided by that particular healthcare organization. It helps the coders to enter correct CPT medical coding for services provided.


Medical billing is definitely regarded as one of the most complex and rigid billing processes, but it is quite necessary for the payers and insurance companies to be aware of the consequences of incorrect CPT medical coding. Any sort of discrepancy in medical billing codes will end up costing more than necessary to the payer or sometimes the healthcare authorities.

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