CPT Billing Code

What is a CPT Billing Code?

CPT Codes are codes that you and other medical professionals and laboratory personnel use to document the medical services and procedures you provide to patients. CPT stands for Current Procedural Terminology, and the five-digit codes are recorded by medical billing specialists who process laboratory billing claims. Each unique code corresponds to a designated service, translated into a numeric, or alphanumeric code, depending on the procedure or service. CPT codes are divided into three different categories, simply named Category 1, Category 2, and Category 3.

Category 1 CPT Codes

Category 1 CPT codes correspond to specific procedures and services offered by medical providers and laboratories. Many medical coders focus on and most frequently use these codes because it’s one of the more important categories of the three. Category 1 is divided into six different sections, which consist of the following:

    • Evaluation and Management
    • Anesthesiology
    • Surgery
    • Radiology
    • Pathology and Laboratory
    • Medicine

Smaller details or services are also documented and coded. For example, extra materials used, such as sterilization or drugs could be coded. Along with codes, come modifiers. Modifiers are two-character extensions (usually numbers) added to the end of a CPT code to provide additional information about the services or procedures. These modifiers are essential to successful laboratory billing because they provide details that insurance companies need to approve claims.

Category 2 CPT Codes

Category 2 CPT Codes record extra information provided by you. These codes never replace Category 1 or Category 3 codes; they simply provide supplemental information. For example, extra recorded information could be in regard to patient management, patient medical history, and follow-ups. There are numerous details you could include with Category 2 CPT codes, but those are just a few examples. In Category 2, the alphanumeric codes always end in “F,” to ensure they are categorized correctly. These (and all the codes in the other categories) are organized in very specific classifications based on the information or details given by providers.

Category 3 CPT Codes

The last category, Category 3 CPT Codes, are designated for new and developing technologies and services. Category 3 is made up of temporary codes for emergent and experimental services. They help track the best emergency medical procedures for health services and the government. Many of the Category 3 codes eventually get reclassified as Category 1, but only after the CPT Editorial Panel approves the codes. The codes in Category 3 are alphanumeric codes that always end in T.

Many of the codes within these three categories are continually updated, revised, and even discarded if they’re not used or relevant. To ensure you receive the maximum reimbursement for services provided, you need knowledgeable laboratory billing specialists who stay current on changing CPT codes and understand the importance of accurate coding.

The certified medical billing specialist at Medcare MSO specializes in the unique aspects of laboratory billing and changing CPT codes. Accurate and timely billing practices are essential for labs, and our services are tailored to each client to ensure maximum reimbursement and success.

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