CPT CODINGCPT编码.ppt

CPT ICD-9 CODING Debra Dockter NP-BC Objective of Coding Provider - To prepare a standardized “bill” for services given to a patient. Payer - To determine the amount to be paid to the provider. Definition CPT (current procedural terminology) Codes - are numbers assigned to every task service a medical practitioner may provide to a patient. includes: medical surgical diagnostic services *Used by insurers to determine the amount of reimbursement a practitioner will receive from the insurance company. CPT Codes Developed, maintained, and copyrighted by AMA (American Medical Association) New codes are developed for new services, current codes may be revised, old unused codes are discarded annually. *The exception: Medicare patient CPT Codes Examples 99201 a physical exam 90658 flu vaccination 90716 chicken pox vaccine (varicella) 12002 laceration repair *Service reimbursement will vary according to medical provider and insurance company. 3 Key Components for CPT Coding Necessary components needed for billing a patient visit : * History of problem(s) * Exam related to problem(s) * Medical Decision These components are determined by: Evaluation Medical Decision Making *Great resource: Evaluation Medical Decision Making The levels of E M services are based on 4 types of examinations: Problem Focused Expanded Problem Focused Detailed Comprehensive Patient Criteria for E/M I. Patient Type: New No professional services in the last 3 years. Patient Type: Established Maintained professional services in the last 3 years. Billing for Problem Focus Visit Problem Focus Visit – presenting problem self limited or minor, the provider will spend 10 minutes face to face with the patient and/or family. New patient visit CPT