CPT codes are the basic form of an encoded language that describes the procedures and services performed by medical professionals. These codes are all specific to a particular form of care that the patient receives, making it easier for hospitals, patients and insurance companies to understand what diagnosis was made and the procedures that were taken.
Function
CPT Codes stand for "Current Procedural Terminology" as used by the American Medical Association. It sets similar terminology for all facets of the medical profession in surgical and diagnostic services. It communicates information about services and procedures in a uniform fashion. Physicians, coders, patients and insurance companies all use the same terminology in order to better identify the services and procedures that are being performed or have taken place.
Features
CPT codes are known as Level 1 of the Healthcare Common Procedure Coding System. The remaining levels of the coding procedure are left to performance management and emerging technological considerations. When a patient's care is delivered, the nurses, doctors and administrators use specific words and abbreviations to define what service and procedures have been performed. When future medical personnel and insurance agents look at the files, they are able to easily identify what occurred and what actions were taken. This has streamlined the entire process of healthcare.
Significance
Established in 1978, the Healthcare Common Procedure Coding System was the first to provide standardized coding within the health care industry. It was deemed necessary by health insurance providers such as Medicare and Medicaid to ensure claims were processed consistently and orderly. The coding system was initially voluntary, however, with the Health Insurance Portability and Accountability Act of 1996, the coding procedures were implemented nationwide as a mandatory practice.
Considerations
Every year, the CPT codes are reviewed and renewed by the CPT Editorial Panel. This panel is a wing of the American Medical Association and makes any changes to the coding procedures or codes used themselves. Many advisory groups are set up throughout the course of the year in an effort to analyze the codes in place and observe to see if changes are necessary. This creates a situation in which nurses and coding administrators must continue to stay abreast of the changes.
Effects
Some observers of the healthcare industry have complained that these coding procedures have merely increased the costs to patients and insurance companies. Although streamlining the paperwork, specialized coding nurses and administrators need to be hired in medical facilities to ensure the procedures are being followed. In addition, insurance companies have staff to confirm the proper codes are being used for billing purposes. Many believe that this system is inefficient and could be more easily implemented.
Tags: insurance companies, coding procedures, patients insurance, patients insurance companies, American Medical, American Medical Association, Coding System