How Does a CPT Become a Code?

How Does a CPT Become a Code?

Some of the most integral components of medical billing are current procedural terminology codes (CPT codes). In order to understand correct coding practices for medical billing, it is important to understand how a CPT code becomes a code.

The first step in issuing a code for CPT comes in the form of a suggestion. Medical personnel, physicians, and state associations regularly make suggestions to the American Medial Association. After a staff member from the AMA reviews the suggestion, that staff member determines if the issue has already been addressed or if it is a new one that needs to be resolved for medical billing purposes. If that staff member decides the suggestion is currently unaddressed, it is forwarded onto the CPT advisory committee to uphold the integrity of medical billing practices.

Medical billing is a very sensitive procedure that requires the utmost research when developing CPT codes. If the advisory committee decides a medical billing code change should take place, the research begins. Medical Physicians, text books, and periodicals are consulted in order to provide the most accurate information. Without this research, medical billing would not be the exact science it is today.

Once all possible information is gathered, the new procedure is issued a code. Under the Health Insurance Portability and Accountability Act of 1996, these CPT medical billing codes are annually updated and are effective on January 1st of every year. In order to prepare medical billers for this yearly change, the AMA makes CPT books available the previous fall. During the months prior to the codes’ effective date, medical billing companies feverishly prepare their systems for the upcoming changes. These can be some of their busiest days.

Medical billing is not as simple as writing a procedure down and sending it to an insurance company. It is much more complicated. Similarly, creating current procedurally terminology codes is not as simple as assigning a code to a procedure. There are a lot of individuals doing countless hours of research to provide these medical billing CPT codes. The flawless medical billing practices today would not be possible without the seamless implementation system for CPT codes.

View all Articles by: Melissa Clark, CCS-P