In 1966, the American Medical Association created Current Procedural Terminology (CPT), a national standard code for medical services and procedures that hospitals, doctors' offices and third-party billers (insurance companies) use. First published in 1977 by the World Health Organization, these codes classify diseases by breaking them down into signs, symptoms, findings, complaints, circumstances and external causes and are used for morbidity and mortality reports.
Medical Billing 101 By Vikki Sloviter “It’s Greek to me.” How often external causes and are used for your child’s general assessment have you taken your child to the morbidity and mortality reports. —it will be checked off on the en- doctor and, at the end of the Today, ICD-9-CM codes are a stan- counter form and billed (CPT code visit, handed the receptionist a dard code that hospitals, doctors’ 94760). form that the doctor has partially offices and insurance companies filled out by checking off boxes or use for medical billing. Supplies, Vaccinations: Ad- circling procedures or code num- ditional categories include im- bers? You may have no idea what The Encounter Form munizations, injections, lab work, you’re looking at, why that form The printed form with the CPT and supplies. Not only is the flu is important, or what happens to codes is often called an encounter vaccine that your child received that form after it leaves your hand. form, and essentially describes, last fall billed (90658) but the But you should. in billing terms, what happened administration of that vaccine is during your child’s office visit and also billed (90471). And, if your Generally understanding what the what the office is going to bill the child sprained her wrist and was form—often called an “encounter” insurance company. There are given an arm sling, the sling is form—is and what happens to it usually two or three CPT code billed (A4565). after you leave the office is the categories that the doctor checks first step in understanding how off: the type of office visit, the Diagnosis: Usually on the bot- health insurance works and un- procedure(s) that were performed, tom of the form with CPT codes derstanding how your child’s office and sometimes the supplies given (or sometimes on the back), visit coordinates with your health or vaccinations that were admin- you’ll either see a list of common insurance. And why health insur- istered. diagnosis codes with your child’s ance costs so much. circled, or if there is no such list, Office Visit: One category is the your child’s diagnosis code will be Medical Coding type of office visit your child had written down as a three-to-five CPT codes: In 1966, the Ameri- and how long it was. This category digit number. Some common pe- can Medical Association created is often abbreviated “E/M” on the diatric diagnoses include “eczema” Current Procedural Terminology form, for “evaluation and manage- (692), “postnasal drip” (784.91), (CPT), a national standard code for ment.” The E/M code your child’s “fussy infant” (780.91) and “bron- medical services and procedures doctor checks off corresponds to chitis” (490)—not to be confused that hospitals, doctors’ offices the type of visit your child had. with “acute bronchitis (466) or and third-party billers (insurance For example, if your child is an “asthmatic bronchitis” (493.9). companies) use. established patient (not new) and If your child has any symptom or saw the doctor for about 10 min- condition, there is an ICD-9 code Today there are more than 8,000 utes, the CPT code 99212 would for it. codes to describe almost every be checked off. imaginable service and procedure At this point you’re probably won- that a patient may have performed Procedures: A second category dering why parents need to know during an office visit, and every includes the procedure(s) that about medical billing. If you’ve single one is billable. Every CPT were
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