CPT codes (Current Procedural Terminology) are found and used in various paperwork and documentation as we transition through any healthcare experience. Once you understand what CPT codes are, and how they are used to determine everything from your diagnosis to the cost of your healthcare, then figuring out what the particular codes used for your care can be useful.
What Does a CPT Code Look Like?
A CPT code is a five digit alphanumeric code with no decimal marks. Most CPT codes consist of 5 numbers. Some are used frequently like 99213 or 99214 (for general check ups). Some CPT codes may have a letter at the end of them, using 4 numbers and one letter.
Patient Paperwork - Where to Find CPT Codes
- As we leave a doctor's appointment, check out of the hospital, or any other medical facility, we are handed paperwork that, to the professionals, is a numeric summary of the services they provided to us. The five character codes are usually CPT codes.
There are other codes on that paperwork, too. Some may be ICD codes, which may have numbers or letters and usually have decimal points. If you are curious about codes with decimal points, check out ICD codes.
If you use Medicare, those codes will be called HCPCS codes, but for patient purposes, the codes are the same.
- When we receive a bill from the doctor, before or after it has been sent to our payer (insurance or Medicare), it will have a list of services. Next to each service will be a 5-digit code. That's the CPT code.
- When we receive an EOB, Explanation of Benefits, from our payer (insurance, Medicare or others), then it will show how much of each service was paid for on our behalf. Like the doctor's bill, each service will be aligned with its CPT code.
Provider Paperwork - Where Providers Are Using CPT Codes
- CPT codes directly affect a provider's income. As such, they are very particular about how coding is done, and spend huge sums of money each year in the management of billing and coding. Medical coding is its own career, and can be very lucrative for the right person.
- After we leave the doctor's office, the billing and coding people submit to our payers a list of the services they provided to us. This may be done by postal mail or fax, but more and more, doctors and facilities are using electronic means to store and transfer this information.
How to Match CPT Codes to the Services They Represent
If you have paperwork that has a CPT code on it, and you want to figure out what that code represents, you can do so in a number of ways:
- Do a CPT code search on the American Medical Association website for free. This is a new capability and allows patients to search for a CPT code, or use a keyword to see what the associated CPT code might be.
- Contact your doctor's office and ask them to help you match CPT codes and services.
- Contact your payer's billing personnel and ask them to help you.
- Remember that some codes may be bundled, but can be looked up in the same way.