An Outline Of CPT Coding In Medical Billing

CPT Coding

CPT Coding in Medical Billing


Common Procedural Technology (CPT) codes are the services provided by a medical practitioner to a patient. The services provided by a medical practitioner may include medical, surgical and diagnostic services.

The main talking point within all practitioners is how the CPT codes are used? The utilization of the CPT codes boils down on numerous factors. CPT codes are utilized for both medical billing and tracking processes. They are typically the same as the medical codes associated with Healthcare Common Procedure System (HCPS). In this section, I have highlighted ways of utilizing the CPT codes and the places where we can find them.

Way of using CPT codes

As the CPT codes are very much associated with the patient’s medical care, all medical workplaces are very vigilant about the coding procedures and their implementation. They appoint appropriate medical coding specialists to ensure the effective implementation of medical codes.

1. Initial aspect

The medical practitioner initiates the medical coding procedure. If they consider the paper claims, they will visualize which CPT codes are utilized at a particular time. If they visualize EHR (Electronic Health Record) during a patient’s visit, the system catches it. The healthcare systems allow the staff to comfortably access the codes depending on the service name.

2. Verification of medical coding

Once the patient leaves the medical workplace, the practitioner’s records are visualized by medical coders and billers so they can finalize the appropriate medical codes for certain procedures. The finalization of medical codes is a massive priority because efficiency completely depends on the appropriate allocation of medical codes.

The medical billing panel then delivers a list of services a patient submits to his insurer. Medical professionals usually utilize electronic means to save and deliver these details. Some of the information can be delivered through email.

3. Medical claim procedure

The practitioner’s health plan utilizes the medical codes to initialize the claim procedure and estimate the reimbursement rates regarding a doctor and the amount a patient owes. The reimbursement is critical in bringing consistency within the revenue cycle. Furthermore, an appropriate revenue cycle means financial stability for a medical practitioner.

4. Research

The medical insurance organizations and the government experts visualize the healthcare data to estimate the medical costs for the patients in their healthcare systems. The analysts of federal hierarchies utilize the data of medical coding to visualize the trends in medical care as well as the budget of Medicare.

Places to find CPT codes

As a customer goes through his healthcare experience, he will visualize CPT codes in numerous documentations.

1. Paperwork

Once a patient is done with a doctor’s appointment or gets discharged from a hospital, he is offered paperwork that provides complete details regarding the services a doctor provides.

The five character codes are usually said to be the CPT codes. The ICD (International Classification of Disease) codes are also part of the paperwork. However, they are in the form of numbers and letters.

2. Medical bills

Once the doctor delivers a medical bill to his patient, it will have the details of the services provided to him. The medical bill may or may not be delivered to the patient’s payer before the patient. Next to every service, there is a 5-digit code. That 5-digit code is said to be the CPT code.

3. EOB (Explanation of Benefits)

Once a patient receives an explanation of benefits from the payer, it will give the adequate details regarding the investment in each provided service. Just like the doctor’s medical bill, every medical service will be associated with a CPT code.


A patient must have a complete understanding of medical procedures to ensure appropriate medical care. If there are certain details in the medical bill that he is unable to understand, he must collaborate with his healthcare provider to clarify all misunderstandings. The patient must be proactive in ensuring that his healthcare is comprehensively tracked.

Medical Billing Benefits is an established healthcare newswire that gives insights regarding numerous US-based organizations dealing with CPT coding. We ensure that the practitioners have all the information at their disposal to get the best out of their medical practice. This brings efficiency to their work tasks. Subscribe to our newsfeed today and get to know about CPT coding.

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