CPT Codes and Medical Bills – Advocates Law

In a previous article, we discussed ICD codes and their purpose in medical coding. However, there’s another equally important coding system used by multiple medical providers. Current Procedural Terminology (CPT) codes are used to specify what type of treatment or procedure took place at the time of medical service.

History of CPT Codes

The American Medical Association (AMA) first developed CPT in 1966 to encourage medical providers to adopt a standard and uniform coding system for treatment and procedures. CPT has been revised and updated throughout the years; the currently used edition is the fourth iteration. The codes are used for nearly any type of treatment including physician services, radiology, surgery, ambulance transport, and many other services.

CPT codes are maintained and updated by the CPT Editorial Panel. This panel is made up 17 people, most of whom are physicians. They have split CPT codes into three categories. The first category is required when treating a patient. This category is the meat of CPT and is used to tell what type of service was provided to the patient.

The second and third categories of CPT are optional. The second category is used for data tracking and supplemental information. The third category is a bit trickier. This category is used for emerging technology, meaning that there is no current CPT code for a new procedure but the treating physicians feels as though the procedure is necessary for the patient. However, before performing the procedure the physician must first either confirm at least 1 CPT practitioner would also perform the procedure, the procedure is supported by peer reviewed journals, or there is evidence of its effectiveness.

Why is CPT Important?

In some cases, PIP will specify CPT codes are needed in order to pay the medical bill. There are some providers who do not list CPT codes, not because they’re forgetful or trying to be dishonest. Providers like that usually have one specific specialty, like massage therapy, and are not used to billing insurance companies.

Will Not Having CPT Codes Affect My Case?

While not affecting the outcome of the case, it may affect your ability to pay your medical bills. If your medical bills are getting rejected by PIP or your health insurance for not having CPT codes, it’s important to hire an experienced attorney who can work with your medical providers to make sure they are getting paid or holding your bills so they don’t go into collections. Attorneys like The Advocates can sometimes even get the necessary CPT codes to give to PIP or your health insurance.

If you’ve suffered from an injury and are questioning the medical system, give us a call today. Your initial consultation is always free!