From the Guidelines
CPT Code Definition
The Current Procedural Terminology (CPT) code is a standardized system used to describe and code medical, surgical, and diagnostic services and procedures, with specific codes existing for developmental screening (96110) and testing (96111) 1.
- Developmental Screening Code: The CPT code 96110 is used for developmental screening, which does not include payment for medical provider services, as it is expected to be administered by a nonphysician 1.
- Developmental Testing Code: In contrast, the CPT code 96111 is used for developmental testing, which is a more comprehensive assessment 1.
- Billing and Coding: When billing for developmental screening and surveillance, it is essential to carefully review the processes to ensure that appropriate CPT codes are used to document screening procedures and ensure proper payment, with the preventive care code used with the modifier 25 appended and 96110 1.
- Importance of Accurate Coding: Accurate use of CPT codes, such as 96110 and 96111, allows for standardized and efficient billing and reimbursement, reflecting physician work, practice expenses, and professional liability expenses 1.
From the Research
Definition of Current Procedural Terminology (CPT) Code
- The Current Procedural Terminology (CPT) system is a standardized numerical coding system for reporting medical procedures and services 2, 3, 4, 5, 6.
- It is used for reimbursement of health care providers by Medicare and other third-party payers 2, 3.
- CPT codes provide a standard language and numerical coding methodology to accurately communicate across many stakeholders, including patients, and the medical, surgical, diagnostic, and therapeutic services provided by qualified healthcare professionals (QHPs) 3.
Purpose of CPT Codes
- CPT codes are used to track healthcare utilization, identify services for payment, and gather statistical healthcare information about populations 3.
- They are essential for ensuring that healthcare data are captured accurately and consistently, and that health claims are processed properly for Medicare, Medicaid, and other health programs 3.
- CPT codes are also used for conducting research, evaluating healthcare utilization, and developing medical guidelines and other forms of healthcare documentation 3.
Development and Maintenance of CPT Codes
- The CPT system was developed by the American Medical Association (AMA) in 1966 5.
- The system has evolved in complexity and sophistication over the years, with input opportunities available to medical specialty societies and others 5.
- The CPT maintenance process has become more transparent, with resources available to help healthcare providers stay current 5.
Importance of Accurate CPT Coding
- Accurate CPT coding is crucial for appropriate compensation as well as for compliance with Medicare policies 2.
- Erroneous coding may result in loss of revenues and/or significant monetary penalties for a hospital or practice 2.
- A multidisciplinary approach involving both healthcare providers and professional coders appears to be the best way to achieve accuracy in CPT coding 2.