by Gail I. Smith, MA, RHIA, CCS-P
I am fan of old movies. Every Christmas, I watch The Lemon Drop Kid (1951) that stars Bob Hope and Marilyn Maxwell. This little-known movie with a thin plot introduced the classic Christmas song “Silver Bells.” There is another song in the movie that reminds me of CPT. The song is titled “It Doesn’t Cost a Dime to Dream.” A portion of the lyrics goes like this:
“We’ll have a maid who has a maid
Who has a maid to serve the maid’s lemonade?”
CPT seems to have a lot of ‘maids’ to serve the code set.
The American Medical Association (AMA), the owner of CPT, offers additional resources to aid in accurate and defensible application of the code set. While one might ask why a HIPAA-recognized code set needs to have so many costly ‘maids,’ the reality is that the complexity of the CPT system requires additional explanation.
The following are the resources coders may need to make sense of CPT:
Guidelines: There is not a separate document that contains guidelines (such as the Official Guidelines for Coding and Reporting used with the ICD-10-CM/PCS code sets). It is all embedded in the coding system with Notes, Coding Tips and instructional text.
CPT Assistant: If the Notes, Coding Tips and instructional text still leave you with questions, for accurate coding, AMA provides their official newsletter CPT Assistant. In addition to discussing the latest codes and trends in medicine, the newsletter offers clinical scenarios that “demystify confusing codes.” CPT Assistant is offered on a subscription basis.
Coding Essentials for (Specialty): Sometimes CPT Assistant does not answer our question, so we need to go to another source such as the CPT library of Coding Essentials organized by specialty, such as cardiology, general surgery & gastroenterology, etc. These are electronic books to help translate the CPT codes to plain English. These books are available at an additional cost not included with the CPT Assistant subscription.
CPT Changes: An Insider’s View: At the beginning of every year, along with the introduction of the new/revised codes, CPT publishes a book called CPT Changes: An Insider’s View that promises better understanding of the code set. A fee is associated with this publication as well.
The task of deciphering CPT codes is not just the challenge facing coders but is extended to many other individuals and organizations such as providers, medical societies, and technology companies. Imagine explaining this to a new student and them asking “does it have to be this complicated?”
CPT® Coding: Introduction to CPT Coding
CPT® coding is used by physicians and hospitals to describe medical, surgical, and diagnostic services provided to patients. This foundational course provides an introduction to the CPT coding system, CPT guidelines, and correct coding for hospital outpatient services. Learn more here.