Medical coding is being pursued as a profession for many in the US. There are already about a 100,000 medical coders in the US, and this number has been rising steadily. This profession is catching up in other parts of the world, too.
The fundamental tool or guide with which medical coders work is The Current Procedural Terminology (CPT), which is a collection of a huge gamut of coding concepts. The CPT is spread over several layers and levels and covers every discipline and aspect of the medical and healthcare professions.
CPT coding concepts are necessary because it is on these codes that professionals in the healthcare industry work. Billers, hospital management and providers use these codes day in and day out, and their work is based on these. CPT coding concepts are indispensable to these professionals, because CPT codes are constructed on principles and the dynamics that are unique to each sector of the healthcare industry.
Since CPT coding is automated, a medical coder needs to have just as much knowledge as is necessary for feeding the right input. The medical coder need not have extensive prior knowledge of coding or billing to function smoothly, but needs to have sound grasp of the fundamentals of CPT coding concepts, to the extent of having the ability to understand which code to apply to which condition or disease. Knowledge that ensures all the aspects of billing, namely compliance, reimbursement and accuracy is needed, rather than all the details of the CPT codes.
CPT coding concepts start with the elementary aspects of coding concepts. These include the organization of the CPT manual, manual symbols, and the place of service codes. These CPT coding concepts then move on to the higher levels of disciplines relating to professionals. Evaluation and Management (E & M), rules concerning obstetrics and gynecology, surgical guidelines, modifiers and the CPT appendices are some of these higher CPT coding concepts.
In order to ensure ease of compliance with regulatory guidelines, the Office of the Inspector General's initiative for Current Procedural Terminology has issued guidelines under what is called The CPT Coding Compliance Program. The guidelines issued in this program have to be implemented in conjunction with the American Medical Association/CMS 1995 or 1997 CPT Coding Guidelines.
CPT coding concepts are finessed under the guidelines of this program. These are some of the CPT coding concepts this program inculcates and expects implementation of: