CPT codes represent the procedures. Each specific procedure or CPT code carries a specific dollar ($) value. Yes, all game revolves around the money, which is hidden in this five digit numerial code called as CPT Code.

Only, Medical coders and billers will be knowing about these confidential CPT codes and how to decode them in dollar values. But, this whole coding procedure should be done very carefully because each  numerical number carry a heavy dollar amount.  Let us learn through an example.

Pricing of CPT Codes

Let us just take an example of an outpatient case. Patient is undergone a limited abdomen ultrasound in a Non-Facility. The Procedure code for this exam will be CPT code 76705. The actual cost for this exam for global code and with modifier 26 & TC is given below.

76705 Global Price: 92.18$

76705 -26 : 29.98$

76705-TC : 62.19$

Global code will not have any modifier, which means the procedure is done in global settings where the provider has performed both the technical and professional components of the procedure.

If only the technical component like here ,use of ultrasound,  to be paid, then only 62.19$ will be final payment.

If only the the professional component of the procedure has to be paid, then only 29.98$ will be the final payment.

Adding both TC (Techninal) and Professional Component will give the final price for global settings. (62.19$+29.98$=92.18$)

Note: Under the MPFS, payment amounts are based on the relative resources required to provide services and vary among payment localities as resource costs vary geographically as measured by the geographic practice cost indices (GPCIs). The payment locality is determined based on the location where a specific service code was furnished. 

Number decreases but Dollar($) Value increases

Coming back to the topic, how the change in single numerical number or digit affects the CPT code in payment procedures.

Now, here if a medical coder codes a limited ultasound abdomen exam as complete ultrasound, then CPT code will change by a single digit (76705->76700).

Now, here the number is changed or reduce from 5->0, but this decrease has increased the amount of the procedure. Below is the Non-Facility price for complete abdomen ultrasound exam code 76700.

76700 for Non-Facility Price

76700 Global Price: 123.49$

76700-26 : 41.54$

76700-TC : 81.96$

Compare the limited and complete abdomen ultrasound code

Now, just think for a second, the change in a single digit of 5 -> 0 in the CPT code, has almost increase the cost of the procedure code from 91.18$ to 123.49$ in global setting. Their is an increase of around 32$, because of mere change in 5->0. This is the affect CPT code has on dollar ($) in coding.

91.18$-> 123.49$ (Global setting)

29.98$ -> 41.54$ (with 26 modifier)

62.19$ -> 81.96$ (with TC component)

Here, you can understand every digit or number of CPT code has significant importance. Medical coders who are mainly responsible for capturing the CPT codes, should not code a even a single wrong numerical or CPT code, because it directly changes the total value of the procedure in sense of money.

The main thing to understand through this example is, CPT code should be coded perfectly as per the documentation in the medical report. Yes, their will be some human or machine errors which we have to discuss.

Human or Machine Errors

Human errors will be mostly the typo errors. The medical coders sometimes to process more charts, in hurry can do typo errors. So, it is very important to focus more while coding hugh volume of charts to avoid any typo coding errros.

Human errors also include downcoding and upcoding when the coders have insufficient knowledge about general or client coding guidelines. This can reduced by going through coding guidelines everyday before coding medical charts.

Machine or coding software errors will be very less. This will happen when the system gets hanged or shutdown while processing a medical chart.These happens very rarely but should be take care.

Coding software are programmed and updated regularly, hence the coding errors are reduced drastically using these softwares.

Conclusion

Finally, it would just like to add that, those who think the CPT code is just a five digit numerical code and can be easily learnt, is not that simple. We have seen through this article that each CPT code is different and have a specific dollar value. Hence, while coding CPT codes do follow all coding guidelines and code them perfectly.