Understanding CPT Codes & Medical Billing Basics

New to medical billing? Here's what every attending physician needs to know about CPT codes and the billing process.

What are CPT Codes?

Current Procedural Terminology (CPT) codes are five-digit numbers that describe the medical services you provide. Created by the AMA, these codes are how you get paid for your work.

Simple Example:

• You perform an office visit → You use code 99213
• You read an EKG → You use code 93010
• You do a cardiac catheterization → You use code 93458

The Six Main CPT Categories

Category	Code Range	What It Covers
Evaluation & Management (E/M)	99000-99499	Office visits, consults, hospital rounds
Surgery	10000-69999	Any surgical procedure
Medicine	90000-99999	Injections, echo, cardiac cath, etc.
Radiology	70000-79999	X-rays, CT scans, MRI
Pathology/Laboratory	80000-89999	Blood work, tissue samples
Anesthesia	00100-01999	Anesthesia services

Medical Billing 101

Here's the simplified process of how you get paid:

1. You see a patient and document what you did
2. Your coder assigns CPT codes based on your documentation
3. The claim goes to insurance with codes and diagnosis
4. Insurance reviews and pays (hopefully!)
5. Patient pays any remaining balance

Common Modifiers You'll See

Modifier	What It Means	When You'd Use It
-25	"I did a separate E/M visit AND a procedure"	Follow-up visit where new complaint requires separate evaluation
-26	"I only interpreted, didn't perform"	Reading an echo performed by tech/another facility
-TC	"I only performed, didn't interpret"	Facility billing for echo when you bill separately for reading
-59	"These are distinct procedures"	Cath on LAD separate from cath on RCA same session
-LT/-RT	"Left side" or "Right side"	Pacemaker placement, indicating which side

Documentation Tips

What You Need to Document:

• Chief complaint - Why patient came in (required)
• Medical decision making - Your clinical reasoning (always required)
• History and/or Exam - At least one is required
• Time - If you're billing based on time spent
• Counseling/Coordination - If significant

For Time-Based Billing:

• Document total time spent
• Note counseling and care coordination
• Typical times: Level 3 = 30-44 minutes, Level 4 = 45-59 minutes

For Procedures:

• Medical necessity - Why this procedure was needed
• What you did - Step-by-step description
• Findings - What you discovered
• Plan - Next steps based on results

Key Concepts for New Attendings

Medical Necessity: Everything must be medically necessary. Document why each service was required.

Bundling: Some procedures include other services. An echo includes basic measurements - you can't bill separately for those.

Professional vs. Technical Components:

• Professional (reading) = Modifier -26
• Technical (performing) = Modifier -TC
• Both together = No modifier needed

Global Periods: Surgery includes routine follow-up care. Don't bill separately for standard post-op visits.

Red Flags to Avoid

• Don't upcode - Bill what you actually did, not the highest level
• Don't assume - When in doubt, ask your coder or biller
• Don't skip documentation - "If it's not documented, it didn't happen"
• Don't bill unbundled - Learn what's included in each code

How ReCODE Chat Helps

As a new attending, ReCODE Chat can:

• Explain any CPT code in detail (try /code + code number)
• Help verify your documentation supports the codes
• Guide you on modifiers and billing rules
• Provide examples of proper documentation

Your First Week Checklist

1. Meet with your biller/coder - Understand your practice's process
2. Learn your common codes - Know the top 10 codes for your specialty
3. Document thoroughly - Better too much than too little
4. Ask questions - Use ReCODE Chat or your coding team
5. Review your work - Check denied claims to learn

Remember: Accurate coding starts with good documentation. When in doubt, document more rather than less, and never hesitate to ask for help.

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Ready to start using ReCODE Chat? Begin with Getting Started.