Prospective Payment System (CPT) Reporting
The Omnibus Budget Reconciliation Act mandated the use of Current Procedural Terminology (CPT) reporting. It was enacted as a Prospective Payment System (PPS) for reporting services provided to Medicare recipients. Meeting the needs of physicians to aide in reporting and communicating professional services rendered to patients through office and hospital out-patient services is why the CPT classification system was created. CPT is a descriptive listing of codes and terms for diagnostic and therapeutic procedures and medical services. The CPT manual is updated annually by the American Medical Association (AMA).
The differences in the ICD-10 (or ICD-9-CM) compared to the CPT is these classification systems were created by the World Health Organization
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931 Words | 4 PagesThose two types of bills are the CMS-1500-professional paper claim form and the UB-04-institutional paper claim form. The CMS-1500 is used by physicians, therapists, and other professionals (3). The UB-04 is used by facilities including hospitals, surgery centers, skilled nursing facilities, home health agencies, some transportation providers, and so forth (3). Diagnosis codes that are used for the CMS-1500 forms must describe, the patient’s condition, must always have at least one or more ICD-10-CM code on the form, applies to a particular visit, and does not generally affect reimbursement for professional services (3). The procedure codes physicians and most non0physician healthcare providers use CPT codes to show what services were done, a CPT code is assigned to each service that was done that day, Level II HCPCS codes are also used to reflect what was done, both of these codes determine reimbursement, and most of the payers have developed a fee schedule (3).
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