CPB Certified Professional Biller Certification Practice Exam

Which coding system is used to report professional services to payers?

1. International Classification of Diseases (ICD)

2. Current Procedural Terminology (CPT)

3. Health Care Common Procedure Coding System (HCPCS)

4. Diagnosis Related Groups (DRG)

The correct answer is: Current Procedural Terminology (CPT)

The Current Procedural Terminology (CPT) coding system is specifically designed to describe and report professional medical services and procedures to payers, including insurance companies. CPT codes are used by healthcare providers to document and communicate the services performed during patient encounters, such as evaluations, surgical procedures, and other professional services. CPT codes are essential for the billing process as they provide detailed information about the services rendered, which is necessary for reimbursement from payers. This specificity and focus on professional services is what distinguishes CPT from other coding systems. In contrast, the International Classification of Diseases (ICD) coding system is primarily used for diagnosing patients and reporting diseases and health conditions rather than specifically detailing procedures performed. The Health Care Common Procedure Coding System (HCPCS) includes codes for items and services not covered by CPT, often related to products, supplies, and non-physician services. Diagnosis Related Groups (DRG) are used to classify hospital cases for the purposes of payment and do not relate directly to the reporting of professional services.