CPT® Codes: What Are They, Why Are They Necessary, and How Are They Developed?
CPT® Codes: What Are They, Why Are They Necessary, and How Are They Developed?
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DOI：
10.1089/wound.2013.0483
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发表时间：
2013-12-01
影响因子：
4.9
通讯作者：
Dotson, Peggy
中科院分区：
文献类型：
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作者：
Dotson, Peggy
合格的医疗保健专业人员（QHPs）需要确定他们提供的专业服务，并以机构、私人和政府支付者、研究人员和其他相关方普遍理解的方式报告这些服务。QHPs的数据用于跟踪医疗保健的使用情况，确定支付服务，并收集有关人口的统计医疗保健信息。在美国，医疗保险公司每年要处理超过50亿份索赔。为确保准确、一致地获取医疗保健数据，并确保医疗保险、医疗补助和其他健康计划的健康索赔得到正确处理，医疗服务和程序的标准化编码系统至关重要。由美国医学协会（AMA）开发的现行程序术语（CPT (R)）系统正是用于这些目的。AMA系统提供了一种标准语言和数字编码方法，以便在许多利益相关者（包括患者、医疗、外科、诊断和治疗服务）之间准确沟通。CPT描述性术语和相关代码提供了最广泛接受的医学术语，用于报告医疗程序和服务，以处理索赔、进行研究、评估医疗保健利用、制定医疗指南和其他形式的医疗保健文档。
Qualified healthcare professionals (QHPs) need to identify the professional services they provide and to report those services in a way that can be universally understood by institutions, private and government payers, researchers, and others interested parties. The QHPs' data are used to track healthcare utilization, identify services for payment, and to gather statistical healthcare information about populations. Each year, in the United States, healthcare insurers process over 5 billion claims for payment. 1 To ensure that healthcare data are captured accurately and consistently and that health claims are processed properly for Medicare, Medicaid, and other health programs, a standardized coding system for medical services and procedures is essential. The Current Procedural Terminology (CPT (R)) system, developed by the American Medical Association (AMA), is used for just these purposes. The AMA system provides a standard language and numerical coding methodology to accurately communicate across many stakeholders, including patients, the medical, surgical, diagnostic, and therapeutic services provided by QHPs. The CPT descriptive terminology and associated code numbers provide the most widely accepted medical nomenclature used to report medical procedures and services for processing claims, conducting research, evaluating healthcare utilization, and developing medical guidelines and other forms of healthcare documentation.