CPT, CDT, Anesthesia codes, RVU and Physician Fees

Note Due to AMA copyright on CPT, you must be a registered user: either on free trial or subscription based - to use this part of the ICD10Doc application

CPT Modifiers explained

Watch a short YouTube movie and see how easy it is to calculate the CPT, RVU and Physicians Fees with ICD10Doc.

1. Find a CPT or CDT (Dental) code that interests you, with the search or reverse search functions on the Home page. You may find a CPT code also while browsing LCD (Local Coverage Determination). The result will show in its own box as CPT / HCPCS - with the relevant facility and non-facility RVU as well as the Anesthesia units whuch are used for calculating fees.



Click on the link that you'd like to continue with.



2. The next screen asks for the region - in order to match the correct Medicare carrier for reimbursement. From the drop down menu pick the region, the locality and the correct Medicare carrier for your caculation purposes and then click on the big blue button to calculate the fees.



3a. The page after picking the region will show Facility and Non Facility, RVU, Fees, Limiting charges and other details such as Impactors & Modifiers that may influence the physician fee.







3b. If on the other hand, the CPT code is an Anesthesia code, you may be on a page which at the bottom has a big blue button - Calculate Anesthesia Fees. Enter the Time Units and Modifying units and click on this button, since the Anesthesia fees are calculated differently. Read more about the Anesthesia Fees
.

Background

From Wikipedia: The Current Procedural Terminology (CPT) code set is a medical code set maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set (copyright protected by the AMA) describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes.
CPT coding is similar to ICD-9 and ICD-10 coding, except that it identifies the services rendered rather than the diagnosis on the claim.
ICD code sets also contain procedure codes but these are only used in the inpatient setting.

Terms

Assistant at Surgery
Bilateral Surgery
Calculation Flag
Conversion Factor
Co-Surgeons
Endoscopic Base Code
Facility NA Indicator
Facility PE OPPS
Facility PE RVU
Facility Total RVU
Formula Used
Global Surgery Days
Imaging Family Indicator
Intra Op
Modifier
MP for OPPS
Multiple Procedures
MP RVU
Non Facility NA Indicator
Non Facility PE OPPS
Non Facility PE RVU
Non Facility Total RVU
PC / TC Indicator
Post Op
Pre Op
Status Code
Supervision Diag. Procedure
Team Surgery
Work, PE, MP GPCI
Work RVU


For more information on CPT and RVU, visit CMS web site
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