Current procedural terminology coding for surgical pathology: A review and one academic center’s experience with pathologist-verified coding

Abstract

Context.—The Current Procedural Terminology (CPT) system is a standardized numerical coding system for reporting medical procedures and services, and is the basis for reimbursement of health care providers by Medicare and other third-party payers. Accurate CPT coding is therefore crucial for appropriate compensation as well as for compliance with Medicare policies, and erroneous coding may result in loss of revenues and/or significant monetary penalties for a hospital or practice. Objective.—To provide a review of the history, current state, and basic principles of CPT coding, in particular as it applies to the practice of surgical pathology, and to present our experience with initiating a new system of pathologist involvement in the review and verification of CPT codes, including the most common codes that require modification in our practice at the time of sign-out or post–sign-out auditing. Data Sources.—Review of English language literature, published CPT resources from the American Medical Association and other professional organizations, and billing quality data from a single institution. Conclusions.—Although the appropriate extent of physician involvement in CPT coding is a matter of some debate, a multidisciplinary approach involving both health care providers and professional coders appears to be the best way to achieve accuracy.