The procedure code is one the most important items to be entered on the insurance claim form. Since it is necessary for the insurance carrier to understand exactly what service or procedure was provided, this code must reflect that service exactly.
The procedure coding scheme is a precise process requiring knowledge of medical terminology and clinical procedures. Since the practitioner is the professional with the best ability to judge the service provided, it should be the practitioner's
responsibility to determine the procedure code that best reflects the child's services.
The Current Procedural Terminology, Fourth Edition (CPT-4), is a systematic listing and coding of procedures and services performed by or under the supervision and/or prescription of a physician. CPT-4 became the procedural coding system in 1985 when
the federal Healthcare Financing Administration and the American Medical Association published the Healthcare Financing Common Procedural Coding System (HCPCS), a national-level coding system for reporting health care services to the Medicare and
Under CPT-4, each procedure or service is identified by a five-digit code. The practitioner should select the procedure code that most accurately identifies the services performed. It is unnecessary to provide the written description on the filing
form when the numeric code is provided. In fact, if both are given and the description provided is different from the procedure referenced by number, it may cause the carrier to reject the claim or to request additional information.
For procedure codes, refer to the Physicians' Current Procedural Terminology, (CPT-4), 2005. Books listing the codes may be purchased from a local technical book store or use an internet search for resources.