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What is in that alphabet soup? Deciphering Coding Acronyms to Support Reimbursement

Healio Orthopedics • Orthopedics Today

January 2018

The physician’s role in the revenue cycle is important for optimizing charge capture in independent and employment settings. Understanding key acronyms related to code sets and reimbursement guidelines is important to an organization’s bottom line and future physician compensation.

This article explains five coding acronyms that physicians must understand, how they differ and why each is important.

1. CPT – Current Procedural Terminology

CPT is a code set used in health care billing to describe both professional and diagnostic services. CPT codes are typically the foundation of insurance company reimbursement for physician services, and both private practices and hospitals are reimbursed at either government-assigned allowable rates or payer-contracted rates. Thus, correct CPT reporting is essential for revenue optimization. The frequency of CPT reporting may impact physician compensation, as many employed physicians are credited for work relative value units (RVUs) that are linked to the CPT codes billed.

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