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Where Can I Find Specific Definitions on the CPT Codes?

Kathleen Weissberg, OTD, OTR/L

March 26, 2015

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Question

Where can I find specific definitions on the CPT codes?

Answer

I would recommend looking in two places.  The first is a book that comes out of the AMA, the American Medical Association, because they actually own the CPT codes.  This book describes every single CPT code and what is involved in it.  If you cannot get your hands on this book, I would recommend that you go to your Medicare Administrative Contractor.  Each one of the MACs will have local coverage determinations for OT, PT, and speech on their website, and within those there will be very specific guidelines, more often than not, on what is involved in a CPT code and what they look for in documentation from us.  The one that I go to most regularly is National Government Services.  I am not saying they are good, bad, or otherwise, but I happen to like how they lay out to their definitions and what they would want to see in the documentation to support that.  If you use these documents, your payers clearly spell out what they want to see from your documentation.  If you do not, they are probably not going to pay.


kathleen weissberg

Kathleen Weissberg, OTD, OTR/L

Dr. Kathleen Weissberg, (MS in OT, 1993; Doctoral 2014) in her 25+ years of practice, has worked in rehabilitation and long-term care as an executive, researcher and educator.  She has established numerous programs in nursing facilities; authored peer-reviewed publications on topics such as low vision, dementia quality care, and wellness; has spoken at numerous conferences both nationally and internationally, for 20+ State Health Care Associations, and for 25+ state LeadingAge affiliates.  She provides continuing education support to over 17,000 therapists, nurses, and administrators nationwide as National Director of Education for Select Rehabilitation. She is a Certified Dementia Care Practitioner and a Certified Montessori Dementia Care Practitioner.  She serves as the Region 1 Director for the American Occupational Therapy Association Political Affairs Affiliates and is an adjunct professor at both Chatham University in Pittsburgh, PA and Gannon University in Erie, PA. 


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