Gauging Patient and Practice Behavior with CPT Codes
CPT codes are the US standard for describing and billing optical and medical services in a healthcare setting. The acronym “CPT” stands for Current Procedural Terminology, which is used to accurately detail provided services for patients.
Your CPT and charge codes can tell you a lot about your practice, your providers, and your patients. They contain information about the types of exams your patients are receiving, and what optional services they are electing to have. They reveal the success of your patient recall programs, your marketing and new patient acquisition strategies, and the effectiveness of your in-office dialogues. CPT billing reports can also accurately describe the types of patients you are attracting to your practice. There’s a wealth of intelligence waiting to be uncovered in your billing and charge code reports.
Your CPT analysis should include more than “just” the CPT codes that you bill to insurance. Because some procedures are considered “optional,” and never billed to vision care plans, practices may choose to use custom codes, which become a sort of in-office shorthand for additional clarity in specific situations. Any analysis you do on your CPT activities should include all services, whether listed under CPT codes or not, and those that may have additional notations as part of the description.
Basic CPT Analysis Reports
One of our most popular dashboards in EDGEPro is the CPT Breakout report. This insightful report collects and organizes information about the services you provide in your office. It contains 5 highly useful data points, which we recommend be part of any CPT analysis:
- Quantity of services performed;
- Percent of overall services;
- Total list (U&C) value of services;
- Patient responsibility / out-of-pocket charges;
- Third-party payments.
These five points provide the starting point for understanding how your patients, staff, and providers are interacting in your clinic. Once you have this basic information, a picture of your practice actually emerges from the data. Here are some of the questions you might begin to answer with clear CPT reporting:
- How many of my patients are choosing fundus photography (or other optional service)?
- What portion of my refractive exams are provided to new patients?
- How many patients are we seeing for vision therapy?
- How many patients are returning for interim contact lens checks?
- What is the average value of my exams and services under specific managed vision care plans?
- How many contact lens exams are we providing?
- Which providers have the highest incidence of optional services?
Advanced Uses for CPT / Charge Code Reporting
There’s more than just productivity to be gained from monitoring and tracking your CPT codes. These reports can help you effectively evaluate the utilization of specialized equipment in your office. It can also provide information on whether that same equipment has generated enough income to justify its purchase. Has it paid for itself yet? Do we need to make better use of it?
Another advanced-user tip for CPT monitoring is to spot-check your provider documentation for certain types of billing codes. For instance, conducting an occasional internal audit for documentation of level 4 and 5 office visit codes could help your practice be audit-ready as well as promoting best practices within the clinic.
CPT and charge codes are really the core functions around which your practice revolves. After all, you’re in the business of helping patients maintain their eye health, not just “get glasses.” Understanding your services performance allows you to better maximize your patient engagement, and it also helps you to ensure that your practice is providing the services essential to maximizing their eye health.