CPT & ICD-10 Codes

Insurance billing uses two code systems:

• CPT codes describe the procedure (what you did).
• ICD-10 codes describe the diagnosis (why you did it).

Both have to line up on a claim. The CPT says "manual therapy"; the ICD-10 says "low back pain"; together they tell the payer the service was clinically justified.

CPT codes

CPT (Current Procedural Terminology) codes are owned by the AMA and updated annually. Each has a standard rate you set based on your fee schedule.

You'll typically use a small set of codes that match the modalities your practice delivers. Common categories include manual therapy, therapeutic exercise, neuromuscular re-education, psychotherapy, and evaluation and management visits.

ICD-10 codes

ICD-10 codes describe the client's condition or reason for treatment. They support the medical necessity of the procedures you billed.

Pick the most specific code available. "Low back pain" has more specific subcodes (chronic, with sciatica, etc.) that paint a clearer clinical picture than the generic version.

Using codes in Stillpoint

• When creating a claim, search the picker by code number or description.
• Link each CPT code to one or more ICD-10 codes.
• Recently used codes surface first, so your common combinations stay close at hand.

Tips

• Verify diagnosis codes support the procedures you're billing. A mismatch is the leading cause of denials.
• Code sets update annually; the codes you used last year may have shifted. When in doubt, check the current AMA / CMS reference.
• Use the most specific code available rather than a general or "unspecified" version.
• Consult each payer's guidelines for their covered procedures and documentation requirements.