Application of the CPT System_ CH 02

8/11/2019 Application of the CPT System_ CH 02

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Basic Current Procedural

Terminology

HCPCS Coding

2 14 edition

Chapter 2:

Application of the CPT System


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Conditions for Inclusion of a Procedure

within CPT Commonly performed by physicians across the

country

Consistent with contemporary medical practice


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CPT Category IMajor Sections

Evaluation and Management (E/M)

Anesthesiology

Surgery

Radiology

Pathology and Laboratory

Medicine


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Evaluation and Management (9920199499): An overview

Physician visit codes

Consultation codes

Emergency Department Services

Critical Care

Nursing Facility Care


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Anesthesiology

(00100

01999) Anatomic format

Include general, regional, supplementation of local

anesthesia

Includes preop and postop visits, monitoring,

administration of fluids and/or blood

Some insurance carriers use timeforreimbursement


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Surgery (1004069990)

Largest section and most difficult

Note section divided into:

Section (Surgery)

Subsection/category (Urinary system)

Subcategory (Kidney)

Heading (Incision)

Procedure codes (50010)


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Radiology (7001079999)

Four subsectionsDiagnostic radiology

Diagnostic ultrasound

Radiation oncology

Nuclear medicine

Most hospitals maintain these codes in

computerized file (chargemaster)


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Pathology and Laboratory

(80048

89399) Most hospitals maintain codes in computerized

file (chargemaster)

Physicians maintain list of common proceduresperformed (superbill or computer file)


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Medicine (9028199199)

Specialized section

Types of codes

Psychiatric services

Physical therapy

Ophthalmological services

Cardiac catheterization


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Category II Codes

Added in 2004

Performance measurements

For data collection End with letter F

Use is optional

Example:

4002F Statin therapy, prescribed


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Category III Codes

Emerging technology Alphanumericcodes

Used for data collection

Temporary Updates available on AMAs Web site

Payment depends on the payer

Example:

0085T Breath test for heart transplant rejection


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Format: Conventions and Characteristics of

CPT

Stand alone and

semicolon ( ; )

Bullet

Triangle

Facing triangles

Plus sign +

Circled bullet Null Symbol

Pending FDA Approval

Symbol

# Resequenced Code


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Symbols: Stand Alone and Semicolon

Example

37600 Ligation; external carotid artery37605 internal or common carotid artery

Code 37600 stands alone, meaning it needs nointerpretation.

Because code 37605 is indented, it relies on thedescription before the semicolon in the preceding entryto complete the code description.

Therefore, Code 37605 reads as:Ligation; internal or common carotid artery


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Symbols: Bullet

Indicates a new code for the current year Listed in Appendix B

Example:

46707 Repair of anorectal fistula with plug (eg,

porcine small intestine submucosa

[SIS])


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Symbols: Triangle

Indicates a revised code for the current year Listed in Appendix B

Example:21555 Excision, tumor, soft tissue of neck or

anterior thorax, subcutaneous; less

than 3 cm


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Symbols: Facing triangles

Indicates new or revised text

Used throughout CPT

Example: appears after code 39502

(For laparoscopic paraesophageal hernia repair,

see 43281, 43282)


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Symbols: Plus sign +

Designed as an add-on code Must be used in addition to the primary procedure code

Summary of codes in Appendix D


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Symbols: Plus SignExample

11200 Removal of skin tags, multiplefibrocutaneous tags, any area; up to and

including 15 lesions

+ 11201 each additional ten lesions, or part

thereof (List separately in addition tocode for primary procedure)

Note: 11201 is used in conjunction with 11200.


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Symbols: Null Symbol

Exemption to modifier 51 Alerts coders to the fact that the code cannot be

appended with modifier 51

Applies to physician coding onlyAll exempt codes listed in Appendix E


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Symbols: Null Symbol

Example

17004 Destruction (eg. laser surgery,

electrosurgery, cryosurgery, surgical

curettement), premalignant lesions (eg.Actinic keratoses), 15 or more lesions


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Symbols: Circled bullet

Indicates that CPT code includes conscious sedation asan inherent part of providing the procedure

Example: 33010 Pericardiocentesis; initial


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Symbols: Pending FDA Approval Symbol

Identifies codes for vaccines that are pending FDAapproval

Example:

90650 Human Papilloma virus (HPV) vaccine,

types 16, 18, bivalent, 3 dose schedule, forintramuscular use


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Symbols: # Resequenced Code

CPT codes do not appear in numeric sequence

For example:

46221 Hemorrhodectomy; internal, by rubber band ligation(s)

#46945 Hemorrhoidectomy, internal, by ligation other than rubber

band; single hemorrhoid column/group

23


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Unlisted Procedure

Allows the coder to assign a code to a procedure notlisted in CPT

Assigned as a last resort

Payers want documentation (operative report)

Note: The Alphabetic Index lists all unlisted procedures.


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Appendices

Appendix A: List of modifiers Appendix B: Summary of additions, deletions, and

revisions

Appendix C: Clinical examples for E/M coding

Appendix D: Summary of add-on codes

Appendix E: Summary of CPT codes exempt frommodifier 51


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Appendices - continued

Appendix F: Summary of CPT Codes exempt frommodifier 63

Appendix G: Summary of CPT Codes which include

conscious sedation

Appendix H: Alphabetic index of performance

measures by clinical condition or topic

Appendix I: Genetic testing code modifiers


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Appendices - continued

Appendix J: Electrodiagnostic medicine listing ofsensory, motor and mixed nerves

Appendix K: Product pending FDA approval

Appendix L: Vascular families Appendix M: Crosswalk for deleted CPT codes

Appendix N: Summary of Resequenced CPT codes


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Index

First step for locating a code

Alphabetic list

Main terms in bold print

Subterms indented

Never code directly from the index


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Health Record Documentation

CPT-4 and ICD-9-CM codes reported on the healthinsurance claim form or billing statement must be

supported by the documentationin the health

record


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Abstracting

Look for key action termsExcision

Biopsy

Removal


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Coding References

CPT Assistantauthoritative reference

CMS Medicare/Medicaid Transmittals

Contains payer advice

Can be confusing if it contradicts CPT guidelines


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Coding Skills

Abstracting

documentationUse of CPT

Accurate

code assignment

Knowledge of payer

guidelines and NCCI

Use of software

and resour ces

Application of the CPT System_ CH 02

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