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  1. 1. INTRODUCTION TO CPT PART THREE Chapter 9 CPT: Radiology, Pathology and Laboratory, and Medicine Codes McGraw-Hill/Irwin Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
  2. 2. <ul><li>LEARNING OUTCOMES </li></ul><ul><li>After studying this chapter, you should be able to: </li></ul><ul><li>Discuss the organization, key guidelines, and common modifiers for the Radiology section of CPT. </li></ul><ul><li>Discuss the importance of the number of views taken in radiology coding. </li></ul><ul><li>Explain the difference between the professional and technical components of a procedure. </li></ul><ul><li>Describe the use of contrast material in assigning radiology codes. </li></ul><ul><li>Distinguish between screening and diagnostic services. </li></ul><ul><li>Describe the organization, key guidelines, and common modifiers for the Pathology and Laboratory section of CPT. </li></ul><ul><li>Recognize common laboratory panels and their associated codes. </li></ul><ul><li>Describe the organization, key guidelines, and common modifiers for the Medicine section of CPT. </li></ul><ul><li>Describe the correct coding of immunizations. </li></ul><ul><li>Assign CPT radiology, pathology and laboratory, and medicine codes with appropriate modifiers based on procedural statements. </li></ul>9-
  3. 3. KEY TERMS <ul><li>Administration </li></ul><ul><li>Analyte </li></ul><ul><li>Ancillary services </li></ul><ul><li>Assay </li></ul><ul><li>Automated </li></ul><ul><li>Biofeedback </li></ul><ul><li>Cardiac catheterization </li></ul><ul><li>Charge capture </li></ul><ul><li>Charge description master (CDM) </li></ul><ul><li>CLIA-waived test </li></ul><ul><li>Clinical Laboratory Improvement Amendment (CLIA) </li></ul><ul><li>Complete blood count (CBC) </li></ul><ul><li>Complete lab test </li></ul><ul><li>Computerized axial tomography scan (CT or CAT scan) </li></ul><ul><li>Continuous positive airway pressure (CPAP) </li></ul><ul><li>Contrast material (media) </li></ul><ul><li>Diagnostic procedure </li></ul><ul><li>Echocardiography </li></ul><ul><li>Electrocardiogram (ECG/EKG) </li></ul><ul><li>Encounter form </li></ul><ul><li>Fluoroscopy </li></ul>9-
  4. 4. KEY TERMS <ul><li>Hemodialysis </li></ul><ul><li>Immunotherapy </li></ul><ul><li>Magnetic resonance imaging (MIR) </li></ul><ul><li>Mammography </li></ul><ul><li>Manual </li></ul><ul><li>Modality </li></ul><ul><li>Nuclear medicine </li></ul><ul><li>Panel </li></ul><ul><li>Peritoneal dialysis </li></ul><ul><li>Positron emission tomography (PET) </li></ul><ul><li>Professional component (PC) </li></ul><ul><li>Radiation oncology </li></ul><ul><li>Radiologic examination </li></ul><ul><li>Radiology </li></ul><ul><li>Radiology report </li></ul><ul><li>Red blood cell count (RBC) </li></ul><ul><li>Screening procedure </li></ul><ul><li>Single proton emission computerized tomography (SPECT) </li></ul><ul><li>Spirometry </li></ul><ul><li>Technical component (TC) </li></ul><ul><li>Ultrasound </li></ul><ul><li>White blood cell (WBC) count </li></ul>9-
  5. 5. ANCILLARY SERVICES <ul><li>Support the diagnosis and treatment of a disease or injury. </li></ul><ul><li>Include work such as: laboratory tests, radiological studies, pathology studies, physical therapy and speech therapy. </li></ul><ul><li>These services are provided to the patient at the request of a physician. </li></ul><ul><li>Some are performed in the hospital and others are done in physician offices, clinics or another facility. </li></ul>9-
  6. 6. RADIOLOGY <ul><li>CPT codes in this section concentrate on medical imaging to prevent, diagnose, and treat diseases or injuries. </li></ul><ul><li>Radiologists diagnose disease by obtaining and interpreting medical images. </li></ul><ul><li>Radiologist also treat a number of diseases by radiation. </li></ul><ul><li>Codes in this section can be used by any physician of any medical specialty to report radiological services performed by the physician or under the physician’s supervision. </li></ul>9-
  7. 7. RADIOLOGY SECTION <ul><li>Has 7 subsections </li></ul><ul><ul><li>Diagnostic Radiology 70000 – 76499 </li></ul></ul><ul><ul><li>Diagnostic Ultrasound 76500 – 76999 </li></ul></ul><ul><ul><li>Radiologic Guidance 77001 – 77032 </li></ul></ul><ul><ul><li>Breast, Mammography 77051 – 77059 </li></ul></ul><ul><ul><li>Bone/Joint Studies 77071 – 77084 </li></ul></ul><ul><ul><li>Radiation Oncology 77261 – 77999 </li></ul></ul><ul><ul><li>Nuclear Medicine 78000 – 79999 </li></ul></ul><ul><li>Organized by the method or type of radiology and the purpose of the service </li></ul><ul><ul><li>Subdivided by anatomical site & type of service </li></ul></ul>9-
  8. 8. RADIOLOGY GUIDELINES <ul><li>The physician ordering the radiology service needs to submit an order giving the reason for the examination. </li></ul><ul><li>If contrast materials are used, be sure to check for a bundled code or need for two codes. </li></ul><ul><li>A complete radiological service includes the use of equipment/supplies and the physician’s work. Modifiers are typically used to show which component was done, unless the physician did both. </li></ul><ul><ul><li>Technical component (TC) – the staff, technologists work, equipment, supplies or preinjection/postinjection services; typically the facility charge </li></ul></ul><ul><ul><li>Professional component (PC) – reading and interpreting the radiological test and providing a written report with findings; typically reported by the physician </li></ul></ul>9-
  9. 9. RADIOLOGY MODIFIERS <ul><li>-22 – unusual (increased) procedural service </li></ul><ul><li>-26 – professional component </li></ul><ul><li>-32 – mandated services </li></ul><ul><li>-51 – multiple procedures </li></ul><ul><li>-52 – reduced services </li></ul><ul><li>-58 – staged or related procedure or service by the same physician during the postop period </li></ul><ul><li>-59 – distinct procedural service </li></ul><ul><li>-62 – two surgeons-63 – procedure performed on infants less than 4 kg </li></ul><ul><li>-66 – surgical team </li></ul><ul><li>-76 – repeat procedure by same physician </li></ul><ul><li>-77 – repeat procedure by another physician </li></ul><ul><li>-78 – return to the operating room for a related procedure during the postoperative period </li></ul><ul><li>-79 – unrelated procedure or service by the same physician during the postoperative period </li></ul><ul><li>-80 – assistant surgeon </li></ul><ul><li>-99 – multiple modifiers </li></ul><ul><li>-LT, -RT, -TA to -T9, -FA to –F9, -LC, -LD, -RC – Anatomical modifiers </li></ul>9-
  10. 10. DIAGNOSTIC RADIOLOGY <ul><li>Arranged by anatomical site and then modality </li></ul><ul><li>Common procedures: </li></ul><ul><ul><li>Radiologic Examination </li></ul></ul><ul><ul><li>Computerized Axial Tomography (CT or CAT scan) </li></ul></ul><ul><ul><li>Magnetic Resonance Imaging (MRI) </li></ul></ul><ul><ul><li>Fluoroscopy </li></ul></ul><ul><ul><li>Diagnostic Ultrasound </li></ul></ul><ul><ul><li>Radiologic Guidance </li></ul></ul><ul><ul><li>Mammography </li></ul></ul><ul><ul><li>Bone/Joint Studies </li></ul></ul><ul><ul><li>Radiation Oncology </li></ul></ul><ul><ul><li>Nuclear Medicine </li></ul></ul>9-
  11. 11. STEPS IN ASSIGNING RADIOLOGY CODES <ul><li>Review the complete medical documentation and identify the type of service performed. </li></ul><ul><li>Locate the body site being viewed. </li></ul><ul><li>Locate the terms in the CPT index. </li></ul><ul><li>Read the code descriptors to select codes based on radiology terminology. </li></ul><ul><li>Consider assignment of modifiers. </li></ul>9-
  12. 12. PATHOLOGY AND LABORATORY <ul><li>Contains a broad range of codes from routine tests performed in a physician office to highly sophisticated labs </li></ul><ul><li>Laboratory services are done to assess patient specimens </li></ul><ul><li>Pathology services are done to identify diseases by studying cells and tissues under a microscope </li></ul><ul><li>Most codes are for the technical component only </li></ul>9-
  13. 13. PATHOLOGY AND LABORATORY GUIDELINES <ul><li>Guidelines and notes are located before the codes. </li></ul><ul><li>Assign as many codes as necessary to capture all services performed. </li></ul><ul><li>Unlisted codes are available and should be assigned only after checking Category III or HCPCS level II codes. </li></ul><ul><li>Every laboratory test must be ordered by a physician, physician’s assistant or registered nurse practitioner. </li></ul>9-
  14. 14. PATHOLOGY AND LABORATORY SUBSECTIONS <ul><li>Organ or disease panels 80048-80076 </li></ul><ul><li>Drug testing 80100-80103 </li></ul><ul><li>Therapeutic drug assays 80150-80299 </li></ul><ul><li>Evocative/suppression testing 80400-80440 </li></ul><ul><li>Consultations (clinical Pathology) 80500-80502 </li></ul><ul><li>Urinalysis 81000-81099 </li></ul><ul><li>Chemistry 82000-84999 </li></ul><ul><li>Hematology and coagulation 85002-85999 </li></ul><ul><li>Immunology 86000-86849 </li></ul><ul><li>Transfusion Medicine 86850-86999 </li></ul><ul><li>Microbiology 87001-87999 </li></ul><ul><li>Anatomic Pathology 88000-88099 </li></ul><ul><li>Cytopathology 88104-88199 </li></ul><ul><li>Cytogenetic Studies 88230-88299 </li></ul><ul><li>Surgical Pathology 88300-88399 </li></ul><ul><li>Transcutaneous Procedures 88400 </li></ul><ul><li>Other Procedures 89049-89240 </li></ul><ul><li>Reproductive Medicine Procedures 89250-89356 </li></ul>9-
  15. 15. COMPLETE LABORATORY CODES <ul><li>Includes ordering the procedure or test, obtaining the sample or specimen, handling the specimen, performing the actual procedure or test, and analyzing and interpreting the results </li></ul><ul><li>Blood can be collected via a vein, capillary stick or other device. </li></ul><ul><li>All lab work is regulated by Clinical Laboratory Improvement Amendments (CLIA) rules. </li></ul>9-
  16. 16. PATHOLOGY AND LABORATORY MODIFIERS <ul><li>-22 – unusual (increased) procedural services </li></ul><ul><li>-26 – professional component </li></ul><ul><li>-32 – mandated services </li></ul><ul><li>-52 – reduced services </li></ul><ul><li>-53 – discounted procedure </li></ul><ul><li>-59 – distinct procedural service </li></ul><ul><li>-90 – reference (outside) laboratory </li></ul><ul><li>-91 – Repeat clinical diagnostic lab test </li></ul>9-
  17. 17. ORGAN AND DISEASE-ORIENTED PANELS <ul><li>A panel is a group of lab tests commonly performed together to diagnose organ dysfunction or to monitor a disease </li></ul><ul><li>Common Panels: </li></ul><ul><ul><li>Basic metabolic 80048 </li></ul></ul><ul><ul><li>General Health 80050 </li></ul></ul><ul><ul><li>Electrolyte 80051 </li></ul></ul><ul><ul><li>Comprehensive metabolic 80053 </li></ul></ul><ul><ul><li>Obstetric 80055 </li></ul></ul><ul><ul><li>Lipid 80061 </li></ul></ul><ul><ul><li>Renal function 80069 </li></ul></ul><ul><ul><li>Acute Hepatitis 80074 </li></ul></ul><ul><ul><li>Hepatic function 80076 </li></ul></ul>9-
  18. 18. LABORATORY CODES <ul><li>Common procedures: </li></ul><ul><ul><li>Drug testing </li></ul></ul><ul><ul><li>Therapeutic drug assays </li></ul></ul><ul><ul><li>Evocative/suppression testing </li></ul></ul><ul><ul><li>Urinalysis </li></ul></ul><ul><ul><li>Chemistry </li></ul></ul><ul><ul><li>Hematology and coagulation </li></ul></ul><ul><ul><li>Immunology </li></ul></ul><ul><ul><li>Transfusion medicine </li></ul></ul><ul><ul><li>Microbiology </li></ul></ul><ul><ul><li>Cytopathology </li></ul></ul><ul><ul><li>Pathology consultations </li></ul></ul><ul><ul><li>Surgical pathology </li></ul></ul>9-
  19. 19. STEPS IN ASSIGNING LABORATORY CODES <ul><li>Based on the documentation locate the services in the CPT index. </li></ul><ul><li>Read all code descriptions from the code ranges provided. </li></ul><ul><li>Select code based on whether the procedure was quantitative or qualitative. </li></ul><ul><li>Consider modifier assignment. </li></ul>9-
  20. 20. MEDICINE SECTION <ul><li>Includes codes for procedures that are primarily evaluative, diagnostic and/or therapeutic. </li></ul><ul><li>Codes for non-invasive or minimally invasive procedures </li></ul><ul><li>Most procedures are typically performed in the physician office. </li></ul><ul><li>Many codes are driven by time, quantity, age and professional component service. </li></ul><ul><li>Located directly before the Category II and Category III codes </li></ul><ul><li>Subsections are arranged by specialty areas or type of service </li></ul>9-
  21. 21. MEDICINE GUIDELINES <ul><li>When coding multiple procedures, watch for unbundling, add-on codes, and separate procedures. </li></ul><ul><li>Many times more than one code is required. </li></ul><ul><li>E/M codes can only be assigned in addition if this was a significant, separate E/M service. </li></ul>9-
  22. 22. MEDICINE SUBSECTIONS <ul><li>Immune Globulins 90281-90399 </li></ul><ul><li>Immunization Administration 90465-90474 for Vaccines/ Toxoids </li></ul><ul><li>Vaccines, Toxoids 90476-90749 </li></ul><ul><li>Hydration, Therapeutic, 90760-90799 Prophylactic, & Diagnostic Injections & Infusions </li></ul><ul><li>Psychiatry 90801-90899 </li></ul><ul><li>Biofeedback 90901-90911 </li></ul><ul><li>Dialysis 90918-90999 </li></ul><ul><li>Gastroenterology 91000-91299 </li></ul><ul><li>Ophthalmology 92002-92499 </li></ul><ul><li>Special Otorhinolarngologic services 92502-92700 </li></ul><ul><li>Cardiovascular 92950-93799 </li></ul><ul><li>Noninvasive Vascular Diagnostic Studies 93875-93990 </li></ul><ul><li>Pulmonary 94002-94799 </li></ul><ul><li>Allergy and Clinical Immunology 95004-95199 </li></ul><ul><li>Endocrinology 95250-95251 </li></ul><ul><li>Neurology and Neuromuscular Procedures 95805-96020 </li></ul>9-
  23. 23. MEDICINE SUBSECTIONS <ul><li>Medical Genetics and Genetic Counseling Services 96040 </li></ul><ul><li>Central Nervous System Tests 96101-96120 </li></ul><ul><li>Health and Behavior Assessment 96150-96155 </li></ul><ul><li>Chemotherapy Administration 96401-96549 </li></ul><ul><li>Photodynamic Therapy 96567-96571 </li></ul><ul><li>Special Dermatological Procedures 96900-96999 </li></ul><ul><li>Physical Medicine and Rehabilitation 97001-97799 </li></ul><ul><li>Medical Nutrition Therapy 97802-97804 </li></ul><ul><li>Acupuncture 97810-97814 </li></ul><ul><li>Osteopathic Manipulative Treatment 98925-98929 </li></ul><ul><li>Chiropractic Manipulative Treatment 98940-98943 </li></ul><ul><li>Education and Training for Patient Self Management 98960-98962 </li></ul><ul><li>Special Services, Procedures and reports 99000-99091 </li></ul><ul><li>Qualifying Circumstances for Anesthesia 99100-99140 </li></ul><ul><li>Moderate (Conscious) Sedation 99143-99199 </li></ul><ul><li>Home Health Procedures/Services 99500-99602 </li></ul>9-
  24. 24. MEDICINE MODIFIERS <ul><li>-22 – unusual (increased) procedural service </li></ul><ul><li>-26 – professional component </li></ul><ul><li>-51 – multiple procedures </li></ul><ul><li>-52 – reduced services </li></ul><ul><li>-53 – discontinued procedure </li></ul><ul><li>-55 – postoperative management </li></ul><ul><li>-56 – preoperative management </li></ul><ul><li>-57 – decision for surgery </li></ul><ul><li>-58 – staged or related procedure or service by the same physician during the postop period </li></ul><ul><li>-59 – distinct procedural service </li></ul><ul><li>-76 – repeat procedure by same physician </li></ul><ul><li>-77 – repeat procedure by another physician </li></ul><ul><li>-78 – return to the operating room for a related procedure during the postoperative period </li></ul><ul><li>-79 – unrelated procedure or service by the same physician during the postoperative period </li></ul><ul><li>-LC, -LD, -RC – Coronary artery modifiers </li></ul><ul><li>-LT, -RT, -TA to -T9, -FA to –F9, - Anatomical modifiers </li></ul>9-
  25. 25. ASSIGNING MEDICINE CODES <ul><li>Review the documentation and determine the type of service provided. </li></ul><ul><li>Locate main terms in the CPT index. </li></ul><ul><li>Determine if drugs were given. </li></ul><ul><li>Check subterms and read descriptors thoroughly. </li></ul><ul><li>Verify that the code description matches the services documented. </li></ul><ul><li>Assign codes for all significant services and consider modifiers, if appropriate. </li></ul>9-