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Introduction to CPT Coding
WHAT ARE WE DOING HERE? Coding Systems….how many? What are the differences? Who uses what? ……our focus for AHMS 160
History of CPT 1966    Published by AMA 1970    Five-digit codes 1983    Adopted as part of HCPCS                   ...
History of CPT 1986    Omnibus Budget Reconciliation Act (OBRA) 1996    HIPAA 2004    MMA
CPT Mandated Reporting Home health care and hospice agencies Outpatient hospital departments Physicians who are employe...
CPT Mandated Reporting Home health care and hospice agencies Outpatient hospital departments Physicians who are employe...
Non-Reportable Services Considered integral to procedure No separate code reported
Examples of Non-Reportable Services Administering sedatives Cleansing, shaving, and prepping of skin Draping and positi...
CPT Categories Category I codes    Procedures and services Category II codes    Performance measures Category III cod...
Organization of CPT Six sections    Evaluation and Management (E/M) (99201–99499)    Anesthesia (00100–01999, 99100–991...
CPT Index Alphabetic main terms    Boldfaced    Represent procedures or services, organs, anatomic     sites, condition...
Selection from CPT Index  Current Procedural Terminology © 2010 American Medical Association. All rights  reserved.
CPT Index Organization    Procedures or services (e.g., endoscopy)    Organs or other anatomic sites (e.g., elbow)    ...
CPT Index Boldfaced type    Main terms, categories, subcategories, and code numbers Italicized type    Cross-reference...
Appendices Appendix A    List of modifiers and descriptions Appendix B    Annual CPT coding additions, deletions, and ...
Appendices Appendix D    List of add-on codes    Identified with plus symbol (+) Appendix E    List of codes exempt f...
Appendices Appendix G    Summary of CPT codes identified with bull’s eye symbol    Codes that include Moderate (Conscio...
Appendices Appendix H    *Removed from CPT; Alphabetical Listing is available from     the AMA web site: www.ama-assn.or...
Appendices Appendix J    Electrodiagnostic medicine listing of sensory, motor, and     mixed nerves Appendix K    List...
Appendices Appendix L    List of vascular families Appendix M    List of deleted CPT codes and descriptions with cross...
CPT Symbols Bullet located to the left of code identifies new procedures  and services Triangle located to the left of c...
CPT SYMBOLS Plus identifies add-on codes for procedures commonly, but  not always, performed at the same time and by the ...
CPT Symbols Circle with slash identifies forbidden or prohibited codes  exempt from modifier -51 Bull’s eye identifies p...
CPT Symbols Symbol                                                CPT EntryUse of                   ; 11000 Debridement of...
CPT Guidelines Define terms and explain assignment of codes for  procedure and services Located at beginning of each CPT...
Sections, Subsections, Categories, and Subcategories Six sections subdivided into the following:    Subsections    Cate...
Sections, Subsections, Categories, andSubcategories           Selection from CPT that illustrates sections, subsections, c...
Unlisted Procedures and Services Unlisted procedure or unlisted service    Assigned when provider performs procedure or ...
Sections, Subsections, Categories, and Subcategories Notes, parenthetical notes, and descriptive qualifiers in  each sect...
Instructional Notes Blocked un-indented note Indented parenthetical note Parenthetical note
Descriptive Qualifiers Terms that clarify assignment of CPT code Can you find the descriptive qualifier in code 35188?  ...
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Ahms 160 ch. 8 pp part i

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Ahms 160 ch. 8 pp part i

  1. 1. Introduction to CPT Coding
  2. 2. WHAT ARE WE DOING HERE? Coding Systems….how many? What are the differences? Who uses what? ……our focus for AHMS 160
  3. 3. History of CPT 1966  Published by AMA 1970  Five-digit codes 1983  Adopted as part of HCPCS (continued)
  4. 4. History of CPT 1986  Omnibus Budget Reconciliation Act (OBRA) 1996  HIPAA 2004  MMA
  5. 5. CPT Mandated Reporting Home health care and hospice agencies Outpatient hospital departments Physicians who are employees of health care facility Physicians who see patients in their offices or clinics and in patients’ homes
  6. 6. CPT Mandated Reporting Home health care and hospice agencies Outpatient hospital departments Physicians who are employees of health care facility Physicians who see patients in their offices or clinics and in patients’ homes
  7. 7. Non-Reportable Services Considered integral to procedure No separate code reported
  8. 8. Examples of Non-Reportable Services Administering sedatives Cleansing, shaving, and prepping of skin Draping and positioning of patient Irrigating wound Inserting and removing drains
  9. 9. CPT Categories Category I codes  Procedures and services Category II codes  Performance measures Category III codes  Emerging technology
  10. 10. Organization of CPT Six sections  Evaluation and Management (E/M) (99201–99499)  Anesthesia (00100–01999, 99100–99140)  Surgery (10021–69990)  Radiology (70010–79999)  Pathology and Laboratory (80048–89398)  Medicine (90281–99199, 99500–99607)
  11. 11. CPT Index Alphabetic main terms  Boldfaced  Represent procedures or services, organs, anatomic sites, conditions, eponyms, or abbreviations  Subterms indented below
  12. 12. Selection from CPT Index Current Procedural Terminology © 2010 American Medical Association. All rights reserved.
  13. 13. CPT Index Organization  Procedures or services (e.g., endoscopy)  Organs or other anatomic sites (e.g., elbow)  Conditions (e.g., wound)  Synonyms (e.g., finger joint or intercarpal joint)  Eponyms (e.g., Whitman procedure)  Abbreviations (e.g., MRI) (continued)
  14. 14. CPT Index Boldfaced type  Main terms, categories, subcategories, and code numbers Italicized type  Cross-reference terms (e.g., see)  Directs coders to index entry under which codes are listed
  15. 15. Appendices Appendix A  List of modifiers and descriptions Appendix B  Annual CPT coding additions, deletions, and revisions Appendix C  Clinical examples for codes found in E/M section (continued)
  16. 16. Appendices Appendix D  List of add-on codes  Identified with plus symbol (+) Appendix E  List of codes exempt from modifier -51 Appendix F  List of codes exempt from modifier -63 (continued)
  17. 17. Appendices Appendix G  Summary of CPT codes identified with bull’s eye symbol  Codes that include Moderate (Conscious) Sedation (MCS) (continued)
  18. 18. Appendices Appendix H  *Removed from CPT; Alphabetical Listing is available from the AMA web site: www.ama-assn.org/go/cpt Appendix I  Genetic testing modifiers (continued)
  19. 19. Appendices Appendix J  Electrodiagnostic medicine listing of sensory, motor, and mixed nerves Appendix K  List of codes pending Food and Drug Administration (FDA) approval (continued)
  20. 20. Appendices Appendix L  List of vascular families Appendix M  List of deleted CPT codes and descriptions with crosswalk to new CPT codes
  21. 21. CPT Symbols Bullet located to the left of code identifies new procedures and services Triangle located to the left of code identifies revision of code description Horizontal triangle symbols surround revised guidelines and notes (continued)
  22. 22. CPT SYMBOLS Plus identifies add-on codes for procedures commonly, but not always, performed at the same time and by the same surgeon as the primary procedure (+)
  23. 23. CPT Symbols Circle with slash identifies forbidden or prohibited codes exempt from modifier -51 Bull’s eye identifies procedure that includes MCS Flash identifies codes that classify products pending FDA approval (continued)
  24. 24. CPT Symbols Symbol CPT EntryUse of ; 11000 Debridement of extensive eczematoussemicolon or infected skin; up to 10% of body surfaceUse of plus + 11001 Each additional 10% of body surfacesymbol (List separately in addition to code for primary procedure)Use of -51 17004 Destruction (e.g., laser surgery,modifier electrosurgery, cryosurgery,exemption chemosurgery, surgical curettement),symbol premalignant lesions (e.g., actinic keratoses), 15 or more lesionsUse of 33206 Insertion or replacement of permanentbull’s eye pacemaker with transvenousCurrent Procedural Terminology © 2010 American Medical Association. All rights reserved.symbol electrode(s); atrial
  25. 25. CPT Guidelines Define terms and explain assignment of codes for procedure and services Located at beginning of each CPT section  Guidelines from one CPT section do not apply to another CPT section Should be reviewed before assigning code
  26. 26. Sections, Subsections, Categories, and Subcategories Six sections subdivided into the following:  Subsections  Categories  Subcategories Guidelines at beginning of each subsection (continued)
  27. 27. Sections, Subsections, Categories, andSubcategories Selection from CPT that illustrates sections, subsections, categories, subcategories, notes, and descriptive qualifiers Current Procedural Terminology © 2010 American Medical Association. All rights reserved.
  28. 28. Unlisted Procedures and Services Unlisted procedure or unlisted service  Assigned when provider performs procedure or service for which there is no CPT code Special report must accompany claim to provide more information  e.g., copy of procedure report
  29. 29. Sections, Subsections, Categories, and Subcategories Notes, parenthetical notes, and descriptive qualifiers in each section, subsection, category, and subcategory
  30. 30. Instructional Notes Blocked un-indented note Indented parenthetical note Parenthetical note
  31. 31. Descriptive Qualifiers Terms that clarify assignment of CPT code Can you find the descriptive qualifier in code 35188? That’s right; head and neck qualifies the procedure as opposed to the same procedure involving the thorax and abdomen or extremities.

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