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Ahms 160 ch. 8 pp part i
- 1. Introduction to CPTCoding
- 2. WHAT ARE WEDOING HERE? Coding Systems….how many? What are the differences? Who uses what? ……our focus for AHMS 160
- 3. History of CPT 1966 Published by AMA 1970 Five-digit codes 1983 Adopted as part of HCPCS (continued)
- 4. History of CPT 1986 Omnibus Budget Reconciliation Act (OBRA) 1996 HIPAA 2004 MMA
- 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. 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. Non-Reportable Services Consideredintegral to procedure No separate code reported
- 8. Examples of Non-ReportableServices Administering sedatives Cleansing, shaving, and prepping of skin Draping and positioning of patient Irrigating wound Inserting and removing drains
- 9. CPT Categories CategoryI codes Procedures and services Category II codes Performance measures Category III codes Emerging technology
- 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. CPT Index Alphabeticmain terms Boldfaced Represent procedures or services, organs, anatomic sites, conditions, eponyms, or abbreviations Subterms indented below
- 12. Selection from CPTIndex Current Procedural Terminology © 2010 American Medical Association. All rights reserved.
- 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. CPT Index Boldfacedtype 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. 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. 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. Appendices Appendix G Summary of CPT codes identified with bull’s eye symbol Codes that include Moderate (Conscious) Sedation (MCS) (continued)
- 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. 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. Appendices Appendix L List of vascular families Appendix M List of deleted CPT codes and descriptions with crosswalk to new CPT codes
- 21. CPT Symbols Bulletlocated 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. CPT SYMBOLS Plusidentifies add-on codes for procedures commonly, but not always, performed at the same time and by the same surgeon as the primary procedure (+)
- 23. CPT Symbols Circlewith 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. CPT Symbols Symbol CPT Entry Use of ; 11000 Debridement of extensive eczematous semicolon or infected skin; up to 10% of body surface Use of plus + 11001 Each additional 10% of body surface symbol (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 lesions Use of 33206 Insertion or replacement of permanent bull’s eye pacemaker with transvenous Current Procedural Terminology © 2010 American Medical Association. All rights reserved. symbol electrode(s); atrial
- 25. CPT Guidelines Defineterms 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. Sections, Subsections, Categories,and Subcategories Six sections subdivided into the following: Subsections Categories Subcategories Guidelines at beginning of each subsection (continued)
- 27. Sections, Subsections, Categories,and Subcategories Selection from CPT that illustrates sections, subsections, categories, subcategories, notes, and descriptive qualifiers Current Procedural Terminology © 2010 American Medical Association. All rights reserved.
- 28. Unlisted Procedures andServices 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. Sections, Subsections, Categories,and Subcategories Notes, parenthetical notes, and descriptive qualifiers in each section, subsection, category, and subcategory
- 30. Instructional Notes Blockedun-indented note Indented parenthetical note Parenthetical note
- 31. Descriptive Qualifiers Termsthat 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.