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CPT and HCPCS Coding

This document is a lecture on Current Procedural Terminology (CPT) and Health Care Procedure Coding System (HCPCS) coding systems given by Raymond R. Arons at Baruch College/Mount Sinai School of Medicine. It provides a history of CPT, how it is organized and updated, examples of codes for evaluation and management, anesthesia, surgery, radiology, pathology, and medicine. It also includes New York State Medicaid fee schedules for physician services.

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Baruch College/Mount Sinai School of Medicine Program in Health Care Administration and Policy Current Procedural Terminology (CPT) and Health Care Procedure Coding System (HCPCS) Lecture 10CPT January 17, 2011 Raymond R. Arons, Dr. P.H., M.P.H
Lecture 10 CPT and HCPCS Coding System 2 Baruch College/Mount Sinai School of Medicine Program In Health Care Administration and Policy BUS 9100: The Social and Governmental Environment of the Business of Health Care Lecture 10CPT January 11, 2011 Current Procedural Terminology (CPT) and Health Care Procedure Coding System (HCPCS) Raymond R. Arons, Dr. P.H, M.P.H Coding Methods Currently in Use International Classification of Diseases - ICD-9-CM – Coding of Inpatient Discharges International Classification of Diseases - ICD-10-CM – Not yet adopted Diagnosis-related Groupings (DRGs) Medicare – Hospital reimbursement Physician Current Procedure Terminology (CPT) – Physicians for procedures performed Common Procedure Coding System (HCPCS) – Used by vendors of equipment and services 2 Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 3 Current Procedural Terminology (CPT) History Operations Definitions Classification of Procedure Groupings Example codes 3 Current Procedural Terminology (CPT) History CPT was first developed and published by the AMA in 1966. We are now using the fourth edition, the CPT-4 version of this coding system. The purpose of the system when first developed had nothing to do with reimbursement; it was to help standardize terminology among physicians and to serve as a type of shorthand that would simplify medical records for physicians and record clerks. 4 continued... http://findarticles.com/p/articles/mi_m3230/is_10_32/ai_66498630/ (Visited January 10, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 4 Current Procedural Terminology (CPT) History With the introduction of the second edition in 1970, the codes changed from 4 digits to 5 and became far more inclusive. Sometime during this period, laboratory procedures were incorporated into the CPT system. In 1983, HCFA merged CPT with its own Common Procedure Coding System (HCPCS) and mandated that CPT be used for all Medicare billing. . 5 continued... http://findarticles.com/p/articles/mi_m3230/is_10_32/ai_66498630/ (Visited January 10, 2011) Current Procedural Terminology (CPT) History A similar mandate extended this system to Medicaid billing in 1986. The AMA owns the copyright for CPT and collects fees from the users to help defray maintenance expenses. CPT tends to be organized around procedures, while ICD is more focused on diagnosis. Almost all third party payers use CPT as the codified means of processing claims for physician billing 6 continued... http://findarticles.com/p/articles/mi_m3230/is_10_32/ai_66498630/ (Visited January 10, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 5 (CPT) Updates and Methods The CPT system, as developed and maintained by the AMA, is governed by the CPT editorial panel, a group of 16 individuals (virtually all physicians) who are empowered to make final decisions with regard to the content of CPT. This panel is supported at the AMA by a staff of about 12 and by about 75 CPT advisors representing nearly all of the medical specialty societies seated in the AMA House of Delegates). 7 continued... http://findarticles.com/p/articles/mi_m3230/is_10_32/ai_66498630/ (Visited January 10, 2011) (CPT) Updates and Methods The CPT panel also has members from CMS, the Blue Cross/Blue Shield Association, the American Hospital Association, and the private insurance industry. This panel meets about quarterly to consider alterations to the code and any other matters related to the publishing and use of CPT. The AMA Publications Office is responsible for publishing the standard yearly edition of CPT-4, as well as various editions directed at specific specialties. 8 continued... Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 6 http://findarticles.com/p/articles/mi_m3230/is_10_32/ai_66498630/ (Visited January 10, 2011) (CPT) Updates and Method The process of generating a new code or revising an existing one usually begins with a query to the AMA CPT coding office. Requests for changes may come from physicians, medical societies, manufacturers, billing services, hospital coders, or any other interested party. To request a new code or to suggest revising or deleting an existing one, the requesting party must provide information about the frequency of use of the procedure/test in question, how the test/procedure is presently being coded, and documentation of the need for the request 9 continued... CPT Code Organization Medical Management Anesthesia Surgery Radiology Pathology and Laboratory Medicine 10 Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 7 American Medical Association, Current Procedure Terminology CPT 2007,Standard Edition, 2006, Chicago, Illinois S9100 Medical Evaluation and Management Examples Office or Other Outpatient Services Hospital Observation Services Hospital Inpatient Services Consultations ED Services Pediatric Critical Care Transport Critical Care Services Neonatal Services Pediatric Critical Care Inpatient Neonatal Care 11 American Medical Association, Current Procedure Terminology CPT 2007,Standard Edition, 2006, Chicago, Illinois anuary 17, 2011 Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 8 Anesthesia Examples Head Neck Thorax Intrathoracic Spine and Spinal Cord Upper Abdomen Lower Abdomen Perineum Pelvis 12 American Medical Association, Current Procedure Terminology CPT 2007,Standard Edition, 2006, Chicago, Illinois ecture 10CPT Surgery Examples General Integumentary Musculoskeletal Respiratory Cardiovascular Hemic and Lymphatic Mediastinum Digestive Urinary Male Genital 13 Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 9 American Medical Association, Current Procedure Terminology CPT 2007,Standard Edition, 2006, Chicago, Illinois Radiology Examples Diagnostic Imaging Diagnostic Ultrasound Radiologic Guidance Breast Mammography Bone/Joint Studies Radiology Oncology Nuclear Medicine 14 American Medical Association, Current Procedure Terminology CPT 2007,Standard Edition, 2006, Chicago, Illinois Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 10 Pathology and Laboratory Examples Organ or Disease-Oriented Panels Drug Testing Therapeutic Drug Assays Evocation/Suppression Testing Consultation (Clinical Pathology) Urinalysis Hematology and Coagulations Immunology Transfusion Medicine Microbiology 15 American Medical Association, Current Procedure Terminology CPT 2007,Standard Edition, 2006, Chicago, Illinois Medicine Examples Immune Globulins Immunizations for Vaccines Vaccines Toxids Hydration Therapeutics Psychiatry Biofeedback Dialysis Gastroenterology Ophthalmology Cardiovascular 16 Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 11 American Medical Association, Current Procedure Terminology CPT 2007,Standard Edition, 2006, Chicago, Illinois NYS Medicaid Physician Medicine Services Fee Fee NON- FACILITY FACILITY GLOBAL GLOBAL CODE DESCRIPTION FEE FEE 81000 URINALYSIS, BY DIP STICK OR TABLET REAGE 4.00 4.00 81001 URINALYSIS, BY DIP STICK OR TABLET REAGE 4.00 4.00 81002 URINALYSIS, BY DIP STICK OR TABLET REAGE 2.00 2.00 81003 URINALYSIS, BY DIP STICK OR TABLET REAGE 2.00 2.00 81015 URINALYSIS; MICROSCOPIC ONLY 2.00 2.00 81025 URINE PREGNANCY TEST, BY VISUAL COLOR CO 2.00 2.00 83655 LEAD 15.00 15.00 85007 BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EX 1.43 1.43 85013 BLOOD COUNT; SPUN MICROHEMATOCRIT 2.00 2.00 85018 BLOOD COUNT; HEMOGLOBIN (HGB) 2.00 2.00 85025 BLOOD COUNT; COMPLETE (CBC), AUTOMATED ( 3.17 3.17 85041 BLOOD COUNT; RED BLOOD CELL (RBC), AUTOM 3.17 3.17 85048 BLOOD COUNT; LEUKOCYTE (WBC), AUTOMATED 3.17 3.17 85651 SEDIMENTATION RATE, ERYTHROCYTE; NON-AUT 2.00 2.00 17 http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 12 NYS Medicaid Physician Medicine Services Fee Schedule 93603 RIGHT VENTRICULAR RECORDING 143.48 143.48 93609 INTRAVENTRICULAR AND/OR INTRA-ATRIAL MAP 297.03 297.03 93610 INTRA-ATRIAL PACING 169.83 169.83 93612 INTRAVENTRICULAR PACING 178.16 178.16 93613 INTRACARDIAC ELECTROPHYSIOLOGIC 3-DIMENS 243.20 202.67 93615 ESOPHAGEAL RECORDING OF ATRIAL ELECTROGR 47.39 47.39 93616 ESOPHAGEAL RECORDING OF ATRIAL ELECTROGR 61.65 61.65 93618 INDUCTION OF ARRHYTHMIA BY ELECTRICAL PA 306.84 306.84 93619 COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUAT 563.12 563.12 93620 COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUAT 781.92 781.92 93621 COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUAT 1,670.54 1,670.54 93622 COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUAT 1,742.22 1,742.22 18 continued... http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) NYS Medicaid Physician Medicine Services Fee Schedule 93455 CATHETER PLACEMENT IN CORONARY ARTERY(S) 487.72 487.72 173.74 93456 CATHETER PLACEMENT IN CORONARY ARTERY(S) 523.05 523.05 193.04 93457 CATHETER PLACEMENT IN CORONARY ARTERY(S) 592.62 592.62 216.06 93458 CATHETER PLACEMENT IN CORONARY ARTERY(S) 504.21 504.21 186.66 93459 CATHETER PLACEMENT IN CORONARY ARTERY(S) 556.83 556.83 206.88 93460 CATHETER PLACEMENT IN CORONARY ARTERY(S) 595.45 595.45 230.49 93461 CATHETER PLACEMENT IN CORONARY ARTERY(S) 682.69 682.69 254.25 93462 LEFT HEART CATHETERIZATION BY TRANSSEPTA 97.78 78.15 93463 PHARMACOLOGIC AGENT ADMINISTRATION (EG, 49.67 41.39 93464 PHYSIOLOGIC EXERCISE STUDY (EG, BICYCLE 119.97 119.97 54.60 93503 INSERTION AND PLACEMENT OF FLOW DIRECTED 140.00 140.00 93505 ENDOMYOCARDIAL BIOPSY 502.53 502.53 180.86 93530 RIGHT HEART CATHETERIZATION, FOR CONGENI 733.61 733.61 174.04 93531 COMBINED RIGHT HEART CATHETERIZATION AND 1,934.96 1,934.96 339.03 93532 COMBINED RIGHT HEART CATHETERIZATION AND 1,924.01 1,924.01 395.79 93533 COMBINED RIGHT HEART CATHETERIZATION AND 1,803.39 1,803.39 275.48 19 Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 13 NYS Medicaid Physician Anesthesia Services Fee Schedule Examples ANEST CODE DESCRIPTION BASE 00100 ANESTHESIA FOR PROCEDURES ON SALIVARY 5 00102 ANESTHESIA FOR PROCEDURES INVOLVING PLA 6 00103 ANESTHESIA FOR RECONSTRUCTIVE PROCEDU 5 00104 ANESTHESIA FOR ELECTROCONVULSIVE THERA 4 00120 ANESTHESIA FOR PROCEDURES ON EXTERNAL, 5 00124 ANESTHESIA FOR PROCEDURES ON EXTERNAL, 4 00126 ANESTHESIA FOR PROCEDURES ON EXTERNAL, 4 00140 ANESTHESIA FOR PROCEDURES ON EYE; NOT 5 00142 ANESTHESIA FOR PROCEDURES ON EYE; LENS 4 00144 ANESTHESIA FOR PROCEDURES ON EYE; COR 6 00145 ANESTHESIA FOR PROCEDURES ON EYE; VITR 6 00147 ANESTHESIA FOR PROCEDURES ON EYE; IRIDE 4 20 continued... http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) NYS Medicaid Physician Anesthesia Services Fee Schedule Examples 01634 ANESTHESIA FOR OPEN OR SURGICAL ARTHRO 9 01636 ANESTHESIA FOR OPEN OR SURGICAL ARTHRO 15 01638 ANESTHESIA FOR OPEN OR SURGICAL ARTHRO 10 01650 ANESTHESIA FOR PROCEDURES ON ARTERIES 6 01652 ANESTHESIA FOR PROCEDURES ON ARTERIES 10 01654 ANESTHESIA FOR PROCEDURES ON ARTERIES 8 01656 ANESTHESIA FOR PROCEDURES ON ARTERIES 10 01670 ANESTHESIA FOR ALL PROCEDURES ON VEINS 4 01680 ANESTHESIA FOR SHOULDER CAST APPLICATIO 3 01682 ANESTHESIA FOR SHOULDER CAST APPLICATIO 4 01710 ANESTHESIA FOR PROCEDURES ON NERVES, 3 01712 ANESTHESIA FOR PROCEDURES ON NERVES, 5 01714 ANESTHESIA FOR PROCEDURES ON NERVES, 5 01716 ANESTHESIA FOR PROCEDURES ON NERVES, 5 21 http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 14 NYS Medicaid Physician Radiology Services Fee Schedule Examples NON- FACILITY FACILITY GLOBAL GLOBAL CODE DESCRIPTION FEE FEE 70010 MYELOGRAPHY, POSTERIOR FOSSA, RADIOLOGIC 153.98 153.98 70015 CISTERNOGRAPHY, POSITIVE CONTRAST, RADIO 106.59 106.59 70030 RADIOLOGIC EXAMINATION, EYE, FOR DETECTI 21.80 21.80 70100 RADIOLOGIC EXAMINATION, MANDIBLE; PARTIA 24.24 24.24 70110 RADIOLOGIC EXAMINATION, MANDIBLE; COMPLE 30.85 30.85 70120 RADIOLOGIC EXAMINATION, MASTOIDS; LESS T 27.26 27.26 70130 RADIOLOGIC EXAMINATION, MASTOIDS; COMPLE 42.04 42.04 70134 RADIOLOGIC EXAMINATION, INTERNAL AUDITOR 37.42 37.42 70140 RADIOLOGIC EXAMINATION, FACIAL BONES; LE 25.40 25.40 70150 RADIOLOGIC EXAMINATION, FACIAL BONES; CO 34.50 34.50 70160 RADIOLOGIC EXAMINATION, NASAL BONES, COM 24.88 24.88 22 continued... http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) NYS Medicaid Physician Radiology Services Fee Schedule Examples 70488 COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; 314.73 314.73 52.66 70490 COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; W 202.11 202.11 47.96 70491 COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; W 263.26 263.26 51.48 70492 COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; W 315.91 315.91 53.84 70496 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEAD, 329.87 329.87 65.31 70498 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, NECK, 330.18 330.18 65.62 70540 MAGNETIC RESONANCE (EG, PROTON) IMAGING, 326.77 326.77 50.00 70542 MAGNETIC RESONANCE (EG, PROTON) IMAGING, 380.27 380.27 60.31 70543 MAGNETIC RESONANCE (EG, PROTON) IMAGING, 502.55 502.55 79.70 70544 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WI 321.20 321.20 44.72 70545 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WI 364.11 364.11 44.72 23 http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 15 NYS Medicaid Physician Surgery Services Fee Schedule NON- FACILITY FACILITY GLOBAL GLOBAL CODE DESCRIPTION FEE FEE 10021 FINE NEEDLE ASPIRATION; WITHOUT IMAGING 81.61 60.00 10022 FINE NEEDLE ASPIRATION; WITH IMAGING GUI 85.59 72.00 10040 ACNE SURGERY (EG, MARSUPIALIZATION, OPEN 54.25 39.26 10060 INCISION AND DRAINAGE OF ABSCESS (EG, CA 60.50 43.24 10061 INCISION AND DRAINAGE OF ABSCESS (EG, CA 103.19 76.76 10080 INCISION AND DRAINAGE OF PILONIDAL CYST; 97.93 45.10 10081 INCISION AND DRAINAGE OF PILONIDAL CYST; 148.94 76.74 10120 INCISION AND REMOVAL OF FOREIGN BODY, SU 78.42 42.79 10121 INCISION AND REMOVAL OF FOREIGN BODY, SU 149.18 87.61 10140 INCISION AND DRAINAGE OF HEMATOMA, SEROM 85.50 56.28 10160 PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA 70.27 45.44 10180 INCISION AND DRAINAGE, COMPLEX, POSTOPER 131.00 83.94 11000 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR I 29.85 15.44 24 continued... http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) NYS Medicaid Physician Surgery Services Fee Schedule 32665 THORACOSCOPY, SURGICAL; WITH ESOPHAGOMYO 691.75 576.46 32800 REPAIR LUNG HERNIA THROUGH CHEST WALL 539.32 449.44 32810 CLOSURE OF CHEST WALL FOLLOWING OPEN FLA 524.65 437.21 32815 OPEN CLOSURE OF MAJOR BRONCHIAL FISTULA 1,453.79 1,211.49 32820 MAJOR RECONSTRUCTION, CHEST WALL (POSTTR 32851 LUNG TRANSPLANT, SINGLE; WITHOUT CARDIOP 1,549.91 1,291.59 32852 LUNG TRANSPLANT, SINGLE; WITH CARDIOPULM 1,732.54 1,443.78 32853 LUNG TRANSPLANT, DOUBLE (BILATERAL SEQUE 1,853.06 1,544.22 32854 LUNG TRANSPLANT, DOUBLE (BILATERAL SEQUE 2,006.71 1,672.26 32900 RESECTION OF RIBS, EXTRAPLEURAL, ALL STA 788.89 657.41 32905 THORACOPLASTY, SCHEDE TYPE OR EXTRAPLEUR 785.88 654.90 32906 THORACOPLASTY, SCHEDE TYPE OR EXTRAPLEUR 969.20 807.67 32940 PNEUMONOLYSIS, EXTRAPERIOSTEAL, INCLUDIN 719.27 599.39 32960 PNEUMOTHORAX, THERAPEUTIC, INTRAPLEURAL 82.48 47.00 25 http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 16 NYS Medicaid Physician Drug and Drug Administration Services Fee Schedule NON- FACILITY FACILITY GLOBAL GLOBAL CODE DESCRIPTION FEE FEE 90281 IMMUNE GLOBULIN (IG), HUMAN, FOR INTRAMU cost cost 90283 IMMUNE GLOBULIN (IGIV), HUMAN, FOR INTRA cost cost 90284 IMMUNE GLOBULIN (SCIG), HUMAN, FOR USE I cost cost 90291 CYTOMEGALOVIRUS IMMUNE GLOBULIN (CMV-IGI cost cost 90371 HEPATITIS B IMMUNE GLOBULIN (HBIG), HUMA cost cost 90375 RABIES IMMUNE GLOBULIN (RIG), HUMAN, FOR cost cost 90376 RABIES IMMUNE GLOBULIN, HEAT-TREATED (RI cost cost 90378 RESPIRATORY SYNCYTIAL VIRUS, MONOCLONAL cost cost 90384 RHO(D) IMMUNE GLOBULIN (RHIG), HUMAN, FU cost cost 90385 RHO(D) IMMUNE GLOBULIN (RHIG), HUMAN, MI cost cost 90386 RHO(D) IMMUNE GLOBULIN (RHIGIV), HUMAN, cost cost 90389 TETANUS IMMUNE GLOBULIN (TIG), HUMAN, FO cost cost 26 continued... http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) NYS Medicaid Physician Drug and Drug Administration Services Fee Schedule 96361 INTRAVENOUS INFUSION, HYDRATION; EACH AD 10.38 8.65 96365 INTRAVENOUS INFUSION, FOR THERAPY, PROPH 43.84 36.54 96366 INTRAVENOUS INFUSION, FOR THERAPY, PROPH 13.75 11.46 96367 INTRAVENOUS INFUSION, FOR THERAPY, PROPH 21.89 18.25 96368 INTRAVENOUS INFUSION, FOR THERAPY, PROPH 12.83 10.70 96369 SUBCUTANEOUS INFUSION FOR THERAPY OR PRO 96.10 80.09 96370 SUBCUTANEOUS INFUSION FOR THERAPY OR PRO 9.79 8.16 96371 SUBCUTANEOUS INFUSION FOR THERAPY OR PRO 46.79 38.99 96372 THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC 13.23 11.03 96405 CHEMOTHERAPY ADMINISTRATION; INTRALESION 86.65 14.37 96406 CHEMOTHERAPY ADMINISTRATION; INTRALESION 98.36 20.44 96409 CHEMOTHERAPY ADMINISTRATION; INTRAVENOUS 76.60 63.84 96413 CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS 103.82 86.52 96415 CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS 22.99 19.16 27 http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 17 Part 2 Health Care Procedure Coding System -HCPCS Health Care Procedure Coding System - HCPCS History Operations Definitions Classification of Procedure Groupings Example codes 31 Practice Management Information Corporation, HCPCS, Health Care Procedure Coding System, National Level II Medicare Codes, 2006, Los Angeles, Cal. 2005. Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 18 HCPCS History Each year, in the United States, health care insurers process over 5 billion claims for payment. The HCPCS Level II Code Set is one of the standard code sets used for this purpose. The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS.). Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians. 32 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage (Visited Jan 17, 2011) HCPCS History Level II standardized coding system that is used primarily to identify products, supplies, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment the level II HCPCS codes were established for submitting claims for these items. The development and use of level II of the HCPCS began in the 1980's. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits. 33 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage (Visited Jan 17, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 19 HCPCS Categories Transportation Services Medical and Surgical Supplies Administrative, Miscellaneous and Investigational Enteral and Parenteral Therapy Hospital Outpatient PPS Codes Dental Procedures Procedures and Professional Services Rehabilitative Services Drugs Administered Other Than Oral Method Chemotherapy Drugs 34 continued... Practice Management Information Corporation, HCPCS, Health Care Procedure Coding System, National Level II Medicare Codes, 2006, Los Angeles, Cal. 2005. HCPCS Categories K Codes for DMERCS’ USE Only Orthotic Procedures Prosthetics Medical Services Pathology and Laboratory Diagnostic Radiology Servicers Private Payer Codes State Medicaid Agency Codes Vision Services Hearing Services 35 continued... Practice Management Information Corporation, HCPCS, Health Care Procedure Coding System, National Level II Medicare Codes, 2006, Los Angeles, Cal. 2005. Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 20 HCPCS For Medical and Surgical Supplies HCPC Seq Num RIC Long Description A1 00100 7 DRESSING FOR ONE WOUND A2 00100 7 DRESSING FOR TWO WOUNDS A3 00100 7 DRESSING FOR THREE WOUNDS A4 00100 7 DRESSING FOR FOUR WOUNDS A5 00100 7 DRESSING FOR FIVE WOUNDS A6 00100 7 DRESSING FOR SIX WOUNDS A7 00100 7 DRESSING FOR SEVEN WOUNDS A8 00100 7 DRESSING FOR EIGHT WOUNDS A9 00100 7 DRESSING FOR NINE OR MORE WOUNDS AA 00100 7 ANESTHESIA SERVICES PERFORMED PERSONALLY BY ANESTHESIOLOGIST AD 00100 7 MEDICAL SUPERVISION BY A PHYSICIAN: MORE THAN FOUR CONCURRENT ANESTHESIA 36 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage HCPCS For Transportation A0100 00100 3 NON-EMERGENCY TRANSPORTATION; TAXI A0110 00100 3 NON-EMERGENCY TRANSPORTATION AND BUS, INTRA OR INTER STATE CARRIER A0120 00100 3 NON-EMERGENCY TRANSPORTATION: MINI-BUS, MOUNTAIN AREA TRANSPORTS, OR OTHER A0120 00200 4 TRANSPORTATION SYSTEMS A0130 00100 3 NON-EMERGENCY TRANSPORTATION: WHEEL-CHAIR VAN A0140 00100 3 NON-EMERGENCY TRANSPORTATION AND AIR TRAVEL (PRIVATE OR COMMERCIAL) INTRA OR A0140 00200 4 INTER STATE A0160 00100 3 NON-EMERGENCY TRANSPORTATION: PER MILE - CASE WORKER OR SOCIAL WORKER A0170 00100 3 TRANSPORTATION ANCILLARY: PARKING FEES, TOLLS, OTHER A0180 00100 3 NON-EMERGENCY TRANSPORTATION: ANCILLARY: LODGING-RECIPIENT A0190 00100 3 NON-EMERGENCY TRANSPORTATION: ANCILLARY: MEALS-RECIPIENT A0200 00100 3 NON-EMERGENCY TRANSPORTATION: ANCILLARY: LODGING ESCORT A0210 00100 3 NON-EMERGENCY TRANSPORTATION: ANCILLARY: MEALS-ESCORT A0225 00100 3 AMBULANCE SERVICE, NEONATAL TRANSPORT, BASE RATE, EMERGENCY TRANSPORT, ONE WAY 37 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 21 HCPCS For Parenteral Nutrition B4185 00100 3 PARENTERAL NUTRITION SOLUTION, PER 10 GRAMS LIPIDS B4189 00100 3 PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH B4189 00200 4 ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY B4189 00300 4 STRENGTH, 10 TO 51 GRAMS OF PROTEIN - PREMIX B4193 00100 3 PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH B4193 00200 4 ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY B4193 00300 4 STRENGTH, 52 TO 73 GRAMS OF PROTEIN - PREMIX B4197 00100 3 PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH B4197 00200 4 ELECTROLYTES, TRACE ELEMENTS AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, B4197 00300 4 74 TO 100 GRAMS OF PROTEIN - PREMIX B4199 00100 3 PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH B4199 00200 4 ELECTROLYTES, TRACE ELEMENTS AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, B4199 00300 4 OVER 100 GRAMS OF PROTEIN - PREMIX B4216 00100 3 PARENTERAL NUTRITION; ADDITIVES (VITAMINS, TRACE ELEMENTS, HEPARIN, B4216 00200 4 ELECTROLYTES) HOMEMIX PER DAY B4220 00100 3 PARENTERAL NUTRITION SUPPLY KIT; PREMIX, PER DAY B4222 00100 3 PARENTERAL NUTRITION SUPPLY KIT; HOME MIX, PER DAY 38 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage HCPCS For Cardiac Catheters C1722 00100 3 CARDIOVERTER-DEFIBRILLATOR, SINGLE CHAMBER (IMPLANTABLE) C1724 00100 3 CATHETER, TRANSLUMINAL ATHERECTOMY, ROTATIONAL C1725 00100 3 CATHETER, TRANSLUMINAL ANGIOPLASTY, NON-LASER (MAY INCLUDE GUIDANCE, C1725 00200 4 INFUSION/PERFUSION CAPABILITY) C1726 00100 3 CATHETER, BALLOON DILATATION, NON-VASCULAR C1727 00100 3 CATHETER, BALLOON TISSUE DISSECTOR, NON-VASCULAR (INSERTABLE) C1728 00100 3 CATHETER, BRACHYTHERAPY SEED ADMINISTRATION C1729 00100 3 CATHETER, DRAINAGE C1730 00100 3 CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC, OTHER THAN 3D MAPPING (19 OR FEWER C1730 00200 4 ELECTRODES) C1731 00100 3 CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC, OTHER THAN 3D MAPPING (20 OR MORE C1731 00200 4 ELECTRODES) C1732 00100 3 CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION, 3D OR VECTOR MAPPING C1733 00100 3 CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION, OTHER THAN 3D OR VECTOR C1733 00200 4 MAPPING, OTHER THAN COOL-TIP C1749 00100 3 ENDOSCOPE, RETROGRADE IMAGING/ILLUMINATION COLONOSCOPE DEVICE (IMPLANTABLE) C1750 00100 3 CATHETER, HEMODIALYSIS/PERITONEAL, LONG-TERM C1751 00100 3 CATHETER, INFUSION, INSERTED PERIPHERALLY, CENTRALLY OR MIDLINE (OTHER THAN C1751 00200 4 HEMODIALYSIS) C1752 00100 3 CATHETER, HEMODIALYSIS/PERITONEAL, SHORT-TERM C1753 00100 3 CATHETER, INTRAVASCULAR ULTRASOUND C1754 00100 3 CATHETER, INTRADISCAL 39 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 22 HCPCS For Durable Medical Equipment (DME) E0100 00100 3 CANE, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR FIXED, WITH TIP E0105 00100 3 CANE, QUAD OR THREE PRONG, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR E0105 00200 4 FIXED, WITH TIPS E0110 00100 3 CRUTCHES, FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED, E0110 00200 4 PAIR, COMPLETE WITH TIPS AND HANDGRIPS E0111 00100 3 CRUTCH FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED, E0111 00200 4 EACH, WITH TIP AND HANDGRIPS E0112 00100 3 CRUTCHES UNDERARM, WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS AND E0112 00200 4 HANDGRIPS E0113 00100 3 CRUTCH UNDERARM, WOOD, ADJUSTABLE OR FIXED, EACH, WITH PAD, TIP AND HANDGRIP E0114 00100 3 CRUTCHES UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS E0114 00200 4 AND HANDGRIPS E0116 00100 3 CRUTCH, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, WITH PAD, TIP, E0116 00200 4 HANDGRIP, WITH OR WITHOUT SHOCK ABSORBER, EACH E0117 00100 3 CRUTCH, UNDERARM, ARTICULATING, SPRING ASSISTED, EACH E0118 00100 3 CRUTCH SUBSTITUTE, LOWER LEG PLATFORM, WITH OR WITHOUT WHEELS, EACH E0130 00100 3 WALKER, RIGID (PICKUP), ADJUSTABLE OR FIXED HEIGHT E0135 00100 3 WALKER, FOLDING (PICKUP), ADJUSTABLE OR FIXED HEIGHT 40 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage HCPCS For Outpatient Procedures G0106 00200 4 BARIUM ENEMA G0108 00100 3 DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, INDIVIDUAL, PER 30 G0108 00200 4 MINUTES G0109 00100 3 DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, GROUP SESSION (2 OR G0109 00200 4 MORE), PER 30 MINUTES G0117 00100 3 GLAUCOMA SCREENING FOR HIGH RISK PATIENTS FURNISHED BY AN OPTOMETRIST OR G0117 00200 4 OPHTHALMOLOGIST G0118 00100 3 GLAUCOMA SCREENING FOR HIGH RISK PATIENT FURNISHED UNDER THE DIRECT SUPERVISION G0118 00200 4 OF AN OPTOMETRIST OR OPHTHALOMOLOGIST G0120 00100 3 COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0105, SCREENING COLONOSCOPY, G0120 00200 4 BARIUM ENEMA. G0121 00100 3 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR G0121 00200 4 HIGH RISK G0122 00100 3 COLORECTAL CANCER SCREENING; BARIUM ENEMA G0123 00100 3 SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED G0123 00200 4 IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, SCREENING BY G0123 00300 4 CYTOTECHNOLOGIST UNDER PHYSICIAN SUPERVISION 41 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 23 HCPCS For Rehabilitation H0001 00100 3 ALCOHOL AND/OR DRUG ASSESSMENT H0002 00100 3 BEHAVIORAL HEALTH SCREENING TO DETERMINE ELIGIBILITY FOR ADMISSION TO TREATMENT H0002 00200 4 PROGRAM H0003 00100 3 ALCOHOL AND/OR DRUG SCREENING; LABORATORY ANALYSIS OF SPECIMENS FOR PRESENCE OF H0003 00200 4 ALCOHOL AND/OR DRUGS H0004 00100 3 BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES H0005 00100 3 ALCOHOL AND/OR DRUG SERVICES; GROUP COUNSELING BY A CLINICIAN H0006 00100 3 ALCOHOL AND/OR DRUG SERVICES; CASE MANAGEMENT H0007 00100 3 ALCOHOL AND/OR DRUG SERVICES; CRISIS INTERVENTION (OUTPATIENT) H0008 00100 3 ALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (HOSPITAL INPATIENT) H0009 00100 3 ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (HOSPITAL INPATIENT) H0010 00100 3 ALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION H0010 00200 4 PROGRAM INPATIENT) H0011 00100 3 ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION H0011 00200 4 PROGRAM INPATIENT) H0012 00100 3 ALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION 42 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage HCPCS For Injections J1670 00100 3 INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS J1675 00100 3 INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS J1680 00100 3 INJECTION, HUMAN FIBRINOGEN CONCENTRATE, 100 MG J1700 00100 3 INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG J1710 00100 3 INJECTION, HYDROCORTISONE SODIUM PHOSPHATE, UP TO 50 MG J1720 00100 3 INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG J1730 00100 3 INJECTION, DIAZOXIDE, UP TO 300 MG J1740 00100 3 INJECTION, IBANDRONATE SODIUM, 1 MG J1742 00100 3 INJECTION, IBUTILIDE FUMARATE, 1 MG J1743 00100 3 INJECTION, IDURSULFASE, 1 MG J1745 00100 3 INJECTION INFLIXIMAB, 10 MG J1750 00100 3 INJECTION, IRON DEXTRAN, 50 MG J1751 00100 3 INJECTION, IRON DEXTRAN 165, 50 MG J1752 00100 3 INJECTION, IRON DEXTRAN 267, 50 MG J1756 00100 3 INJECTION, IRON SUCROSE, 1 MG J1785 00100 3 INJECTION, IMIGLUCERASE, PER UNIT J1786 00100 3 INJECTION, IMIGLUCERASE, 10 UNITS J1790 00100 3 INJECTION, DROPERIDOL, UP TO 5 MG J1800 00100 3 INJECTION, PROPRANOLOL HCL, UP TO 1 MG 43 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 24 HCPCS For Power Chairs (DME) K0849 00100 3 POWER WHEELCHAIR, GROUP 3 STANDARD, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP K0849 00200 4 TO AND INCLUDING 300 POUNDS K0850 00100 3 POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT K0850 00200 4 CAPACITY 301 TO 450 POUNDS K0851 00100 3 POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY K0851 00200 4 301 TO 450 POUNDS K0852 00100 3 POWER WHEELCHAIR, GROUP 3 VERY HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT K0852 00200 4 WEIGHT CAPACITY 451 TO 600 POUNDS K0853 00100 3 POWER WHEELCHAIR, GROUP 3 VERY HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT K0853 00200 4 CAPACITY 451 TO 600 POUNDS K0854 00100 3 POWER WHEELCHAIR, GROUP 3 EXTRA HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT K0854 00200 4 WEIGHT CAPACITY 601 POUNDS OR MORE K0855 00100 3 POWER WHEELCHAIR, GROUP 3 EXTRA HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT K0855 00200 4 CAPACITY 601 POUNDS OR MORE K0856 00100 3 POWER WHEELCHAIR, GROUP 3 STANDARD, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, K0856 00200 4 PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS K0857 00100 3 POWER WHEELCHAIR, GROUP 3 STANDARD, SINGLE POWER OPTION, CAPTAINS CHAIR, K0857 00200 4 PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS K0858 00100 3 POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, SINGLE POWER OPTION, SLING/SOLID K0858 00200 4 SEAT/BACK, PATIENT WEIGHT 301 TO 450 POUNDS 44 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage HCPCS For Prosthetics L0635 00500 4 PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY L0635 00600 4 INCLUDE PADDING, ANTERIOR PANEL, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, L0635 00700 4 INCLUDES FITTING AND ADJUSTMENT L0636 00100 3 LUMBAR SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID L0636 00200 4 POSTERIOR FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE, L0636 00300 4 POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL L0636 00400 4 STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY L0636 00500 4 PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY L0636 00600 4 INCLUDE PADDING, ANTERIOR PANEL, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED L0637 00100 3 LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND L0637 00200 4 POSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 L0637 00300 4 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES L0637 00400 4 INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, L0637 00500 4 CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, L0637 00600 4 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT L0638 00100 3 LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND L0638 00200 4 POSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 45 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 25 HCPCS For Laboratory Assays M0064 00100 3 BRIEF OFFICE VISIT FOR THE SOLE PURPOSE OF MONITORING OR CHANGING DRUG M0064 00200 4 PRESCRIPTIONS USED IN THE TREATMENT OF MENTAL PSYCHONEUROTIC AND PERSONALITY M0064 00300 4 DISORDERS M0075 00100 3 CELLULAR THERAPY M0076 00100 3 PROLOTHERAPY M0100 00100 3 INTRAGASTRIC HYPOTHERMIA USING GASTRIC FREEZING M0300 00100 3 IV CHELATION THERAPY (CHEMICAL ENDARTERECTOMY) M0301 00100 3 FABRIC WRAPPING OF ABDOMINAL ANEURYSM P2028 00100 3 CEPHALIN FLOCULATION, BLOOD P2029 00100 3 CONGO RED, BLOOD P2031 00100 3 HAIR ANALYSIS (EXCLUDING ARSENIC) P2033 00100 3 THYMOL TURBIDITY, BLOOD P2038 00100 3 MUCOPROTEIN, BLOOD (SEROMUCOID) (MEDICAL NECESSITY PROCEDURE) P3000 00100 3 SCREENING PAPANICOLAOU SMEAR, CERVICAL OR VAGINAL, UP TO THREE SMEARS, BY P3000 00200 4 TECHNICIAN UNDER PHYSICIAN SUPERVISION P3001 00100 3 SCREENING PAPANICOLAOU SMEAR, CERVICAL OR VAGINAL, UP TO THREE SMEARS, P3001 00200 4 REQUIRING INTERPRETATION BY PHYSICIAN P7001 00100 3 CULTURE, BACTERIAL, URINE; QUANTITATIVE, SENSITIVITY STUDY 46 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage HCPCS For Internal Cardiac LVADS Q0495 00100 3 BATTERY/POWER PACK CHARGER FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC Q0495 00200 4 VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY Q0496 00100 3 BATTERY, OTHER THAN LITHIUM-ION, FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC Q0496 00200 4 VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY Q0497 00100 3 BATTERY CLIPS FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST Q0497 00200 4 DEVICE, REPLACEMENT ONLY Q0498 00100 3 HOLSTER FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE, Q0498 00200 4 REPLACEMENT ONLY Q0499 00100 3 BELT/VEST/BAG FOR USE TO CARRY EXTERNAL PERIPHERAL COMPONENTS OF ANY TYPE Q0499 00200 4 VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY Q0500 00100 3 FILTERS FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE, Q0500 00200 4 REPLACEMENT ONLY Q0501 00100 3 SHOWER COVER FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST Q0501 00200 4 DEVICE, REPLACEMENT ONLY Q0502 00100 3 MOBILITY CART FOR PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY Q0503 00100 3 BATTERY FOR PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY, EACH Q0504 00100 3 POWER ADAPTER FOR PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY, Q0504 00200 4 VEHICLE TYPE Q0505 00100 3 MISCELLANEOUS SUPPLY OR ACCESSORY FOR USE WITH VENTRICULAR ASSIST DEVICE Q0506 00100 3 BATTERY, LITHIUM-ION, FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR Q0506 00200 4 ASSIST DEVICE, REPLACEMENT ONLY 47 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 26 HCPCS For More Injections S0017 00100 3 INJECTION, AMINOCAPROIC ACID, 5 GRAMS S0020 00100 3 INJECTION, BUPIVICAINE HYDROCHLORIDE, 30 ML S0021 00100 3 INJECTION, CEFOPERAZONE SODIUM, 1 GRAM S0023 00100 3 INJECTION, CIMETIDINE HYDROCHLORIDE, 300 MG S0028 00100 3 INJECTION, FAMOTIDINE, 20 MG S0030 00100 3 INJECTION, METRONIDAZOLE, 500 MG S0032 00100 3 INJECTION, NAFCILLIN SODIUM, 2 GRAMS S0034 00100 3 INJECTION, OFLOXACIN, 400 MG S0039 00100 3 INJECTION, SULFAMETHOXAZOLE AND TRIMETHOPRIM, 10 ML S0040 00100 3 INJECTION, TICARCILLIN DISODIUM AND CLAVULANATE POTASSIUM, 3.1 GRAMS S0073 00100 3 INJECTION, AZTREONAM, 500 MG S0074 00100 3 INJECTION, CEFOTETAN DISODIUM, 500 MG S0077 00100 3 INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG S0078 00100 3 INJECTION, FOSPHENYTOIN SODIUM, 750 MG S0080 00100 3 INJECTION, PENTAMIDINE ISETHIONATE, 300 MG S0081 00100 3 INJECTION, PIPERACILLIN SODIUM, 500 MG S0088 00100 3 IMATINIB, 100 MG 48 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage HCPCS For Encounters with Health Workers T1015 00100 3 CLINIC VISIT/ENCOUNTER, ALL-INCLUSIVE T1016 00100 3 CASE MANAGEMENT, EACH 15 MINUTES T1017 00100 3 TARGETED CASE MANAGEMENT, EACH 15 MINUTES T1018 00100 3 SCHOOL-BASED INDIVIDUALIZED EDUCATION PROGRAM (IEP) SERVICES, BUNDLED T1019 00100 3 PERSONAL CARE SERVICES, PER 15 MINUTES, NOT FOR AN INPATIENT OR RESIDENT OF A T1019 00200 4 HOSPITAL, NURSING FACILITY, ICF/MR OR IMD, PART OF THE INDIVIDUALIZED PLAN OF T1019 00300 4 TREATMENT (CODE MAY NOT BE USED TO IDENTIFY SERVICES PROVIDED BY HOME HEALTH T1019 00400 4 AIDE OR CERTIFIED NURSE ASSISTANT) T1020 00100 3 PERSONAL CARE SERVICES, PER DIEM, NOT FOR AN INPATIENT OR RESIDENT OF A T1020 00200 4 HOSPITAL, NURSING FACILITY, ICF/MR OR IMD, PART OF THE INDIVIDUALIZED PLAN OF T1020 00300 4 TREATMENT (CODE MAY NOT BE USED TO IDENTIFY SERVICES PROVIDED BY HOME HEALTH T1020 00400 4 AIDE OR CERTIFIED NURSE ASSISTANT) T1021 00100 3 HOME HEALTH AIDE OR CERTIFIED NURSE ASSISTANT, PER VISIT T1022 00100 3 CONTRACTED HOME HEALTH AGENCY SERVICES, ALL SERVICES PROVIDED UNDER CONTRACT, T1022 00200 4 PER DAY T1023 00100 3 SCREENING TO DETERMINE THE APPROPRIATENESS OF CONSIDERATION OF AN INDIVIDUAL T1023 00200 4 FOR PARTICIPATION IN A SPECIFIED PROGRAM, PROJECT OR TREATMENT PROTOCOL, PER T1023 00300 4 ENCOUNTER T1024 00100 3 EVALUATION AND TREATMENT BY AN INTEGRATED, SPECIALTY TEAM CONTRACTED TO PROVIDE T1024 00200 4 COORDINATED CARE TO MULTIPLE OR SEVERELY HANDICAPPED CHILDREN, PER ENCOUNTER T1025 00100 3 INTENSIVE, EXTENDED MULTIDISCIPLINARY SERVICES PROVIDED IN A CLINIC SETTING TO T1025 00200 4 CHILDREN WITH COMPLEX MEDICAL, PHYSICAL, MENTAL AND PSYCHOSOCIAL IMPAIRMENTS, 49 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
Lecture 10 CPT and HCPCS Coding System 27 HCPCS For Ophthalmology Items V2020 00100 3 FRAMES, PURCHASES V2025 00100 3 DELUXE FRAME V2100 00100 3 SPHERE, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00, PER LENS V2101 00100 3 SPHERE, SINGLE VISION, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS V2102 00100 3 SPHERE, SINGLE VISION, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00D, PER LENS V2103 00100 3 SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, .12 TO V2103 00200 4 2.00D CYLINDER, PER LENS V2104 00100 3 SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.12 TO V2104 00200 4 4.00D CYLINDER, PER LENS V2105 00100 3 SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO V2105 00200 4 6.00D CYLINDER, PER LENS V2106 00100 3 SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D V2106 00200 4 CYLINDER, PER LENS V2107 00100 3 SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00 SPHERE, V2107 00200 4 .12 TO 2.00D CYLINDER, PER LENS V2108 00100 3 SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25D TO PLUS OR MINUS 7.00D V2108 00200 4 SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS V2109 00100 3 SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D V2109 00200 4 SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS V2110 00100 3 SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO 7.00D SPHERE, OVER 6.00D V2110 00200 4 CYLINDER, PER LENS 50 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage 9,148 HCPCS Codes 51 Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA

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CPT and HCPCS Coding

  • 1.
    Baruch College/Mount Sinai School of Medicine Program in Health Care Administration and Policy Current Procedural Terminology (CPT) and Health Care Procedure Coding System (HCPCS) Lecture 10CPT January 17, 2011 Raymond R. Arons, Dr. P.H., M.P.H
  • 2.
    Lecture 10 CPTand HCPCS Coding System 2 Baruch College/Mount Sinai School of Medicine Program In Health Care Administration and Policy BUS 9100: The Social and Governmental Environment of the Business of Health Care Lecture 10CPT January 11, 2011 Current Procedural Terminology (CPT) and Health Care Procedure Coding System (HCPCS) Raymond R. Arons, Dr. P.H, M.P.H Coding Methods Currently in Use International Classification of Diseases - ICD-9-CM – Coding of Inpatient Discharges International Classification of Diseases - ICD-10-CM – Not yet adopted Diagnosis-related Groupings (DRGs) Medicare – Hospital reimbursement Physician Current Procedure Terminology (CPT) – Physicians for procedures performed Common Procedure Coding System (HCPCS) – Used by vendors of equipment and services 2 Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 3.
    Lecture 10 CPTand HCPCS Coding System 3 Current Procedural Terminology (CPT) History Operations Definitions Classification of Procedure Groupings Example codes 3 Current Procedural Terminology (CPT) History CPT was first developed and published by the AMA in 1966. We are now using the fourth edition, the CPT-4 version of this coding system. The purpose of the system when first developed had nothing to do with reimbursement; it was to help standardize terminology among physicians and to serve as a type of shorthand that would simplify medical records for physicians and record clerks. 4 continued... http://findarticles.com/p/articles/mi_m3230/is_10_32/ai_66498630/ (Visited January 10, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 4.
    Lecture 10 CPTand HCPCS Coding System 4 Current Procedural Terminology (CPT) History With the introduction of the second edition in 1970, the codes changed from 4 digits to 5 and became far more inclusive. Sometime during this period, laboratory procedures were incorporated into the CPT system. In 1983, HCFA merged CPT with its own Common Procedure Coding System (HCPCS) and mandated that CPT be used for all Medicare billing. . 5 continued... http://findarticles.com/p/articles/mi_m3230/is_10_32/ai_66498630/ (Visited January 10, 2011) Current Procedural Terminology (CPT) History A similar mandate extended this system to Medicaid billing in 1986. The AMA owns the copyright for CPT and collects fees from the users to help defray maintenance expenses. CPT tends to be organized around procedures, while ICD is more focused on diagnosis. Almost all third party payers use CPT as the codified means of processing claims for physician billing 6 continued... http://findarticles.com/p/articles/mi_m3230/is_10_32/ai_66498630/ (Visited January 10, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 5.
    Lecture 10 CPTand HCPCS Coding System 5 (CPT) Updates and Methods The CPT system, as developed and maintained by the AMA, is governed by the CPT editorial panel, a group of 16 individuals (virtually all physicians) who are empowered to make final decisions with regard to the content of CPT. This panel is supported at the AMA by a staff of about 12 and by about 75 CPT advisors representing nearly all of the medical specialty societies seated in the AMA House of Delegates). 7 continued... http://findarticles.com/p/articles/mi_m3230/is_10_32/ai_66498630/ (Visited January 10, 2011) (CPT) Updates and Methods The CPT panel also has members from CMS, the Blue Cross/Blue Shield Association, the American Hospital Association, and the private insurance industry. This panel meets about quarterly to consider alterations to the code and any other matters related to the publishing and use of CPT. The AMA Publications Office is responsible for publishing the standard yearly edition of CPT-4, as well as various editions directed at specific specialties. 8 continued... Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 6.
    Lecture 10 CPTand HCPCS Coding System 6 http://findarticles.com/p/articles/mi_m3230/is_10_32/ai_66498630/ (Visited January 10, 2011) (CPT) Updates and Method The process of generating a new code or revising an existing one usually begins with a query to the AMA CPT coding office. Requests for changes may come from physicians, medical societies, manufacturers, billing services, hospital coders, or any other interested party. To request a new code or to suggest revising or deleting an existing one, the requesting party must provide information about the frequency of use of the procedure/test in question, how the test/procedure is presently being coded, and documentation of the need for the request 9 continued... CPT Code Organization Medical Management Anesthesia Surgery Radiology Pathology and Laboratory Medicine 10 Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 7.
    Lecture 10 CPTand HCPCS Coding System 7 American Medical Association, Current Procedure Terminology CPT 2007,Standard Edition, 2006, Chicago, Illinois S9100 Medical Evaluation and Management Examples Office or Other Outpatient Services Hospital Observation Services Hospital Inpatient Services Consultations ED Services Pediatric Critical Care Transport Critical Care Services Neonatal Services Pediatric Critical Care Inpatient Neonatal Care 11 American Medical Association, Current Procedure Terminology CPT 2007,Standard Edition, 2006, Chicago, Illinois anuary 17, 2011 Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 8.
    Lecture 10 CPTand HCPCS Coding System 8 Anesthesia Examples Head Neck Thorax Intrathoracic Spine and Spinal Cord Upper Abdomen Lower Abdomen Perineum Pelvis 12 American Medical Association, Current Procedure Terminology CPT 2007,Standard Edition, 2006, Chicago, Illinois ecture 10CPT Surgery Examples General Integumentary Musculoskeletal Respiratory Cardiovascular Hemic and Lymphatic Mediastinum Digestive Urinary Male Genital 13 Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 9.
    Lecture 10 CPTand HCPCS Coding System 9 American Medical Association, Current Procedure Terminology CPT 2007,Standard Edition, 2006, Chicago, Illinois Radiology Examples Diagnostic Imaging Diagnostic Ultrasound Radiologic Guidance Breast Mammography Bone/Joint Studies Radiology Oncology Nuclear Medicine 14 American Medical Association, Current Procedure Terminology CPT 2007,Standard Edition, 2006, Chicago, Illinois Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 10.
    Lecture 10 CPTand HCPCS Coding System 10 Pathology and Laboratory Examples Organ or Disease-Oriented Panels Drug Testing Therapeutic Drug Assays Evocation/Suppression Testing Consultation (Clinical Pathology) Urinalysis Hematology and Coagulations Immunology Transfusion Medicine Microbiology 15 American Medical Association, Current Procedure Terminology CPT 2007,Standard Edition, 2006, Chicago, Illinois Medicine Examples Immune Globulins Immunizations for Vaccines Vaccines Toxids Hydration Therapeutics Psychiatry Biofeedback Dialysis Gastroenterology Ophthalmology Cardiovascular 16 Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 11.
    Lecture 10 CPTand HCPCS Coding System 11 American Medical Association, Current Procedure Terminology CPT 2007,Standard Edition, 2006, Chicago, Illinois NYS Medicaid Physician Medicine Services Fee Fee NON- FACILITY FACILITY GLOBAL GLOBAL CODE DESCRIPTION FEE FEE 81000 URINALYSIS, BY DIP STICK OR TABLET REAGE 4.00 4.00 81001 URINALYSIS, BY DIP STICK OR TABLET REAGE 4.00 4.00 81002 URINALYSIS, BY DIP STICK OR TABLET REAGE 2.00 2.00 81003 URINALYSIS, BY DIP STICK OR TABLET REAGE 2.00 2.00 81015 URINALYSIS; MICROSCOPIC ONLY 2.00 2.00 81025 URINE PREGNANCY TEST, BY VISUAL COLOR CO 2.00 2.00 83655 LEAD 15.00 15.00 85007 BLOOD COUNT; BLOOD SMEAR, MICROSCOPIC EX 1.43 1.43 85013 BLOOD COUNT; SPUN MICROHEMATOCRIT 2.00 2.00 85018 BLOOD COUNT; HEMOGLOBIN (HGB) 2.00 2.00 85025 BLOOD COUNT; COMPLETE (CBC), AUTOMATED ( 3.17 3.17 85041 BLOOD COUNT; RED BLOOD CELL (RBC), AUTOM 3.17 3.17 85048 BLOOD COUNT; LEUKOCYTE (WBC), AUTOMATED 3.17 3.17 85651 SEDIMENTATION RATE, ERYTHROCYTE; NON-AUT 2.00 2.00 17 http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 12.
    Lecture 10 CPTand HCPCS Coding System 12 NYS Medicaid Physician Medicine Services Fee Schedule 93603 RIGHT VENTRICULAR RECORDING 143.48 143.48 93609 INTRAVENTRICULAR AND/OR INTRA-ATRIAL MAP 297.03 297.03 93610 INTRA-ATRIAL PACING 169.83 169.83 93612 INTRAVENTRICULAR PACING 178.16 178.16 93613 INTRACARDIAC ELECTROPHYSIOLOGIC 3-DIMENS 243.20 202.67 93615 ESOPHAGEAL RECORDING OF ATRIAL ELECTROGR 47.39 47.39 93616 ESOPHAGEAL RECORDING OF ATRIAL ELECTROGR 61.65 61.65 93618 INDUCTION OF ARRHYTHMIA BY ELECTRICAL PA 306.84 306.84 93619 COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUAT 563.12 563.12 93620 COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUAT 781.92 781.92 93621 COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUAT 1,670.54 1,670.54 93622 COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUAT 1,742.22 1,742.22 18 continued... http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) NYS Medicaid Physician Medicine Services Fee Schedule 93455 CATHETER PLACEMENT IN CORONARY ARTERY(S) 487.72 487.72 173.74 93456 CATHETER PLACEMENT IN CORONARY ARTERY(S) 523.05 523.05 193.04 93457 CATHETER PLACEMENT IN CORONARY ARTERY(S) 592.62 592.62 216.06 93458 CATHETER PLACEMENT IN CORONARY ARTERY(S) 504.21 504.21 186.66 93459 CATHETER PLACEMENT IN CORONARY ARTERY(S) 556.83 556.83 206.88 93460 CATHETER PLACEMENT IN CORONARY ARTERY(S) 595.45 595.45 230.49 93461 CATHETER PLACEMENT IN CORONARY ARTERY(S) 682.69 682.69 254.25 93462 LEFT HEART CATHETERIZATION BY TRANSSEPTA 97.78 78.15 93463 PHARMACOLOGIC AGENT ADMINISTRATION (EG, 49.67 41.39 93464 PHYSIOLOGIC EXERCISE STUDY (EG, BICYCLE 119.97 119.97 54.60 93503 INSERTION AND PLACEMENT OF FLOW DIRECTED 140.00 140.00 93505 ENDOMYOCARDIAL BIOPSY 502.53 502.53 180.86 93530 RIGHT HEART CATHETERIZATION, FOR CONGENI 733.61 733.61 174.04 93531 COMBINED RIGHT HEART CATHETERIZATION AND 1,934.96 1,934.96 339.03 93532 COMBINED RIGHT HEART CATHETERIZATION AND 1,924.01 1,924.01 395.79 93533 COMBINED RIGHT HEART CATHETERIZATION AND 1,803.39 1,803.39 275.48 19 Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 13.
    Lecture 10 CPTand HCPCS Coding System 13 NYS Medicaid Physician Anesthesia Services Fee Schedule Examples ANEST CODE DESCRIPTION BASE 00100 ANESTHESIA FOR PROCEDURES ON SALIVARY 5 00102 ANESTHESIA FOR PROCEDURES INVOLVING PLA 6 00103 ANESTHESIA FOR RECONSTRUCTIVE PROCEDU 5 00104 ANESTHESIA FOR ELECTROCONVULSIVE THERA 4 00120 ANESTHESIA FOR PROCEDURES ON EXTERNAL, 5 00124 ANESTHESIA FOR PROCEDURES ON EXTERNAL, 4 00126 ANESTHESIA FOR PROCEDURES ON EXTERNAL, 4 00140 ANESTHESIA FOR PROCEDURES ON EYE; NOT 5 00142 ANESTHESIA FOR PROCEDURES ON EYE; LENS 4 00144 ANESTHESIA FOR PROCEDURES ON EYE; COR 6 00145 ANESTHESIA FOR PROCEDURES ON EYE; VITR 6 00147 ANESTHESIA FOR PROCEDURES ON EYE; IRIDE 4 20 continued... http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) NYS Medicaid Physician Anesthesia Services Fee Schedule Examples 01634 ANESTHESIA FOR OPEN OR SURGICAL ARTHRO 9 01636 ANESTHESIA FOR OPEN OR SURGICAL ARTHRO 15 01638 ANESTHESIA FOR OPEN OR SURGICAL ARTHRO 10 01650 ANESTHESIA FOR PROCEDURES ON ARTERIES 6 01652 ANESTHESIA FOR PROCEDURES ON ARTERIES 10 01654 ANESTHESIA FOR PROCEDURES ON ARTERIES 8 01656 ANESTHESIA FOR PROCEDURES ON ARTERIES 10 01670 ANESTHESIA FOR ALL PROCEDURES ON VEINS 4 01680 ANESTHESIA FOR SHOULDER CAST APPLICATIO 3 01682 ANESTHESIA FOR SHOULDER CAST APPLICATIO 4 01710 ANESTHESIA FOR PROCEDURES ON NERVES, 3 01712 ANESTHESIA FOR PROCEDURES ON NERVES, 5 01714 ANESTHESIA FOR PROCEDURES ON NERVES, 5 01716 ANESTHESIA FOR PROCEDURES ON NERVES, 5 21 http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 14.
    Lecture 10 CPTand HCPCS Coding System 14 NYS Medicaid Physician Radiology Services Fee Schedule Examples NON- FACILITY FACILITY GLOBAL GLOBAL CODE DESCRIPTION FEE FEE 70010 MYELOGRAPHY, POSTERIOR FOSSA, RADIOLOGIC 153.98 153.98 70015 CISTERNOGRAPHY, POSITIVE CONTRAST, RADIO 106.59 106.59 70030 RADIOLOGIC EXAMINATION, EYE, FOR DETECTI 21.80 21.80 70100 RADIOLOGIC EXAMINATION, MANDIBLE; PARTIA 24.24 24.24 70110 RADIOLOGIC EXAMINATION, MANDIBLE; COMPLE 30.85 30.85 70120 RADIOLOGIC EXAMINATION, MASTOIDS; LESS T 27.26 27.26 70130 RADIOLOGIC EXAMINATION, MASTOIDS; COMPLE 42.04 42.04 70134 RADIOLOGIC EXAMINATION, INTERNAL AUDITOR 37.42 37.42 70140 RADIOLOGIC EXAMINATION, FACIAL BONES; LE 25.40 25.40 70150 RADIOLOGIC EXAMINATION, FACIAL BONES; CO 34.50 34.50 70160 RADIOLOGIC EXAMINATION, NASAL BONES, COM 24.88 24.88 22 continued... http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) NYS Medicaid Physician Radiology Services Fee Schedule Examples 70488 COMPUTED TOMOGRAPHY, MAXILLOFACIAL AREA; 314.73 314.73 52.66 70490 COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; W 202.11 202.11 47.96 70491 COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; W 263.26 263.26 51.48 70492 COMPUTED TOMOGRAPHY, SOFT TISSUE NECK; W 315.91 315.91 53.84 70496 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEAD, 329.87 329.87 65.31 70498 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, NECK, 330.18 330.18 65.62 70540 MAGNETIC RESONANCE (EG, PROTON) IMAGING, 326.77 326.77 50.00 70542 MAGNETIC RESONANCE (EG, PROTON) IMAGING, 380.27 380.27 60.31 70543 MAGNETIC RESONANCE (EG, PROTON) IMAGING, 502.55 502.55 79.70 70544 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WI 321.20 321.20 44.72 70545 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WI 364.11 364.11 44.72 23 http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 15.
    Lecture 10 CPTand HCPCS Coding System 15 NYS Medicaid Physician Surgery Services Fee Schedule NON- FACILITY FACILITY GLOBAL GLOBAL CODE DESCRIPTION FEE FEE 10021 FINE NEEDLE ASPIRATION; WITHOUT IMAGING 81.61 60.00 10022 FINE NEEDLE ASPIRATION; WITH IMAGING GUI 85.59 72.00 10040 ACNE SURGERY (EG, MARSUPIALIZATION, OPEN 54.25 39.26 10060 INCISION AND DRAINAGE OF ABSCESS (EG, CA 60.50 43.24 10061 INCISION AND DRAINAGE OF ABSCESS (EG, CA 103.19 76.76 10080 INCISION AND DRAINAGE OF PILONIDAL CYST; 97.93 45.10 10081 INCISION AND DRAINAGE OF PILONIDAL CYST; 148.94 76.74 10120 INCISION AND REMOVAL OF FOREIGN BODY, SU 78.42 42.79 10121 INCISION AND REMOVAL OF FOREIGN BODY, SU 149.18 87.61 10140 INCISION AND DRAINAGE OF HEMATOMA, SEROM 85.50 56.28 10160 PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA 70.27 45.44 10180 INCISION AND DRAINAGE, COMPLEX, POSTOPER 131.00 83.94 11000 DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR I 29.85 15.44 24 continued... http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) NYS Medicaid Physician Surgery Services Fee Schedule 32665 THORACOSCOPY, SURGICAL; WITH ESOPHAGOMYO 691.75 576.46 32800 REPAIR LUNG HERNIA THROUGH CHEST WALL 539.32 449.44 32810 CLOSURE OF CHEST WALL FOLLOWING OPEN FLA 524.65 437.21 32815 OPEN CLOSURE OF MAJOR BRONCHIAL FISTULA 1,453.79 1,211.49 32820 MAJOR RECONSTRUCTION, CHEST WALL (POSTTR 32851 LUNG TRANSPLANT, SINGLE; WITHOUT CARDIOP 1,549.91 1,291.59 32852 LUNG TRANSPLANT, SINGLE; WITH CARDIOPULM 1,732.54 1,443.78 32853 LUNG TRANSPLANT, DOUBLE (BILATERAL SEQUE 1,853.06 1,544.22 32854 LUNG TRANSPLANT, DOUBLE (BILATERAL SEQUE 2,006.71 1,672.26 32900 RESECTION OF RIBS, EXTRAPLEURAL, ALL STA 788.89 657.41 32905 THORACOPLASTY, SCHEDE TYPE OR EXTRAPLEUR 785.88 654.90 32906 THORACOPLASTY, SCHEDE TYPE OR EXTRAPLEUR 969.20 807.67 32940 PNEUMONOLYSIS, EXTRAPERIOSTEAL, INCLUDIN 719.27 599.39 32960 PNEUMOTHORAX, THERAPEUTIC, INTRAPLEURAL 82.48 47.00 25 http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 16.
    Lecture 10 CPTand HCPCS Coding System 16 NYS Medicaid Physician Drug and Drug Administration Services Fee Schedule NON- FACILITY FACILITY GLOBAL GLOBAL CODE DESCRIPTION FEE FEE 90281 IMMUNE GLOBULIN (IG), HUMAN, FOR INTRAMU cost cost 90283 IMMUNE GLOBULIN (IGIV), HUMAN, FOR INTRA cost cost 90284 IMMUNE GLOBULIN (SCIG), HUMAN, FOR USE I cost cost 90291 CYTOMEGALOVIRUS IMMUNE GLOBULIN (CMV-IGI cost cost 90371 HEPATITIS B IMMUNE GLOBULIN (HBIG), HUMA cost cost 90375 RABIES IMMUNE GLOBULIN (RIG), HUMAN, FOR cost cost 90376 RABIES IMMUNE GLOBULIN, HEAT-TREATED (RI cost cost 90378 RESPIRATORY SYNCYTIAL VIRUS, MONOCLONAL cost cost 90384 RHO(D) IMMUNE GLOBULIN (RHIG), HUMAN, FU cost cost 90385 RHO(D) IMMUNE GLOBULIN (RHIG), HUMAN, MI cost cost 90386 RHO(D) IMMUNE GLOBULIN (RHIGIV), HUMAN, cost cost 90389 TETANUS IMMUNE GLOBULIN (TIG), HUMAN, FO cost cost 26 continued... http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) NYS Medicaid Physician Drug and Drug Administration Services Fee Schedule 96361 INTRAVENOUS INFUSION, HYDRATION; EACH AD 10.38 8.65 96365 INTRAVENOUS INFUSION, FOR THERAPY, PROPH 43.84 36.54 96366 INTRAVENOUS INFUSION, FOR THERAPY, PROPH 13.75 11.46 96367 INTRAVENOUS INFUSION, FOR THERAPY, PROPH 21.89 18.25 96368 INTRAVENOUS INFUSION, FOR THERAPY, PROPH 12.83 10.70 96369 SUBCUTANEOUS INFUSION FOR THERAPY OR PRO 96.10 80.09 96370 SUBCUTANEOUS INFUSION FOR THERAPY OR PRO 9.79 8.16 96371 SUBCUTANEOUS INFUSION FOR THERAPY OR PRO 46.79 38.99 96372 THERAPEUTIC, PROPHYLACTIC, OR DIAGNOSTIC 13.23 11.03 96405 CHEMOTHERAPY ADMINISTRATION; INTRALESION 86.65 14.37 96406 CHEMOTHERAPY ADMINISTRATION; INTRALESION 98.36 20.44 96409 CHEMOTHERAPY ADMINISTRATION; INTRAVENOUS 76.60 63.84 96413 CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS 103.82 86.52 96415 CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS 22.99 19.16 27 http://www.emedny.org/ProviderManuals/Physician/index.html (visited January 11, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 17.
    Lecture 10 CPTand HCPCS Coding System 17 Part 2 Health Care Procedure Coding System -HCPCS Health Care Procedure Coding System - HCPCS History Operations Definitions Classification of Procedure Groupings Example codes 31 Practice Management Information Corporation, HCPCS, Health Care Procedure Coding System, National Level II Medicare Codes, 2006, Los Angeles, Cal. 2005. Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 18.
    Lecture 10 CPTand HCPCS Coding System 18 HCPCS History Each year, in the United States, health care insurers process over 5 billion claims for payment. The HCPCS Level II Code Set is one of the standard code sets used for this purpose. The HCPCS is divided into two principal subsystems, referred to as level I and level II of the HCPCS.). Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians. 32 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage (Visited Jan 17, 2011) HCPCS History Level II standardized coding system that is used primarily to identify products, supplies, such as ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office. Because Medicare and other insurers cover a variety of services, supplies, and equipment the level II HCPCS codes were established for submitting claims for these items. The development and use of level II of the HCPCS began in the 1980's. Level II codes are also referred to as alpha-numeric codes because they consist of a single alphabetical letter followed by 4 numeric digits, while CPT codes are identified using 5 numeric digits. 33 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage (Visited Jan 17, 2011) Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 19.
    Lecture 10 CPTand HCPCS Coding System 19 HCPCS Categories Transportation Services Medical and Surgical Supplies Administrative, Miscellaneous and Investigational Enteral and Parenteral Therapy Hospital Outpatient PPS Codes Dental Procedures Procedures and Professional Services Rehabilitative Services Drugs Administered Other Than Oral Method Chemotherapy Drugs 34 continued... Practice Management Information Corporation, HCPCS, Health Care Procedure Coding System, National Level II Medicare Codes, 2006, Los Angeles, Cal. 2005. HCPCS Categories K Codes for DMERCS’ USE Only Orthotic Procedures Prosthetics Medical Services Pathology and Laboratory Diagnostic Radiology Servicers Private Payer Codes State Medicaid Agency Codes Vision Services Hearing Services 35 continued... Practice Management Information Corporation, HCPCS, Health Care Procedure Coding System, National Level II Medicare Codes, 2006, Los Angeles, Cal. 2005. Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 20.
    Lecture 10 CPTand HCPCS Coding System 20 HCPCS For Medical and Surgical Supplies HCPC Seq Num RIC Long Description A1 00100 7 DRESSING FOR ONE WOUND A2 00100 7 DRESSING FOR TWO WOUNDS A3 00100 7 DRESSING FOR THREE WOUNDS A4 00100 7 DRESSING FOR FOUR WOUNDS A5 00100 7 DRESSING FOR FIVE WOUNDS A6 00100 7 DRESSING FOR SIX WOUNDS A7 00100 7 DRESSING FOR SEVEN WOUNDS A8 00100 7 DRESSING FOR EIGHT WOUNDS A9 00100 7 DRESSING FOR NINE OR MORE WOUNDS AA 00100 7 ANESTHESIA SERVICES PERFORMED PERSONALLY BY ANESTHESIOLOGIST AD 00100 7 MEDICAL SUPERVISION BY A PHYSICIAN: MORE THAN FOUR CONCURRENT ANESTHESIA 36 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage HCPCS For Transportation A0100 00100 3 NON-EMERGENCY TRANSPORTATION; TAXI A0110 00100 3 NON-EMERGENCY TRANSPORTATION AND BUS, INTRA OR INTER STATE CARRIER A0120 00100 3 NON-EMERGENCY TRANSPORTATION: MINI-BUS, MOUNTAIN AREA TRANSPORTS, OR OTHER A0120 00200 4 TRANSPORTATION SYSTEMS A0130 00100 3 NON-EMERGENCY TRANSPORTATION: WHEEL-CHAIR VAN A0140 00100 3 NON-EMERGENCY TRANSPORTATION AND AIR TRAVEL (PRIVATE OR COMMERCIAL) INTRA OR A0140 00200 4 INTER STATE A0160 00100 3 NON-EMERGENCY TRANSPORTATION: PER MILE - CASE WORKER OR SOCIAL WORKER A0170 00100 3 TRANSPORTATION ANCILLARY: PARKING FEES, TOLLS, OTHER A0180 00100 3 NON-EMERGENCY TRANSPORTATION: ANCILLARY: LODGING-RECIPIENT A0190 00100 3 NON-EMERGENCY TRANSPORTATION: ANCILLARY: MEALS-RECIPIENT A0200 00100 3 NON-EMERGENCY TRANSPORTATION: ANCILLARY: LODGING ESCORT A0210 00100 3 NON-EMERGENCY TRANSPORTATION: ANCILLARY: MEALS-ESCORT A0225 00100 3 AMBULANCE SERVICE, NEONATAL TRANSPORT, BASE RATE, EMERGENCY TRANSPORT, ONE WAY 37 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 21.
    Lecture 10 CPTand HCPCS Coding System 21 HCPCS For Parenteral Nutrition B4185 00100 3 PARENTERAL NUTRITION SOLUTION, PER 10 GRAMS LIPIDS B4189 00100 3 PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH B4189 00200 4 ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY B4189 00300 4 STRENGTH, 10 TO 51 GRAMS OF PROTEIN - PREMIX B4193 00100 3 PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH B4193 00200 4 ELECTROLYTES, TRACE ELEMENTS, AND VITAMINS, INCLUDING PREPARATION, ANY B4193 00300 4 STRENGTH, 52 TO 73 GRAMS OF PROTEIN - PREMIX B4197 00100 3 PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH B4197 00200 4 ELECTROLYTES, TRACE ELEMENTS AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, B4197 00300 4 74 TO 100 GRAMS OF PROTEIN - PREMIX B4199 00100 3 PARENTERAL NUTRITION SOLUTION; COMPOUNDED AMINO ACID AND CARBOHYDRATES WITH B4199 00200 4 ELECTROLYTES, TRACE ELEMENTS AND VITAMINS, INCLUDING PREPARATION, ANY STRENGTH, B4199 00300 4 OVER 100 GRAMS OF PROTEIN - PREMIX B4216 00100 3 PARENTERAL NUTRITION; ADDITIVES (VITAMINS, TRACE ELEMENTS, HEPARIN, B4216 00200 4 ELECTROLYTES) HOMEMIX PER DAY B4220 00100 3 PARENTERAL NUTRITION SUPPLY KIT; PREMIX, PER DAY B4222 00100 3 PARENTERAL NUTRITION SUPPLY KIT; HOME MIX, PER DAY 38 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage HCPCS For Cardiac Catheters C1722 00100 3 CARDIOVERTER-DEFIBRILLATOR, SINGLE CHAMBER (IMPLANTABLE) C1724 00100 3 CATHETER, TRANSLUMINAL ATHERECTOMY, ROTATIONAL C1725 00100 3 CATHETER, TRANSLUMINAL ANGIOPLASTY, NON-LASER (MAY INCLUDE GUIDANCE, C1725 00200 4 INFUSION/PERFUSION CAPABILITY) C1726 00100 3 CATHETER, BALLOON DILATATION, NON-VASCULAR C1727 00100 3 CATHETER, BALLOON TISSUE DISSECTOR, NON-VASCULAR (INSERTABLE) C1728 00100 3 CATHETER, BRACHYTHERAPY SEED ADMINISTRATION C1729 00100 3 CATHETER, DRAINAGE C1730 00100 3 CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC, OTHER THAN 3D MAPPING (19 OR FEWER C1730 00200 4 ELECTRODES) C1731 00100 3 CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC, OTHER THAN 3D MAPPING (20 OR MORE C1731 00200 4 ELECTRODES) C1732 00100 3 CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION, 3D OR VECTOR MAPPING C1733 00100 3 CATHETER, ELECTROPHYSIOLOGY, DIAGNOSTIC/ABLATION, OTHER THAN 3D OR VECTOR C1733 00200 4 MAPPING, OTHER THAN COOL-TIP C1749 00100 3 ENDOSCOPE, RETROGRADE IMAGING/ILLUMINATION COLONOSCOPE DEVICE (IMPLANTABLE) C1750 00100 3 CATHETER, HEMODIALYSIS/PERITONEAL, LONG-TERM C1751 00100 3 CATHETER, INFUSION, INSERTED PERIPHERALLY, CENTRALLY OR MIDLINE (OTHER THAN C1751 00200 4 HEMODIALYSIS) C1752 00100 3 CATHETER, HEMODIALYSIS/PERITONEAL, SHORT-TERM C1753 00100 3 CATHETER, INTRAVASCULAR ULTRASOUND C1754 00100 3 CATHETER, INTRADISCAL 39 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 22.
    Lecture 10 CPTand HCPCS Coding System 22 HCPCS For Durable Medical Equipment (DME) E0100 00100 3 CANE, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR FIXED, WITH TIP E0105 00100 3 CANE, QUAD OR THREE PRONG, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR E0105 00200 4 FIXED, WITH TIPS E0110 00100 3 CRUTCHES, FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED, E0110 00200 4 PAIR, COMPLETE WITH TIPS AND HANDGRIPS E0111 00100 3 CRUTCH FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS, ADJUSTABLE OR FIXED, E0111 00200 4 EACH, WITH TIP AND HANDGRIPS E0112 00100 3 CRUTCHES UNDERARM, WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS AND E0112 00200 4 HANDGRIPS E0113 00100 3 CRUTCH UNDERARM, WOOD, ADJUSTABLE OR FIXED, EACH, WITH PAD, TIP AND HANDGRIP E0114 00100 3 CRUTCHES UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, PAIR, WITH PADS, TIPS E0114 00200 4 AND HANDGRIPS E0116 00100 3 CRUTCH, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, WITH PAD, TIP, E0116 00200 4 HANDGRIP, WITH OR WITHOUT SHOCK ABSORBER, EACH E0117 00100 3 CRUTCH, UNDERARM, ARTICULATING, SPRING ASSISTED, EACH E0118 00100 3 CRUTCH SUBSTITUTE, LOWER LEG PLATFORM, WITH OR WITHOUT WHEELS, EACH E0130 00100 3 WALKER, RIGID (PICKUP), ADJUSTABLE OR FIXED HEIGHT E0135 00100 3 WALKER, FOLDING (PICKUP), ADJUSTABLE OR FIXED HEIGHT 40 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage HCPCS For Outpatient Procedures G0106 00200 4 BARIUM ENEMA G0108 00100 3 DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, INDIVIDUAL, PER 30 G0108 00200 4 MINUTES G0109 00100 3 DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES, GROUP SESSION (2 OR G0109 00200 4 MORE), PER 30 MINUTES G0117 00100 3 GLAUCOMA SCREENING FOR HIGH RISK PATIENTS FURNISHED BY AN OPTOMETRIST OR G0117 00200 4 OPHTHALMOLOGIST G0118 00100 3 GLAUCOMA SCREENING FOR HIGH RISK PATIENT FURNISHED UNDER THE DIRECT SUPERVISION G0118 00200 4 OF AN OPTOMETRIST OR OPHTHALOMOLOGIST G0120 00100 3 COLORECTAL CANCER SCREENING; ALTERNATIVE TO G0105, SCREENING COLONOSCOPY, G0120 00200 4 BARIUM ENEMA. G0121 00100 3 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR G0121 00200 4 HIGH RISK G0122 00100 3 COLORECTAL CANCER SCREENING; BARIUM ENEMA G0123 00100 3 SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED G0123 00200 4 IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, SCREENING BY G0123 00300 4 CYTOTECHNOLOGIST UNDER PHYSICIAN SUPERVISION 41 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 23.
    Lecture 10 CPTand HCPCS Coding System 23 HCPCS For Rehabilitation H0001 00100 3 ALCOHOL AND/OR DRUG ASSESSMENT H0002 00100 3 BEHAVIORAL HEALTH SCREENING TO DETERMINE ELIGIBILITY FOR ADMISSION TO TREATMENT H0002 00200 4 PROGRAM H0003 00100 3 ALCOHOL AND/OR DRUG SCREENING; LABORATORY ANALYSIS OF SPECIMENS FOR PRESENCE OF H0003 00200 4 ALCOHOL AND/OR DRUGS H0004 00100 3 BEHAVIORAL HEALTH COUNSELING AND THERAPY, PER 15 MINUTES H0005 00100 3 ALCOHOL AND/OR DRUG SERVICES; GROUP COUNSELING BY A CLINICIAN H0006 00100 3 ALCOHOL AND/OR DRUG SERVICES; CASE MANAGEMENT H0007 00100 3 ALCOHOL AND/OR DRUG SERVICES; CRISIS INTERVENTION (OUTPATIENT) H0008 00100 3 ALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (HOSPITAL INPATIENT) H0009 00100 3 ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (HOSPITAL INPATIENT) H0010 00100 3 ALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION H0010 00200 4 PROGRAM INPATIENT) H0011 00100 3 ALCOHOL AND/OR DRUG SERVICES; ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION H0011 00200 4 PROGRAM INPATIENT) H0012 00100 3 ALCOHOL AND/OR DRUG SERVICES; SUB-ACUTE DETOXIFICATION (RESIDENTIAL ADDICTION 42 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage HCPCS For Injections J1670 00100 3 INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS J1675 00100 3 INJECTION, HISTRELIN ACETATE, 10 MICROGRAMS J1680 00100 3 INJECTION, HUMAN FIBRINOGEN CONCENTRATE, 100 MG J1700 00100 3 INJECTION, HYDROCORTISONE ACETATE, UP TO 25 MG J1710 00100 3 INJECTION, HYDROCORTISONE SODIUM PHOSPHATE, UP TO 50 MG J1720 00100 3 INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG J1730 00100 3 INJECTION, DIAZOXIDE, UP TO 300 MG J1740 00100 3 INJECTION, IBANDRONATE SODIUM, 1 MG J1742 00100 3 INJECTION, IBUTILIDE FUMARATE, 1 MG J1743 00100 3 INJECTION, IDURSULFASE, 1 MG J1745 00100 3 INJECTION INFLIXIMAB, 10 MG J1750 00100 3 INJECTION, IRON DEXTRAN, 50 MG J1751 00100 3 INJECTION, IRON DEXTRAN 165, 50 MG J1752 00100 3 INJECTION, IRON DEXTRAN 267, 50 MG J1756 00100 3 INJECTION, IRON SUCROSE, 1 MG J1785 00100 3 INJECTION, IMIGLUCERASE, PER UNIT J1786 00100 3 INJECTION, IMIGLUCERASE, 10 UNITS J1790 00100 3 INJECTION, DROPERIDOL, UP TO 5 MG J1800 00100 3 INJECTION, PROPRANOLOL HCL, UP TO 1 MG 43 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 24.
    Lecture 10 CPTand HCPCS Coding System 24 HCPCS For Power Chairs (DME) K0849 00100 3 POWER WHEELCHAIR, GROUP 3 STANDARD, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY UP K0849 00200 4 TO AND INCLUDING 300 POUNDS K0850 00100 3 POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT WEIGHT K0850 00200 4 CAPACITY 301 TO 450 POUNDS K0851 00100 3 POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT CAPACITY K0851 00200 4 301 TO 450 POUNDS K0852 00100 3 POWER WHEELCHAIR, GROUP 3 VERY HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT K0852 00200 4 WEIGHT CAPACITY 451 TO 600 POUNDS K0853 00100 3 POWER WHEELCHAIR, GROUP 3 VERY HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT K0853 00200 4 CAPACITY 451 TO 600 POUNDS K0854 00100 3 POWER WHEELCHAIR, GROUP 3 EXTRA HEAVY DUTY, SLING/SOLID SEAT/BACK, PATIENT K0854 00200 4 WEIGHT CAPACITY 601 POUNDS OR MORE K0855 00100 3 POWER WHEELCHAIR, GROUP 3 EXTRA HEAVY DUTY, CAPTAINS CHAIR, PATIENT WEIGHT K0855 00200 4 CAPACITY 601 POUNDS OR MORE K0856 00100 3 POWER WHEELCHAIR, GROUP 3 STANDARD, SINGLE POWER OPTION, SLING/SOLID SEAT/BACK, K0856 00200 4 PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS K0857 00100 3 POWER WHEELCHAIR, GROUP 3 STANDARD, SINGLE POWER OPTION, CAPTAINS CHAIR, K0857 00200 4 PATIENT WEIGHT CAPACITY UP TO AND INCLUDING 300 POUNDS K0858 00100 3 POWER WHEELCHAIR, GROUP 3 HEAVY DUTY, SINGLE POWER OPTION, SLING/SOLID K0858 00200 4 SEAT/BACK, PATIENT WEIGHT 301 TO 450 POUNDS 44 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage HCPCS For Prosthetics L0635 00500 4 PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY L0635 00600 4 INCLUDE PADDING, ANTERIOR PANEL, PENDULOUS ABDOMEN DESIGN, PREFABRICATED, L0635 00700 4 INCLUDES FITTING AND ADJUSTMENT L0636 00100 3 LUMBAR SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID L0636 00200 4 POSTERIOR FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE, L0636 00300 4 POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, LATERAL L0636 00400 4 STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES INTRACAVITARY L0636 00500 4 PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSURES, MAY L0636 00600 4 INCLUDE PADDING, ANTERIOR PANEL, PENDULOUS ABDOMEN DESIGN, CUSTOM FABRICATED L0637 00100 3 LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND L0637 00200 4 POSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 L0637 00300 4 VERTEBRA, LATERAL STRENGTH PROVIDED BY RIGID LATERAL FRAME/PANELS, PRODUCES L0637 00400 4 INTRACAVITARY PRESSURE TO REDUCE LOAD ON INTERVERTEBRAL DISCS, INCLUDES STRAPS, L0637 00500 4 CLOSURES, MAY INCLUDE PADDING, SHOULDER STRAPS, PENDULOUS ABDOMEN DESIGN, L0637 00600 4 PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT L0638 00100 3 LUMBAR-SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, WITH RIGID ANTERIOR AND L0638 00200 4 POSTERIOR FRAME/PANELS, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 45 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 25.
    Lecture 10 CPTand HCPCS Coding System 25 HCPCS For Laboratory Assays M0064 00100 3 BRIEF OFFICE VISIT FOR THE SOLE PURPOSE OF MONITORING OR CHANGING DRUG M0064 00200 4 PRESCRIPTIONS USED IN THE TREATMENT OF MENTAL PSYCHONEUROTIC AND PERSONALITY M0064 00300 4 DISORDERS M0075 00100 3 CELLULAR THERAPY M0076 00100 3 PROLOTHERAPY M0100 00100 3 INTRAGASTRIC HYPOTHERMIA USING GASTRIC FREEZING M0300 00100 3 IV CHELATION THERAPY (CHEMICAL ENDARTERECTOMY) M0301 00100 3 FABRIC WRAPPING OF ABDOMINAL ANEURYSM P2028 00100 3 CEPHALIN FLOCULATION, BLOOD P2029 00100 3 CONGO RED, BLOOD P2031 00100 3 HAIR ANALYSIS (EXCLUDING ARSENIC) P2033 00100 3 THYMOL TURBIDITY, BLOOD P2038 00100 3 MUCOPROTEIN, BLOOD (SEROMUCOID) (MEDICAL NECESSITY PROCEDURE) P3000 00100 3 SCREENING PAPANICOLAOU SMEAR, CERVICAL OR VAGINAL, UP TO THREE SMEARS, BY P3000 00200 4 TECHNICIAN UNDER PHYSICIAN SUPERVISION P3001 00100 3 SCREENING PAPANICOLAOU SMEAR, CERVICAL OR VAGINAL, UP TO THREE SMEARS, P3001 00200 4 REQUIRING INTERPRETATION BY PHYSICIAN P7001 00100 3 CULTURE, BACTERIAL, URINE; QUANTITATIVE, SENSITIVITY STUDY 46 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage HCPCS For Internal Cardiac LVADS Q0495 00100 3 BATTERY/POWER PACK CHARGER FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC Q0495 00200 4 VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY Q0496 00100 3 BATTERY, OTHER THAN LITHIUM-ION, FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC Q0496 00200 4 VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY Q0497 00100 3 BATTERY CLIPS FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST Q0497 00200 4 DEVICE, REPLACEMENT ONLY Q0498 00100 3 HOLSTER FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE, Q0498 00200 4 REPLACEMENT ONLY Q0499 00100 3 BELT/VEST/BAG FOR USE TO CARRY EXTERNAL PERIPHERAL COMPONENTS OF ANY TYPE Q0499 00200 4 VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY Q0500 00100 3 FILTERS FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE, Q0500 00200 4 REPLACEMENT ONLY Q0501 00100 3 SHOWER COVER FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST Q0501 00200 4 DEVICE, REPLACEMENT ONLY Q0502 00100 3 MOBILITY CART FOR PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY Q0503 00100 3 BATTERY FOR PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY, EACH Q0504 00100 3 POWER ADAPTER FOR PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY, Q0504 00200 4 VEHICLE TYPE Q0505 00100 3 MISCELLANEOUS SUPPLY OR ACCESSORY FOR USE WITH VENTRICULAR ASSIST DEVICE Q0506 00100 3 BATTERY, LITHIUM-ION, FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR Q0506 00200 4 ASSIST DEVICE, REPLACEMENT ONLY 47 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 26.
    Lecture 10 CPTand HCPCS Coding System 26 HCPCS For More Injections S0017 00100 3 INJECTION, AMINOCAPROIC ACID, 5 GRAMS S0020 00100 3 INJECTION, BUPIVICAINE HYDROCHLORIDE, 30 ML S0021 00100 3 INJECTION, CEFOPERAZONE SODIUM, 1 GRAM S0023 00100 3 INJECTION, CIMETIDINE HYDROCHLORIDE, 300 MG S0028 00100 3 INJECTION, FAMOTIDINE, 20 MG S0030 00100 3 INJECTION, METRONIDAZOLE, 500 MG S0032 00100 3 INJECTION, NAFCILLIN SODIUM, 2 GRAMS S0034 00100 3 INJECTION, OFLOXACIN, 400 MG S0039 00100 3 INJECTION, SULFAMETHOXAZOLE AND TRIMETHOPRIM, 10 ML S0040 00100 3 INJECTION, TICARCILLIN DISODIUM AND CLAVULANATE POTASSIUM, 3.1 GRAMS S0073 00100 3 INJECTION, AZTREONAM, 500 MG S0074 00100 3 INJECTION, CEFOTETAN DISODIUM, 500 MG S0077 00100 3 INJECTION, CLINDAMYCIN PHOSPHATE, 300 MG S0078 00100 3 INJECTION, FOSPHENYTOIN SODIUM, 750 MG S0080 00100 3 INJECTION, PENTAMIDINE ISETHIONATE, 300 MG S0081 00100 3 INJECTION, PIPERACILLIN SODIUM, 500 MG S0088 00100 3 IMATINIB, 100 MG 48 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage HCPCS For Encounters with Health Workers T1015 00100 3 CLINIC VISIT/ENCOUNTER, ALL-INCLUSIVE T1016 00100 3 CASE MANAGEMENT, EACH 15 MINUTES T1017 00100 3 TARGETED CASE MANAGEMENT, EACH 15 MINUTES T1018 00100 3 SCHOOL-BASED INDIVIDUALIZED EDUCATION PROGRAM (IEP) SERVICES, BUNDLED T1019 00100 3 PERSONAL CARE SERVICES, PER 15 MINUTES, NOT FOR AN INPATIENT OR RESIDENT OF A T1019 00200 4 HOSPITAL, NURSING FACILITY, ICF/MR OR IMD, PART OF THE INDIVIDUALIZED PLAN OF T1019 00300 4 TREATMENT (CODE MAY NOT BE USED TO IDENTIFY SERVICES PROVIDED BY HOME HEALTH T1019 00400 4 AIDE OR CERTIFIED NURSE ASSISTANT) T1020 00100 3 PERSONAL CARE SERVICES, PER DIEM, NOT FOR AN INPATIENT OR RESIDENT OF A T1020 00200 4 HOSPITAL, NURSING FACILITY, ICF/MR OR IMD, PART OF THE INDIVIDUALIZED PLAN OF T1020 00300 4 TREATMENT (CODE MAY NOT BE USED TO IDENTIFY SERVICES PROVIDED BY HOME HEALTH T1020 00400 4 AIDE OR CERTIFIED NURSE ASSISTANT) T1021 00100 3 HOME HEALTH AIDE OR CERTIFIED NURSE ASSISTANT, PER VISIT T1022 00100 3 CONTRACTED HOME HEALTH AGENCY SERVICES, ALL SERVICES PROVIDED UNDER CONTRACT, T1022 00200 4 PER DAY T1023 00100 3 SCREENING TO DETERMINE THE APPROPRIATENESS OF CONSIDERATION OF AN INDIVIDUAL T1023 00200 4 FOR PARTICIPATION IN A SPECIFIED PROGRAM, PROJECT OR TREATMENT PROTOCOL, PER T1023 00300 4 ENCOUNTER T1024 00100 3 EVALUATION AND TREATMENT BY AN INTEGRATED, SPECIALTY TEAM CONTRACTED TO PROVIDE T1024 00200 4 COORDINATED CARE TO MULTIPLE OR SEVERELY HANDICAPPED CHILDREN, PER ENCOUNTER T1025 00100 3 INTENSIVE, EXTENDED MULTIDISCIPLINARY SERVICES PROVIDED IN A CLINIC SETTING TO T1025 00200 4 CHILDREN WITH COMPLEX MEDICAL, PHYSICAL, MENTAL AND PSYCHOSOCIAL IMPAIRMENTS, 49 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA
  • 27.
    Lecture 10 CPTand HCPCS Coding System 27 HCPCS For Ophthalmology Items V2020 00100 3 FRAMES, PURCHASES V2025 00100 3 DELUXE FRAME V2100 00100 3 SPHERE, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00, PER LENS V2101 00100 3 SPHERE, SINGLE VISION, PLUS OR MINUS 4.12 TO PLUS OR MINUS 7.00D, PER LENS V2102 00100 3 SPHERE, SINGLE VISION, PLUS OR MINUS 7.12 TO PLUS OR MINUS 20.00D, PER LENS V2103 00100 3 SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, .12 TO V2103 00200 4 2.00D CYLINDER, PER LENS V2104 00100 3 SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 2.12 TO V2104 00200 4 4.00D CYLINDER, PER LENS V2105 00100 3 SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, 4.25 TO V2105 00200 4 6.00D CYLINDER, PER LENS V2106 00100 3 SPHEROCYLINDER, SINGLE VISION, PLANO TO PLUS OR MINUS 4.00D SPHERE, OVER 6.00D V2106 00200 4 CYLINDER, PER LENS V2107 00100 3 SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00 SPHERE, V2107 00200 4 .12 TO 2.00D CYLINDER, PER LENS V2108 00100 3 SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25D TO PLUS OR MINUS 7.00D V2108 00200 4 SPHERE, 2.12 TO 4.00D CYLINDER, PER LENS V2109 00100 3 SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO PLUS OR MINUS 7.00D V2109 00200 4 SPHERE, 4.25 TO 6.00D CYLINDER, PER LENS V2110 00100 3 SPHEROCYLINDER, SINGLE VISION, PLUS OR MINUS 4.25 TO 7.00D SPHERE, OVER 6.00D V2110 00200 4 CYLINDER, PER LENS 50 https://www.cms.gov/HCPCSReleaseCodeSets/01_Overview.asp#TopOfPage 9,148 HCPCS Codes 51 Copyright © 2011 Raymond R. Arons, Teaneck, NJ, USA