Medicine-CPT GUIDELINES by bharath kumar medesun student

1. MEDICINE

2. INTRODUCTION
• The medicine section of CPT includes codes for procedures
that are primarily evaluative, diagnostic and/or therapeutic.
• Medicine codes represent non-invasive or minimally invasive
procedures.
• Most procedures are typically performed in the office

3. • Many codes are driven by time, quantity, age, and professional
component services.
• Located directly before the category II and category III codes.
• Subsections are arranged by specialty areas or type of
services.

4. • When coding multiple procedures, watch for unbundling. Add-
on codes, and separate procedures.
• In many circumstances, more than one code is required
• E/M codes can only be assigned in addition if there was a
significant, separate E/M service performed.

5. MODIFIERS
• Modifiers 22,26,51,52,53,55,56,58,59,76,77,78,79.
• LC,LD,RC-coronary artery modifiers
• LT,RT,TA,to T9, FA to F9-anatomical modifiers.

6. HOW TO ASSIGN MEDICINE
CODES
• Review the documentation and determine the type of service
provided.
• Locate main terms in the CPT index
• Determine if drugs were given
• Check subterms and read descriptors thoroughly.

7. • Verify that the code description matches the services
provided.
• Assign codes for all significant services and consider
modifiers,if appropriate.

8. IMMUNE GLOBULINES,SERUM OR
RECOMBINANT PRODUCTS
• Serum globulins extracted from human blood or recombinant
immune globulin products created in a laboratory through
genetic modification of human/or animal proteins.
• Both are reported in addition to the administration
codes96365-96368,96372,96374,96375.

9. • Modifier-51 should not be reported with this section of
product codes when performed with another procedure.
• Do not use vaccine administration codes(90460-90474) for
immune globulin injections.
• Range of codes(90281-90399)

10. IMMUNIZATION
ADMINISTRATION FOR
VACCINES/TOXOIDS• Report vaccine immunization administration codes
90460,90461,90471,90474 in addition to the vaccine and
toxoid codes 90476-90749.
• Report codes 90460 and 90461 0nly when the physician or
qualified health care professional provides face-to-face
counseling of the patient/family during the administration of a
vaccine.

11. • Immunization administration not accompanied by face-to-face
physician or qualified health care professional counseling to
the patient/family or for administration of vaccines to patients
over 18 yrs of age report codes 90471-90474.
• Range of codes(90460-90474)

12. VACCINES,TOXOIDS
• Codes 90476-90749 identify the vaccine product only.
• To report the administration codes of vaccine/toxoids use
90460,90461,90472,90473,90474 in addition to above codes.
• Modifier-51 should not be reported for this services.

13. • If a significantly separately identifiable evaluation and
management service is performed use separate code in
addition to the vaccine and toxoid administration codes.
• Separate codes are available for combination vaccines. It is
inappropriate to code each component of a combination
vaccine separately.
• Range of code(90476-90749)

14. PSYCHIATRY
• The psychotherapy codes were simplified and expanded to
include time with both the patient and/or family member.
• There are now just three timed codes to be used for
psychotherapy(90832=30min;90834=45min;90837=60min)
instead of a distinction made by setting and whether E/M
services were provided.

15. • When psychotherapy is done in the same encounter as an
E/M service,there are timed add-on codes for psychotherapy
that are to be used by psychiatrists to indicate both the
services.
• Psychotherapy of less than 16 minutes is not reported

16. • Code +90785 is an add-on- code for interactive complexity to
be reported in conjugation with codes for daignostic
psychiatric evaluation(90791,90792)
psychotherapy(90832,90834,90837) psychotherapy when
performed with an E/M service(90833,90836,90838,99201-
99255,99304-99337,99341-99350,and group psychotherapy-
90853.

17. PSYCHIATRIC DIAGNOSTIC
PROCEDURES
• Psychiatric diagnostic evaluation is an integrated
biopsychosocial assessment,including history,mental
status,and recommendations.The evaluation includes
communication with family or other sources and review and
ordering of diagnostic services.
• Range of code(90791-90792)

18. PSYCHOTHERAPY
• Psychotherapy is the treatment of mental illness and
behavioral disturbances in which the physician or other
qualified health care professional,through definitive
therapeutic communication,attempts to alleviate the
emotional disturbances,reverse or change maladaptive
patterns of behavior,and encourage personality growth and
development

19. • Do not report 90846,90847 for family psychotherapy services
less than 26 minutes)
• Range of code(90832-90838)

20. PSYCHOTHERAPY FOR CRISIS
• It is an urgent service
• Treatment includes psychotherapy, mobilization of resources
to defuse the crisis and restore safety and implementation of
psychotherapeutic interventions to minimize the potential for
psychological trauma
• Range of code(90839,90840)

21. HEMODIALYSIS
• Purification of blood using dialysis machine is known as
hemodialysis.
• Codes 90935,90937 are reported to describe the hemodialysis
procedure with all E/M services related to the hemodialysis
procedure.
• These codes are used for inpatient ESRD and non-ESRD
procedures or for outpatient non-ESRD dialysis services.

22. • Code 90937 is reported when patient re evaluation is
required during a hemodialysis procedure.
• Use modifier 25 with E/M codes including new or established
patient office or other op consultations,observation
care,observation care including admission and discharge etc…
• Range of code(90935-90940)

23. END-STAGE RENAL DISEASE
• End stage renal disease (ESRD) is the last stage (stage five) of
chronic kidney disease (CKD). When CKD, polycystic kidney
disease (PKD) or other kidney diseases develop into
ESRD, dialysis or a kidney transplant is necessary to live.
• Codes 90951-90962 are reported once per month to
distinguish age specific services related to the patients ESRD
performed in an op setting with 3 levels of service based on
the number of face to face visits.

24. • Codes 90963-90966 are reported once per month for a full
month of service to distinguish age-specific services for ESRD
services for home dialysis patients.
• E/M services unrelated to ESRD services that can not be
performed during the dialysis session may be reported
separately.
• Range of code(90951-90970)

25. GASTROENTEROLOGY
• Esophageal motility study(91010,+91013) with interpretation
and report is typically used to evaluate for abnormalities of
esophageal function/peristalsis.
• Range of code(91010-91122)

26. OPHTHAMOLOGY
• The medical services of ophthamologists are described in
codes 92002-92499
• General ophthalmological services are divided into new and
established patient categories that are further subdivided by
level of service; intermediate or comprehensive.
• Range of code (92002-92499)

27. SPECIAL
OTORHINOLARYNGOLOGIC
SERVICES• These services are not included in an E/M service
• Audiometric tests in this series require the use of calibrated
electronic equipment,recording of results and a report with
interpretation.hearing tests that are otorhinolaryngologic E/M
services are not reported separately.
• Range of code(92502-92700)

28. CARDIOVASCULAR SERVICES
• 92950 is for reporting cardiopulmonary resuscitation
• CPR is not included in critical care services.if CPR and critical
care services are provided report both services.
• Range of code(92950-92998)

29. CORONARY THERAPEUTIC
SERVICES AND PROCEDURES
• Five major coronary arteries for intervention coding
• Left main-LM
• Left anterior descending-LD
• Left circumflex-LC
• Right coronary-RC
• Ramus intermedius-RI

30. • The reporting hierarchy from highest to lowest,for these base
codes is 92943=92941>92933>92924>92928>92937>92920
• Range of code(92920-92979)

31. CARDIOGRAPHY
• Cardiography is the graphic recording of a physical or
functional aspect of the
heart,eg;apexcardiography,echocardiography,etc…
• Do not use modifier-26 or TC with ECG code
• Range of code(93000-93025)

32. CARDIOVASCULAR MONITORING
SERVICES
• These services are diagnostic medical procedures using In
person and remote technology to assess cardiovascular
rhythm data
• Range of code(93224-93278)

33. IMPLANTABLE AND WEARABLE
CARDIAC DEVICE EVALUATIONS
• These services are diagnostic medical procedures using In
person and remote technology to assess cardiovascular
rhythm data
• Range of code(93279-93299)

34. ECHOCARDIOGRAPHY
• Echocardiography includes obtaining ultrasonic signals from
the heart and great vessels with real time image and doppler
ultrasonic signal documentation with interpretation and
report
• When interpretation is performed separately use modifier-26
• Range of code(93303-93355)

35. CARDIAC CATHETERIZATION
• Cardiac catheterization is performed to take x-ray pictures of
the coronary arteries and cardiac chambers as well as to
measure pressures in the heart.
• Code 93451 is for right heart catheterization
• Code 93452 is for left heart catheterization
• Code 93453 is for both right and left heart catheterization
• Range of code(93451-93568)

36. INTRACARDIAC
ELECTROPHYSIOLOGICAL
PROCEDURES• Intracardiac EPS studies are invasive diagnostic medical
procedures which include the insertion and repositioning of
electrode catheters,recording of electrograms before and
during pacing or programmed stimulation of multiple
locations in the heart analysis of recorded information and
report of the procedure

37. • Modifier-51 should not used to 93600-
93603,93610,93612,93615-93618,93631.
• Range of code(93600-93662)

38. VENTILATOR MANAGEMENT
• Report 94002 for ventilation assist and management services;
hospital inpatient/observation; initial day
• 94003 for each additional day
• For ventilation assist and management services in nursing
facility,per day,report 94004.
• Report home ventilator management services 94005

39. PULMONARY DIAGNOSTIC
TESTING AND THERAPIES
• For spirometry report 94010
• Spirometry performed before and after administration of
branchodilator report 94060
• Range of code(94010-94799)

40. ALLERGY AND CLINICAL
IMMUNOLOGY
• Immunotherapy is the parenteral administration of allergenic
extracts as antigens at periodic intervals, usually on an
increasing dosage scale to a dosage which is maintained as
maintainence therapy.
• Report E/M service with modifier-25
• Range of code(95004-95071)

41. ALLERGEN IMMUNOTHERAPY
• Codes 95115-95199 include the professional services
necessary for allergen immunotherapy.
• Office visit codes may be used in addition to allergen
immunotherapy if other identifiable services are provided at
that time.
• Range of code(95115-95199)

42. NEUROLOGY AND
NEUROMUSCULAR PROCEDURES
• Neurologic services are typically consultative and any of the
levels of consultation(99241-99255)may be appropriate.
• Range of code(95803-95783)

43. ELECTROENCEPHALOGRAPH
Y
• EEG codes 95812-95822 include hyperventilation and or
photic stimulation when appropriate.
• Routine EEG codes 95816-95822 include 20-40 minutes of
recording
• Extended EEG codes 95812-95813 include reporting times
longer than 40 minutes.
• Range of code(95812-95830)

44. ELECTROMYOGRAPHY
• Needle electromyographic procedures include the
interpretation of electrical waveforms measured by
equipment that produces both visible and audible
components of electrical signals recorded from the muscles
studied by the needle electrode.
• Range of code(95860-95875)

45. NERVE CONDUCTION TESTS
• Code 95905 describes nerve conduction tests when
performed with preconfigured electrodes customized to a
specific anatomic site.
• Range of code(95905-95913)

46. AUTONOMIC FUNCTION
TESTS
• The purpose of autonomic nervous system function testing is
to determine the presence of autonomic dysfunction,the site
of autonomic dysfunction and the various autonomic
subsystems that may be disordered.
• Range of code(95921-95943)

47. SPECIAL EEG TESTS
• Codes 95950-95953 and 95956 are used for 24 hours of
recording. for recording more than 12 hours don’t use
modifier-52
• For recording less than 12 hours use modifier-52
• Codes 95961 and 95962 use physician or other qualified
health care professional time as a basis for unit of service.

48. • Report 95961 for the first hour of attendance,use modifier 52
with 95961 for 30 minutes or less,report 95962 for each
additional hour of attendance
• Code 96020 for functional brain mapping
• Range of code(95950-96020)

49. CENTRAL NERVOUS SYSTEM
• Codes in this section are used to report the services provided
during testing of the cognitive function of the central nervous
system.
• A minimum of 31 minutes must be provided to report any per
hour code.
• Range of code(96101-96127)

50. HEALTH AND BEHAVIOR
ASSESSMENT
• These are used to identify the psychological
,behavioral,emotional,cognitive and social factors important
to the prevention,treatment,or management of physical
health problems
• E/M service codes counseling risk factor reduction and
behavior change intervention.should not be reported on the
same day
• Range of code(96150-96161)

51. HYDRATION
• Codes 96360-96361 are intended to report a hydration IV
infusion to consist of a pre-packed fluid and electrolytes
• But are not used to report infusion of drugs or other
substances.
• Minimum of 31 minutes of hydration infusion is required to
report the service.
• Range of code(96360-96361)

52. PHOTODYNAMIC THERAPY
• Sometimes called photo chemotherapy, is a form of
phototherapy using non toxic light sensitive compounds that
exposed selectively to light where upon they become toxic to
targeted malignant and other diseased cells.
• Range of code(96567-96570)

53. SPECIAL DERMATOLOGICAL
PROCEDURES
• Dermatologic services are typically consultative,and any of the
five levels of consultation(99241-99255) may be appropriate
• Range of code(96900-96999)

54. MODALITIES
• Modalities defined as any physical agent applied to produce
therapeutic changes to biologic tissue includes but not limited
to thermal, acoustic light mechanical or electric energy
• Range of code(97010-97039)
• Therapeutic procedures(97110-97546)

55. ACTIVE WOUND CARE
MANAGEMENT
• Active wound care procedures are performed to remove
devitalized and/or necrotic tissue and promote healing.
services require direct contact with the patient
• Range of code(97597-97610)

56. TESTS AND MEASUREMENTS
• Requires direct one-to-one patient contact
• Although tests and measurements are a component of
evaluation and re-evaluation,employers or insurance carriers
may request specialized testing or assessment,which are
reported using codes 97750-97755.
• Range of code(97750-97755)

57. ACUPUNCTURE
• Acupuncture is reported based on 15-minute increments of
personal contact with the patient, not the duration of
acupuncture needle placement.
• Range of code(97810-97814)

58. OSTEOPATHIC MANIPULATIVE
TREATMENT
• Is a form of manual treatment applied by a physician or other
qualified health care professional to eliminate or alleviate
somatic dysfunction and related disorders this treatment may
be accomplished by a variety of techniques.
• Range of code(98925-98929)

59. CHIROPRACTIC MANIPULATIVE
TREATMENT
• Is a form of manual treatment to influence joint and
neurophysiological function.
• This treatment may be accomplished using a variety of
techniques
• Range of code(98940-98943)

60. QUALIFYING CIRCUMSTANCES
FOR ANESTHESIA
• 99100 for patient of extreme age, younger than 1 year and
older than 70
• 99116 anesthesia complicated by utilization of total body
hyperthermia
• 99135 anesthesia complicated by utilization of controlled
hypotension
• 99140 anesthesia complicated by emergency conditions

61. MODERATE SEDATION
• Moderate sedation is a drug induced depression of
consciousness during which patients respond purposefully to
verbal commands, either alone or accompanied by light tactile
stimulation.
• Range of code(99151-99157)

62. HOME HEALTH PROCEDURES
• These codes are used by non-physician health care
professionals
• Physician should utilize the home visit codes 99341-99350 and
utilize CPT codes other than 99500-99600 for any additional
procedure provided to a patient living in a residence.
• Range of code(99500-99600)

63. EXAMPLES
• Code 90720 for diptheria, tetanus toxoids, and whole cell
pertussis vaccine and hemophilus influenza B vaccine for
intramuscular use.
• Ex: MMRV for a 4 year-old with counseling
• Ans:90710,90460,90461x3
• Ex: A 1-yr old female is administered MMR and DTaP. During
the visit the provider discuss the benefits of each vaccine and
potential side effects
• Ans:90460,90461x2(MMR)
90460,90461x2(DTaP)

64. • EX:MMRV for a 4 year-old without counseling
• Ans:90710,90471;1 vaccine
• EX; how would you report a patient encounter in which 2
injectable,single component vaccines are administered, yet
counseling is only provided on I of the 2 vaccines
• Ans;90460,90472 is reported for non-counseled additional
vaccine.

65. • Ex; A child is seen prior to traveling with parents and the
purpose of the visit is to receive yellow fever vaccine.The
nurse provides vaccine counseling and administers the vaccine
• Ans;90717,90471

66. • Ex;A 13-yr old patient receives the HPV vaccine.The ordering
physician discusses the risks of the vaccine and the disease for
which it provides protection and documents that he
personally performed the counseling.
• Ans;90649,90460
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67. THANK YOU