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Chapter 7


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Chapter 7

  1. 1. MEDA 163Chapter 7<br />CPT Coding<br />
  2. 2. CPT Sections<br />Evaluation and Management (E/M) 99201-99499<br />Anesthesia (00100-01999, 99100-99499)<br />Surgery (10021-69990)<br />Radiology (70010-79999)<br />Pathology and Laboratory (80047-89356)<br />Medicine (90281-99199, 99500-99607)<br />
  3. 3. Look it up!<br />Use the index to look up procedures:by procedureby body organby condition<br />
  4. 4. Symbols and Conventions<br />* The asterisk, or star follows a code. Stars can be found only in the Surgery Section. It means that the surgical package concept does not apply (the pre-op and post op services are NOT included with the procedure as listed.<br />◄ The inverted triangles show the reader that some text other than the actual descriptions of the code has been added or changed.<br />+ Codes that have the plus sign are known as "add-on" codes. You will find that some serve in CPT take into account "more parts" of another service.<br />ø The exempt symbol specifically relates the fact that codes found with this notation do not require the use of the multiple procedure modifier-51.<br />
  5. 5. Modifiers<br />Find complete list of CPT modifiers inside front cover of coding manual<br />Clarify services and procedures (there has been an alteration of the service or procedure)<br />CMS 1500 allows up to 4 modifiers per CPT code<br />Special E & M cases<br />Greater, reduced or discontinued services<br />Global surgery<br />Special surgical and procedural events<br />Bilateral & multiple procedures<br />Repeat services<br />Multiple surgeons<br />Professional & technical components<br />Unusual anesthesia<br />Laboratory services<br />
  6. 6. E & M Codes (evaluation and management)<br />New patient/Established patient<br />Key components:1. Extent of history2. Extent of examination3. Medical Decision-making complexity<br />Other components include:1. counseling2. coordination of care3. nature of presenting problem4. time<br />Complexity of patient symptoms<br />Description/need for service<br />Diagnostic & therapeutic procedures<br />Pt. diagnosis & concurrent problems<br />Pertinent physical findings<br />Time, effort, equipment required<br />