Overview of the CPT

CHAPTER 1 : CHAPTER 1 INTRODUCTION TO THE CPT

MEDICAL CODING : MEDICAL CODING Transforms services/procedures/ supplies/drugs into CPT/HCPCS codes Transforms diagnosis and procedures into ICD-9-CM codes

Levels of Service Codes : Levels of Service Codes Level I CPT—Text, Chapters 1-13 Level II HCPCS, National Codes— Text, Chapter 13 Level III Local Codes—phased out due to HIPAA

Diagnosis Codes : Diagnosis Codes ICD-9-CM, Volumes 1 & 2 International Classification of Diseases, 9th Ed., Clinical Modification Text, Chapters 14 and 15

ICD-9-CM : ICD-9-CM Classification system Explains why service was provided Changes diagnoses into codes Diabetes becomes 250.XX

Why Codes? : Why Codes? Computers understand numbers Specific descriptions attached to each code

CPT-4 : CPT-4 Developed by the AMA in 1966 Five-digit codes Updated in November for use January 1

Examples of Types of CPT Codes : Examples of Types of CPT Codes Medical Surgical Diagnostic services Anesthesia, etc.

CPT Codes Allow For : CPT Codes Allow For Communication that is both effective and efficient

Consider : Consider Renal endoscopy through nephrostomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, and insertion of endopyelotomy stent) OR 50575

Codes Are : Codes Are Used to tell third-party payers about services/procedures provided Often used as basis of payment

Incorrect Coding : Incorrect Coding Results in providers being paid inappropriately Either too much or too little

Codes Are Used By : Codes Are Used By Clinics Hospitals Rehabilitation units Wherever health care services are provided

Outpatient Services : Outpatient Services Reported on the insurance form CMS-1500 = universal form

CMS-1500 : CMS-1500 Figure: 1.1

CPT Format : CPT Format Symbols in CPT Used to convey information Bullseye, moderate (conscious) sedation included (full list in Appendix G, CPT) Example 45391, Colonoscopy with endoscopic ultrasound examination Lightning bolt, pending FDA approval Example 90698, Diphtheria, tetanus toxoids, acellular pertussis vaccine

• Bullet = New Code : • Bullet = New Code Figure: 1.2

▲Triangle = Revised Code : ▲Triangle = Revised Code Figure: 1.3

►◄ Right and Left Triangles = Beginning and Ending of Text Change : ►◄ Right and Left Triangles = Beginning and Ending of Text Change Figure: 1.4

+ Plus = Add-On Code : + Plus = Add-On Code Figure: 1.5

Add-On Code : Add-On Code (…Cont’d) Can only be used with another specific code Never used alone Full list in Appendix D of CPT

=Circle With Line, -51 Cannot BeUsed With these Codes : CPT Appendix E contains a listing of - 51 exempt codes Figure: 1.6 =Circle With Line, -51 Cannot Be Used With these Codes

Six CPT Sections (like chapters) : Six CPT Sections (like chapters) Evaluation & Management (E/M) Anesthesia Surgery Radiology Pathology & Laboratory Medicine

Categorized By : Categorized By Sections Subsections Subheadings Categories

Categorized By : Categorized By (…Cont’d) Anatomy Knee or Shoulder Procedure Incision or Excision Condition Fracture or Dislocation Description Cast or Strap Surgical Approach Anterior Cranial Fossa or Middle Cranial Fossa

Categorized By, Example : Categorized By, Example Figure: 1.8 (…Cont’d)

Guidelines : Guidelines Section-specific information begins each section Figure: 1.9

Notes : Notes Must-reading located throughout the CPT Figure: 1.11

Two Types of Codes : Two Types of Codes Stand-alone: Full description Indented: Dependent on preceding stand-alone

Types of Codes, Example : Types of Codes, Example Figure: 1.13

Semicolon : Semicolon Indicates full description in preceding code You must return to the stand-alone for full description

Modifiers Add Information : Modifiers Add Information CPT Modifier Two digits 62 Two surgeons performed a surgical procedure

Level II HCPCS Modifiers : Level II HCPCS Modifiers “-AS” Physician’s Assistant “-F1” Left hand, second digit All modifiers used on CPT or HCPCS

Example of Modifier : Example of Modifier 43820 Gastrojejunostomy -62 two surgeons -43820-62 two surgeons performed a gastrojejunostomy

Modifier on the CMS-1500 : Modifier on the CMS-1500 Modifiers are placed in 24D on CMS-1500 Figure: 1.1

Unlisted Services : Unlisted Services Codes ending in “99” = “no specific code” Equals = Miscellaneous Used if no more specific code Written report must accompany submission

Written Report Indicates: : Written Report Indicates: Nature Extent Need Time Effort Equipment Used

Category II Codes—Supplemental Tracking Codes : Category II Codes— Supplemental Tracking Codes Used for performance measurements Codes collect data concerning quality of care and test(s) required Alphanumeric and end in the letter “F” (1005F) Located after the Medicine section of the CPT manual

Category III Codes—New Technology : Category III Codes— New Technology Temporary codes—up to 3 years Identify emerging technology, services, and procedures Located after medicine section Alphanumeric (0016T) May or may not receive future Category I code status

Category I Codes : Category I Codes Category I codes (00100–99607) Approved by AMA and Food and Drug Administration Proven clinical effectiveness (efficacy) Category III codes have not been approved and have no proven clinical effectiveness

Category Codes : Category Codes Usage order Use Category III code instead of unlisted code Use unlisted code if no Category III code

The Index! : The Index! Used to locate service/procedure terms and codes Speeds up code location Like a dictionary First entries and last entries

CPT Index : CPT Index Figure: 1.17

Presentation of Codes in Index : Presentation of Codes in Index Single code: 38115 Multiple codes: 26645, 26650 - Note comma Range of codes: 22305-22325 - Note hyphen

Location Methods With Examples : Location Methods With Examples Service/procedure: repair, excision Anatomic site:medial nerve, elbow Condition or disease: cleft lip, clot Synonym: toe and interphalangeal joint Eponym: Jones procedure, Heller operation Abbreviation: ECG, PEEP (Pressure Breathing, Positive)

Always : Always Reference index Locate code in main portion of CPT Read the entire description and any notes

“See” in Index : “See” in Index Cross-reference terms “Look here for code” Index: Stem, Brain: See Brainstem

Appendices of CPT : Appendices of CPT Appendix A: Modifiers Appendix B: Additions, Deletions, Revisions Appendix C: Clinical Examples, E/M Codes Appendix D: Add-On Codes Appendix E: -51 Exempt Codes Appendix F: -63 Exempt Codes Appendix G: Include Moderate (Conscious) Sedation

Appendices of CPT : Appendices of CPT (…Cont’d) Appendix H: Performance Measures, Category II Codes Appendix I: Genetic Testing Modifiers Appendix J: Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves Appendix K: Product Pending FDA Approval Appendix L: Vascular Families Appendix M: Crosswalk to Deleted CPT Codes

ConclusionCHAPTER 1 : Conclusion CHAPTER 1 INTRODUCTION TO THE CPT