Lecture Notes to Accompany Jean Jurek Stacey Mosay

Lecture Notes to Accompany Jean Jurek Stacey Mosay Daphne Neris CPT Basics Chapter 12 Part 1

Outline History and Purpose of CPT Organization and Content CPT Punctuation and Symbols Copyright © F. A. Davis 2018 2

Learning Outcomes After studying this chapter, you should be able to: 1. Describe several uses of data collected from health-care claims. 2. Explain the purpose of the CPT code set. 3. Identify the medical settings in which CPT is used. 4. Describe the content and organization of CPT. 5. Identify the meaning of the symbols, format, and punctuation used in CPT. 6. Discuss the purpose and use of CPT modifiers—distinguishing among CPT professional, HCPCS, and facility modifiers. 7. Recognize the importance of using current codes and discuss ways to stay current. 8. Compare and contrast the ICD-10 -CM and CPT code sets. 9. Recognize when an unlisted code is required and identify the purpose and parts of a special report. 10. Demonstrate various ways of finding a CPT code in the Index. 11. List the nine steps to accurately assign CPT codes and append appropriate modifiers. 12. List CPT coding resources and references. Copyright © F. A. Davis 2018 3

History and Purpose of CPT Copyright © F. A. Davis 2018 4

CPT Background Developed in 1966 Maintained by the American Medical Association (AMA) Required for Medicare and Medicaid Claims Combined with Healthcare Common Procedure Coding System (HCPCS)–Code Set for Supplies HCPCS Level I: CPT code in AMA’s CPT manual HCPCS Level II: Maintained by federal government Used to report supplies, drugs, and some services Copyright © F. A. Davis 2018 5

_____ is the mandated code set for supplies under HIPAA. A. AMA B. CPT C. HCPCS D. ICD

CPT Today CPT code information uses: Services reimbursement Trending services nationally Future planning Benchmarking Measuring patient outcomes Copyright © F. A. Davis 2018 7

CPT Organization and Content Copyright © F. A. Davis 2018 8

BOX 12. 1 Parts of the CPT Manual Introduction Appendix D: Summary of CPT Add-on Codes Evaluation and Management (99201– 99499) Appendix E: Summary of CPT Codes Exempt from Modifier – 51 Anesthesia (00100– 01999, 99100 -99140) Appendix F: Summary of CPT Codes Exempt from Modifier – 63 Surgery (10021– 69990) Appendix G: Removed from the CPT code set. Appendix H: Removed from the CPT code set. Radiology (70010– 79999) Appendix I: Removed from the CPT code set. Appendix J: Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves Pathology and Laboratory (80047– 89398, 0001 U-001) Medicine (90281– 99607) Appendix K: Product Pending FDA Approval Category II Codes Appendix L: Vascular Families Category III Codes Appendix M: Renumbered CPT Codes Citation Crosswalk Appendix A: Modifiers Appendix N: Summary of Resequenced CPT Codes Appendix B: Summary of Additions, Deletions, and Revisions Appendix O: Multianalyte Assays with Algorithmic Analyses Appendix C: Clinical Examples Appendix P: CPT Codes That May Be Used for Synchronous Telemedicine Services Copyright © F. A. Davis 2018 9

CPT codes are always _____ digits long. A. Three B. Five C. Seven

Category I Codes: Six Sections Table 12. 1 CPT Category I Code Sections SECTION DEFINITION OF CODES STRUCTURE Evaluation and Physician or other qualified health-care Organized by place and/or type of Management professional services that are performed to service determine the best course for patient care Anesthesia services by or supervised by a physician; Organized by body site includes general, regional, and local anesthesia Surgery Radiology Pathology and Laboratory Medicine KEY GUIDELINES New/established patients; other definitions; Unlisted services, special reports; Selecting an E/M service level Time based; Services covered (bundled) in codes; Unlisted services; special reports; Qualifying circumstances codes Surgical procedures performed by physicians Organized by body system and then Surgical package definition; Follow-up care definition; body site, followed by procedural Add-on codes; Separate procedures; Subsection notes; groups Unlisted services; special reports Radiology services by or supervised by a physician Organized by type of procedure, Unlisted services; special reports; Supervision and followed by body site interpretation; (professional and technical components) Pathology and laboratory services by physicians or Organized by type of procedure Complete procedure; Panels; Unlisted services; special by physician-supervised technicians reports Evaluation, therapeutic, and diagnostic procedures Organized by type of service or Subsection notes (Vaccines, Psychotherapy, End-Stage by or supervised by a physician procedure and specialty Renal Disease, Ophthalmology, Cardiovascular, etc. ); Multiple procedures reported separately; Add-on codes; Separate procedures; Unlisted services; special reports; Supplied materials Copyright © F. A. Davis 2018 11

Category II Codes Created by AMA Track professional patient care performances Alphanumeric codes Services typically included in an evaluation and management service Not directly billable Can be used to determine “pay-for-performance” Copyright © F. A. Davis 2018 12

Category III Codes Introduced in CPT in 2002 Alphanumeric (four digits and a T) Report emerging technology, services, and procedures Procedure must be Food and Drug Administration (FDA) approved Procedure must be performed by many health-care professionals in many areas Copyright © F. A. Davis 2018 13

Category III codes are _____ and always end with _____. A. Four digits, the number 1 B. Four digits, the letter T C. Five digits, the number 1 D. Five digits, the letter T

Appendices A – Modifiers B – Summary of Additions, Deletions, and Revisions C – Clinical Examples D – Summary of CPT Add-On Codes E – Summary of CPT Codes Exempt From Modifier – 51 F – Summary of CPT Codes Exempt From Modifier – 63 G – Summary of CPT Codes That Include Moderate Sedation Copyright © F. A. Davis 2018 J – Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves K – Product Pending FDA Approval L – Vascular Families M – Renumbered CPT Codes Citation Crosswalk N – Summary of Resequenced CPT Codes O – Multianalyte Assays with Algorithmic Analyses 15

CPT Punctuation and Symbols Copyright © F. A. Davis 2018 16

Semicolon ; Use Conserve space and divide common and unique code portions Example 33533 Coronary artery bypass, using arterial graft(s); single arterial graft 33534 Two coronary arterial grafts The unique portion, or descriptor, is “two coronary arterial grafts. ” Therefore, the full procedure represented by code 33534 is read as “ 33534 Coronary artery bypass, using arterial graft(s); two coronary arterial grafts. ” Copyright © F. A. Davis 2018 17

Bullet • , Triangle ▲ Symbol Bullet • Use New code for that year Revised code Triangle ▲ Copyright © F. A. Davis 2018 18

Plus Symbol + Use Example Add-on code for procedure 11200 Removal of skin tags, carried out along with a primary multiple fibrocutaneous tags, procedure any area, up to and including 15 lesions + 11201 Each additional 10 lesions or part thereof (List separately in addition to code for primary procedure. ) Copyright © F. A. Davis 2018 19

Modifier – 51 Exempt , Lightning Bolt, Facing Triangles Symbols Modifier – 51 exempt Lightning bolt Facing triangles Copyright © F. A. Davis 2018 Use This symbol indicates that a code cannot be assigned a – 51 modifier. The lightning bolt signifies that the code is for a pending vaccine. The facing triangle symbol before a code indicates that text is new or has been revised from the prior year’s edition. The triangles mark the beginning and ending of the new or revised text. 20

Circled Bullet, Pound Sign # Use A circled bullet before a code indicates that conscious sedation is included in the service or procedure. A pound sign # before a code signifies it was moved from another section or a new code has been added and there are no available numbers in that sequence of codes. Copyright © F. A. Davis 2018 Example Typically used with scope procedures such as bronchoscopies # 21552 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater. An entry where this code was previously housed directs the coder to the new location. 21552 Code is out of numerical sequence. See 21550– 21632. 21

The _____ indicates that a code has been revised. A. • B. + C. ~ D. ▲

The _____ indicates that the code is new for that year. A. • B. + C. ~ D. ▲

CPT Assistant or CPT Changes: An Insider’s View Guidelines Coder may refer to a specific issue of CPT Assistant or CPT Changes: An Insider’s View for guidance. CPT Assistant is published monthly. CPT Changes: An Insider’s View is published annually. Copyright © F. A. Davis 2018 Examples 90705 Measles virus vaccine, live, for subcutaneous use CPT Assistant Apr 97: 10, Nov 98: 31– 33, Jan 99: 2, Oct 99: 9, Mar 11: 4; CPT Changes: An Insider’s View 2004, 2008 24

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