Medicine CPT copyright 2012 American Medical Association All

Medicine

CPT® copyright 2012 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT® is a registered trademark of the American Medical Association. Medicine 2

Objectives • Overview of Medicine section of CPT® • Highlights from specific sections • Emphasis on carefully reading instructions and guidelines with individual sections • Category II, Category III Codes • Appendices • Index Medicine 3

Medicine • • Immunizations Vaccines, Toxoids Psychiatry Biofeedback Dialysis Gastroenterology Ophthalmology Otorhinolaryngology • • Cardiovascular Pulmonary Endocrinology Neurology Genetics Nutritional Therapy Acupuncture Moderate Sedation Medicine 4

Medicine - continued • • • Non-invasive Diagnostic Vascular Studies Allergy & Clinical Immunology Special Dermatological Procedures Physical Medicine & Rehabilitation Qualifying Circumstances for Anesthesia Home Health Procedures/Services Medicine 5

Medicine and ICD-9 -CM • Alphabetic Index to Diseases • Tabular List • Official Guidelines for Coding and Reporting Medicine 6

Medicine Guidelines • • • Multiple Procedures Add-on Codes Separate Procedures Unlisted Service or Procedure Special Report Materials Supplied by Physician Medicine 7

Immune Globulins (90281 -90399) • • Immune globulins Botulinum antitoxin Cytomegalovirus (CMV) immune globulin Diphtheria antitoxin Hepatitis B immune globulin Rabies immune globulin Tetanus immune globulin Medicine 8

Vaccines and Toxoids (90476 -90749 ) • • • Vaccines Vaccination Immunization Toxins Toxoids Medicine 9

Psychiatry (90785 -90899) • Outpatient, inpatient • Providers psychiatrist (MD) psychologist (Ph. D) clinical social workers (LCSW) • Modifier 22 Increased procedural services • Modifier 52 Reduced services Medicine 10

Psychiatry • Consultation (99241 -99255) • Follow-up by consultant office visits (99211 -99215) rest home, domicile (99334 -99337) home (99347 -99350) • Transfer of care – new or established pt. • Diagnostic psychiatric evaluations (90791 -90792) Medicine 11

Dialysis • Hemodialysis • Miscellaneous Dialysis Procedures • End-Stage Renal Disease Services (ESRD) • Other Dialysis Procedures • Age-specific, reported once per month (90951 -90962) outpatient; (90963 -90966) home services Medicine 12

Dialysis • • Miscellaneous Dialysis Procedures (90945 -90947) Peritoneal dialysis Hemofiltration Patient and helper training (90989 -90993) Medicine 13

Ophthalmological Services • E/M codes (92002 -92014) – New and Established patients • Special Ophthalmological Services Medicine 14

Special Otorhinolaryngologic Services (92502 -92700) • Vestibular Function Tests With and without recording • Audiologic Function Tests • Evaluative and Therapeutic Services • Special Diagnostic Procedures Cardiovascular Services Medicine 15

Noninvasive Vascular Diagnostic Studies (93880 -93990) • • • Cerebrovascular Arterial Studies Extremity Arterial Studies (Including Digits) Extremity Venous Studies (Including Digits) Visceral and Penile Vascular Studies Extremity Arterial-Venous Studies Duplex and Doppler Medicine 16

Pulmonary Studies Covered in the Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Sytems Medicine 17

Allergy and Immunology (95004 -95199) • Allergy Testing – Code 95004 allergen testing – Codes 95017 -95018 drug allergy • Allergen Immunotherapy – Codes 95115 -95199 Medicine 18

Neurology and Neuromuscular Procedures • Sleep testing (95800 -95811, 95782 -95783) sleep studies vs. polysomnography • Routine Electroencephalography (EEG) • Muscle and Range of Motion Testing • Electromyography (EMG) • Guidance for Chemodenervation and Ischemic Muscle Testing Medicine 19

Neurology and Neuromuscular Procedures • • • Nerve Conduction Tests (95905 -95913) Intraoperative Neurophysiology (95940 -95941) Autonomic Function Tests (95921 -95923, 95924 -95943) Evoked Potentials and Reflex Tests (95925 -95937) Special EEG Tests Neurostimulators, Analysis-Programming Medicine 20

Medical Genetics and Genetic Counseling Services • • Chromosome Genetics Genetic counseling Medicine 21

Hydration • Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly complex Drug or Highly Complex Biologic Agent Administration. • Time based codes (96360 -96361) Medicine 22

Non-Chemotherapy Complex Drugs and Substances • Infusions – therapeutic, prophylactic or diagnostic • Specific to time, technique, substances added and additional set-up • Multiple drugs Medicine 23

Chemotherapy (96401 -96549) Services included with chemotherapy: • Use of local anesthesia • IV start • Access to indwelling IV, subcutaneous catheter or port • Flush at conclusion of infusion • Standard tubing, syringes and supplies • Preparation of chemotherapy agent(s) Medicine 24

Chemotherapy • • • Paracentesis Thoracentesis Peritoneocentesis Intrathecal Ventricular or Intraventricular Medicine 25

Physical Medicine and Rehabilitation Treatment plan • Problem list • Goals • Physician review progress each 30 days Progress made – recorded Modify or discontinue therapy Medicine 26

Modalities (97010 -97039) • • Supervised (97010 -97028) Constant Attendance (97032 -97039) Diathermy, Vasopneumatic devices Therapeutic Procedures (97110 -97546) Medicine 27

Wound Care Management Orthotic Management and Prosthetic Management • Active wound care (97597 -97606) – Not to be reported with (11042 -11047) • Orthotic management and Prosthetic management – Orthotics – Prosthetics Medicine 28

Acupuncture (97810 -97814) • Face-to-face time • E/M services reported separately using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) above the usual pre-service and post-serivce work Medicine 29

Osteopathic Manipulative Treatment Chiropractic Manipulative Treatment Osteopathic physician – D. O. Chiropractic Manipulative Treatment – CMT • Five spinal regions: cervical, thoracic, lumbar, sacral, and pelvic • Five extraspinal regions: head, temporomandibular, lower & upper extremities, rib cage, and abdomen Medicine 30

Education and Training for Patient Self-Management Education and training • Self Management • How many in the group? Telephone services – patient, parent, or guardian • 24 hours • 7 days Medicine 31

On-line Medical Evaluation (98969) • On-line encounter or other electronic communication mode of the medical kind • Includes all services provided Medicine 32

Special Services, Procedures and Reports (99000 -99091) Miscellaneous services • 99024 – “tracking” • Mandatory on-call hospital personnel • Patient encounters outside the normal posted business hours or special circumstances at the request of the patient. Medicine 33

Qualifying Circumstances for Anesthesia (99100 -99140) • All are add-on codes +99100 +99116 +99135 +99140 Medicine 34

Moderate (Conscious) Sedation Services included with Moderate Sedation (not reported separately) • Assessment of the patient • Establishment of IV access and fluids • Administration of agent • Maintenance of sedation • Monitoring of oxygen saturation, H. R. , BP • Recovery Medicine 35

Other Services and Procedures • 99183 Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session Medicine 36

Home Health Procedures/Services Define home setting: • Patient’s residence • Assisted living apartments • Group homes • Nontraditional private homes • Custodial care facilities or schools Medicine 37

Home Health Procedures/Services Prenatal services (99500) Postnatal assessment and follow-up care (99501) Home visit for newborn care and assessment (99502) Medicine 38

Home Infusion Procedures/Services • Home Infusion Code 99601 – up to 2 hours Code 99602 – each additional hour of infusion Medicine 39

Medication Therapy Management Services Performed by a pharmacist Documentation required: • Patient history • Current medications • Recommendations Medicine 40

Category II Codes • • • Used for performance measurement Facilitate data collection Use of these codes is optional Used to evaluate quality of care Alphanumeric: example: four digits and letter “F” – 2001 F is Weight recorded Medicine 41

Category III Codes • Data collection regarding new technology • It is preferable to use these codes rather than an unlisted code. • Alpha numeric listings, four digits and the letter “T” Example – 0085 T Breath test for heart transplant rejection Medicine 42

CPT® Appendices • • • Appendix A – modifiers and description Appendix B – summary of additions and deletions Appendix C – clinical examples Appendix D, E F and G are summary lists Appendix H – go to www. ama-assn. org/go/cpt Medicine 43

CPT® Appendices • Appendix I – Genetic Testing Code Modifiers (deleted) • Appendix J – Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves • Appendix K – products pending FDA approval Medicine 44

CPT® Appendices • Appendix L – Vascular families • Appendix M – crosswalk to deleted CPT® codes Index – back of CPT® Book Medicine 45

The End Medicine