1. Introduction to CPT Coding

2. WHAT ARE WE DOING HERE? Coding Systems.how many? What are the differences? Who uses what? our focus for AHMS 160 3. History of CPT 1966 Published by AMA 1970 Five-digit codes 1983 Adopted as part of HCPCS(continued) 4. History of CPT 1986 Omnibus Budget Reconciliation Act (OBRA) 1996 HIPAA 2004 MMA 5. CPT Mandated Reporting Home health care and hospice agencies Outpatient hospital departments Physicians who are employees of health care facility Physicians who see patients in their offices or clinics andin patients homes 6. CPT Mandated Reporting Home health care and hospice agencies Outpatient hospital departments Physicians who are employees of health care facility Physicians who see patients in their offices or clinics andin patients homes 7. Non-Reportable Services Considered integral to procedure No separate code reported 8. Examples of Non-Reportable Services Administering sedatives Cleansing, shaving, and prepping of skin Draping and positioning of patient Irrigating wound Inserting and removing drains 9. CPT Categories Category I codes Procedures and services Category II codes Performance measures Category III codes Emerging technology 10. Organization of CPT Six sections Evaluation and Management (E/M) (9920199499) Anesthesia (0010001999, 9910099140) Surgery (1002169990) Radiology (7001079999) Pathology and Laboratory (8004889398) Medicine (9028199199, 9950099607) 11. CPT Index Alphabetic main terms Boldfaced Represent procedures or services, organs, anatomic sites, conditions, eponyms, or abbreviations Subterms indented below 12. Selection from CPT IndexCurrent Procedural Terminology 2010 American Medical Association. All rightsreserved. 13. CPT Index Organization Procedures or services (e.g., endoscopy) Organs or other anatomic sites (e.g., elbow) Conditions (e.g., wound) Synonyms (e.g., finger joint or intercarpal joint) Eponyms (e.g., Whitman procedure) Abbreviations (e.g., MRI)(continued) 14. CPT Index Boldfaced type Main terms, categories, subcategories, and code numbers Italicized type Cross-reference terms (e.g., see) Directs coders to index entry under which codes are listed 15. Appendices Appendix A List of modifiers and descriptions Appendix B Annual CPT coding additions, deletions, and revisions Appendix C Clinical examples for codes found in E/M section (continued) 16. Appendices Appendix D List of add-on codes Identified with plus symbol (+) Appendix E List of codes exempt from modifier -51 Appendix F List of codes exempt from modifier -63(continued) 17. Appendices Appendix G Summary of CPT codes identified with bulls eye symbol Codes that include Moderate (Conscious) Sedation (MCS)(continued) 18. Appendices Appendix H *Removed from CPT; Alphabetical Listing is available from the AMA web site: www.ama-assn.org/go/cpt Appendix I Genetic testing modifiers (continued) 19. Appendices Appendix J Electrodiagnostic medicine listing of sensory, motor, and mixed nerves Appendix K List of codes pending Food and Drug Administration (FDA) approval (continued) 20. Appendices Appendix L List of vascular families Appendix M List of deleted CPT codes and descriptions with crosswalk to new CPT codes 21. CPT Symbols Bullet located to the left of code identifies new proceduresand services Triangle located to the left of code identifies revision ofcode description Horizontal triangle symbols surround revised guidelinesand notes(continued) 22. CPT SYMBOLS Plus identifies add-on codes for procedures commonly, butnot always, performed at the same time and by the samesurgeon as the primary procedure (+) 23. CPT Symbols Circle with slash identifies forbidden or prohibited codesexempt from modifier -51 Bulls eye identifies procedure that includes MCS Flash identifies codes that classify products pending FDAapproval (continued) 24. CPT Symbols SymbolCPT EntryUse of ; 11000 Debridement of extensive eczematoussemicolonor infected skin; up to 10% of body surfaceUse of plus + 11001 Each additional 10% of body surfacesymbol (List separately in addition to code for primary procedure)Use of -51 17004 Destruction (e.g., laser surgery,modifier electrosurgery, cryosurgery,exemptionchemosurgery, surgical curettement),symbol premalignant lesions (e.g., actinic keratoses), 15 or more lesionsUse of 33206 Insertion or replacement of permanentbulls eye pacemaker with transvenousCurrent Procedural Terminology 2010 American Medical Association. All rights reserved.symbol electrode(s); atrial 25. CPT Guidelines Define terms and explain assignment of codes forprocedure and services Located at beginning of each CPT section Guidelines from one CPT section do not apply to anotherCPT section Should be reviewed before assigning code 26. Sections, Subsections, Categories, and Subcategories Six sections subdivided into the following: Subsections Categories Subcategories Guidelines at beginning of each subsection(continued) 27. Sections, Subsections, Categories, andSubcategories Selection from CPT that illustrates sections, subsections, categories, subcategories, notes, and descriptive qualifiers Current Procedural Terminology 2010 American Medical Association. All rights reserved. 28. Unlisted Procedures and Services Unlisted procedure or unlisted service Assigned when provider performs procedure or service for which there is no CPT code Special report must accompany claim to provide moreinformation e.g., copy of procedure report 29. Sections, Subsections, Categories, and Subcategories Notes, parenthetical notes, and descriptive qualifiers ineach section, subsection, category, and subcategory 30. Instructional Notes Blocked un-indented note Indented parenthetical note Parenthetical note 31. Descriptive Qualifiers Terms that clarify assignment of CPT code Can you find the descriptive qualifier in code 35188?Thats right; head and neck qualifies the procedure asopposed to the same procedure involving the thorax andabdomen or extremities.