Chapter 7 Cpt Coding part 1

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Cpt is level 1 of the

Healthcare common procedure Coding ystem (HCPCS)

Cpt is a listing of

descriptive terms and identifying codes for reporting medical services and procedures

Cpt provides a uniform language

that describes medical, surgical, and diagnostic services

CPT codes are used to report

services and procedures performed on patients

By Providers in
(CPT codes are used to report services and procedures performed on patients)

offices, clinics,and private homes

By providers in institutional settings such as
(CPT codes are used to report services and procedures performed on patients)

hospitals, nursing facilities, and hospices

When the provider is employed by the
(CPT codes are used to report services and procedures performed on patients)

health care facility (eg, many of the physicians associated with Vetrans Adminitration Medical centers are employees if that organization),

By a hospital outpatient department
(CPT codes are used to report services and procedures performed on patients)

(e.g ambulatory surgery, emergency department, and outpatient lab or radiograpihc procedures)

Procedures and services submitted on a claim must be

linked to the ICD-9-Cm code that justifies the need for service or procedure

Category 1 codes

procedures/services identified by a five digit cpt code and descriptor nomencitature: these are the codes traditionally associated with CPT and organized wuthin six sections

Category three codes

contain "emergency technology" temperoary codes assigned for data collection purposes that are assigned an alphanumeric identifieer with a letter in the last field

Theses codes are located after the medicine section, and they will be
(Category three codes)

archived after five years unless acepted for placement

E/M section located at beggining of CPT because

these codes are reported by all specialties

Cpt organizes category 1 pricedures and services within six sexctions

evaluation and mangment e/m, anesthesia, surgery, radiology, pathology, medicine

Five digit code number and narrative description identify

each procedure and services listed in CPT

Appendix E

codes exempt -51 reporting rules

Appendix G

summary of Cpt codes that include moderate (concious) sedation

° bullet located to the left of the code number identifes

new procedures and services added to CPT

/_\ Triangle located to the left of a code number identifies

code description that ahs been revised

>< Horizontal triangles surround

revised guidelines

Remebr Horizontal triangles are not used for

revised code descriptions

+ Plus symbol identifies

add on codes for procedures that are commonly, but not always performed at the same time and by the same surgeon

ø forbidden sympol identifies codes that are

NOT to be used with modifier -51

Θ bulls eye symbol indicates

procedures that includes moderate (conscious) sedation

Moderate (conscious) Sedation

administration of moderate sedation or analgesia, which results in a drug-induced depression of conscousness

Guidelines are located at the beggining of each CPT section and should

be carefully reviewed before attempting to code

Guidelines define terms and explain

assignment of codes for procedures and services located in a particular section

Descriptive qualifers

terms that clarrify the assignment of the cpt codes

they can occur in the
(Descriptive qualifers)

middle of a main clause or after the semicolon and may or may not be enclosed in parantheses

Cpt index is organized by

alphabetical and main terms printed to boldface

The mainterms represent

procedures or serivces , organs, anatomic sites, conditions, eponyms, or abbreviations

Cpt modifiers clarify

services and procedures performed by providers

Cpt modifiers are represented as

two digit numeric codes added to the five digit Cpt code

Modifier -25

significant separately identifiable evaluation and Mangemnt service by the ame physician on the same day of the procedure or other services

modifier -57

decision for surgery

Modifier -22

increased procedural services also meaning abpve and beyond

Evaluation and mangement (e/m section)

located at the begining of Cpt because these codes describe services most freuently provided by physicans

The E/M section is organzed according to place of service (POS)

(e.g. ofice , hospital, home, nursing facility (nf), emergency department, or criticwl care_ type of service Eg. new or intital encounter follow up r subsequent servise, and miscillanous service.

E/m level of service

reflects the ammount of work involved in providing health care to a patient and correct coding requires determining the extent of history and examination performes\d as well as the complexity of medical decision making

Concurrent care is the provision of

similar services such as hopitals inpatient visits, to the same patient by more thn one provider on teh same day

Provider should report diffrent ICd-9-cm diagnosis codes from

those reported by other providers who see the patient on the same day

Levels of E/M service code descriptions include seven compnets

history, examination, medical decision making, counseling, coordination of care, nature of presenting problem, time

E/m code selection is based on three key componets
( key components)

extent of history , extent of examination, complexity of medical decision making

All three componets must be considered when
(key components)

assigning codes for new patients

extent of history is categorized into four levels

problem focused history, expanded problem focused history, detailed history, comprehensive history

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