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45 terms

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