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CPT Coding
| Question | Answer |
|---|---|
| CPT | Current Procedural Terminology |
| Level I of the Healthcare Common Procedure Coding System (HCPCS) | CPT |
| CPT is a listing | of descriptive terms and identifying codes for reporting medical services and procedures |
| MMA requires that | new, revised and deleted ICD-9-CM codes be implemented each October 1 and updated each April |
| Changes to HCPCS level II national codes implemented | January 1 |
| CPT codes are used to report services and procedures performed on patients | by providers in Offices, clinics, private homes and providers in institutional settings; when the provider is employed by the health care facility, by a hospital outpatient department |
| Procedures and services submitted on claim must be linked to ICD-9-CM code that justifies the need for the service or procedure | the code must demonstrated medical necessity for the service or procedure to receive reimbursement consideration by payers. |
| CPT supports | EDI, the computer-based patient record (CPR) or electronic medical record (EMR) and reference/research databases. |
| Category I codes | procedures/services identified by a 5 digit code and descriptor nomenclature; these are traditionally associated w/CPT & organized w/in 6 sections |
| Category II Codes | contain ‘performance measurements’ tracking codes that are assigned an alphanumeric identifier w/a letter in the last field (1234A); these codes will be located after the Medicine section, & their use is optional |
| Category III Codes | contain ‘emerging technology’ temporary codes assigned for data collection purposes that are assigned an alphanumeric identifier w/a letter in the last field (0001T) |
| CPT Category Code 1 codes divided into 6 sections | Evaluation & management (E/M) (99201-99600), Anesthesia (00100-01999), Surgery (10040-69990), Radiology (70010-79999), Pathology & Laboratory (80048-89399), Medicine (90281-99199) |
| Appendix A | listing w/detailed descriptions of each CPT modifier |
| Appendix B | Annual CPT coding changes (added, deleted and revised CPT codes) |
| Appendix C | Clinical examples for codes found in Evaluation and management |
| Appendix D | add on codes; identified w/a + symbol |
| Appendix E | codes exempt from modifier -51 reporting rules |
| Appendix F | CPT codes exempt from modifier -63 |
| Appendix G | Summary of CPT codes that include conscious sedation |
| Appendix H | genetic testing modifiers |
| Appendix I | Category II code modifiers |
| What must a coder do w/indented code descriptions | the coder must refer back to the common portion of the code description that is located before the semicolon. |
| The common portion of the code description | begins w/a capital letter and ends with ; |
| The abbreviated (or subordinate) descriptions | are indented and begin w/lower-case letters placed after the ; |
| Codes reported w/plus signs are never reported as stand-alone codes | they are not classified as add-on codes |
| Codes reported w/a circle and diagonal line going through it represent | identifies codes that are not to be used w/modifies -51. These codes are reported in addition to other codes but are not classified as add-on codes. |
| The bulls-eye symbol denotes | a procedure that includes conscious sedation |
| CPT Category I codes are organized | according to 6 sections that are subdivided into subsections, subcategories, and headings |
| Guidelines | are located at the beginning of each CPT section and should be carefully reviewed before attempting to code. |
| Guidelines | define terms and explain the assignment of codes for procedures and services located in a particular section in CPT |
| Unlisted procedure or service code | assigned when the provider performs a procedure or service for which there is no CPT code. A special report must accompany the claim to describe the nature, extent and need for the procedure or service |
| Two types of instructional notes | 1 blocked unindented note and 2 indented parenthetical note |
| Blocked unindented note | located below a category (or subsection) title and contains instructions that apply to all codes in the category |
| Indented parenthetical note | located below a subsection title, code description, or code description that contains an example |
| Descriptive Qualifiers | terms that clarify the assignment of a CPT Code |
| Coders working in a provider’s office should highlight descriptive qualifiers in CPT that pertain to the office’s specialty | this insures that qualifiers are not overlooked when assigning codes |
| A bullet left of the code | identifies new procedures and services added to the CPT |
| A triangle located to the left of the code | identifies a code description that has been revised |
| Horizontal triangles | surround revised guidelines and notes (this symbol is NOT used for revised code descriptions) |
| The CPT index is organized | by alphabetical main terms printed in boldface which may be followed by indented terms that modify the main term (also called subterms) |
| Index code numbers for specific procedures may be represented as | a single code number, a range of codes separated by a dash, a series of codes separated by commas, or a combination of single codes and ranges of codes |
| Main terms in the CPT index | are printed in boldface type, along w/categories, subcategories, headings and code numbers |
| See | a cross-reference that directs the coders to an index entry under which codes are listed. No code are listed under the original entry. It is printed in italicized type |
| Before selecting a final code | the descriptions of all codes listed for a specific procedure must be carefully investigated |
| Coding must never | be performed solely from the index |
| CPT modifiers | clarify services and procedures performed by providers. Although the code & description remain unchanged, modifiers indicate the descr of the service has been altered |
| A list of all CPT modifiers w/brief descriptions is located | inside the front cover of the coding manual as well as appendix A |
| If the last code description you read is located at the bottom of the index page, what should you do | turn the page and check to see if the description continues |
| To find the main term in the index | you may have to refer to synonyms, translate medical terms to ordinary english or substitute medical words for English terms documented in the provider’s statement |
| The surgery section is organized by | body system |
| What are the three questions that must be asked to code surgeries correctly | What body system is involved? What anatomic site was involved ? What type of procedure was performed? |
| Sometimes the discriminating factor between one code and another will be | the surgical approach or type of procedure documented. Carefully read the procedure outlined in the operative report |
| Surgical package (or global surgery) | includes a variety of services provided by a surgeon |
| Global period | is the number of days associated with the surgical package and is designated by the payer as 0,10,90 days |
| Unbundling | means assigning multiple codes to procedures/services when just one comprehensive code should be reported. Unbundling is not allowed |
| Separate procedure | the parenthetical note follows a code description identifying procedures that are an integral part of another procedure or service |
| Multiple surgical procedures | two or more surgeries performed during the same operative session |
| The major surgical procedure | the procedure reimbursed at the highest level |
| The major surgical procedure should be listed first followed by | the lesser surgeries listed on the claim in descending order of expenses |
| What code is added to each of the lesser surgical procedure that does not have the null or plus sign in front of the code | modifier -51 |
| Skin lesion | any alteration of the skin |
| Shaving | sharp removal by transverse incision or horizontal slicing to remove epidermal and dermal lesions, w/out full-thickness dermal excision |
| Excision | full-thickness dermal removal of a lesion; CPT code includes simple closure |
| Destruction | ablation of tissue using chemical treatment, cryosurgery, electrocautery or laser treatment |
| CPT codes for excursions are reported in cm | if reported in in, you have to convert from inches to cm |
| Simple repair | use of staples, sutures and/or tissue adhesives to repair superficial wounds involoving epidermis, dermis and/or subcutaneous tissues |
| Intermediate repair | layered closure of deeper layers of subcutaneous tissue and superficial fascia in addition to epidermis, dermis and subcutaneous tissues |
| Complex repair | reconstructive complicated wound repair that requires more than layered closure and includes debridement, scar revision, extensive undermining, retention sutures or stents |
Created by:
RobynTerry1977