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Medicine Medicine. Medicine CPT® copyright 2013 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors.

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Presentation on theme: "Medicine Medicine. Medicine CPT® copyright 2013 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors."— Presentation transcript:

1 Medicine Medicine

2 Medicine CPT® copyright 2013 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. CPT® 2

3 Medicine 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 Objectives 3

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

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

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

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

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

9 Medicine Vaccines Vaccination Immunization Toxins Toxoids Vaccines and Toxoids ( ) 9

10 Medicine Outpatient, inpatient Providers psychiatrist (MD) psychologist (PhD) clinical social workers (LCSW) Modifier 22 Increased procedural services Modifier 52 Reduced services Psychiatry ( ) 10

11 Medicine Consultation ( ) Follow-up by consultant office visits ( ) rest home, domicile ( ) home ( ) Transfer of care – new or established pt. Diagnostic psychiatric evaluations ( ) Psychiatry 11

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

13 Medicine Miscellaneous Dialysis Procedures ( ) Peritoneal dialysis Hemofiltration Patient and helper training ( ) Dialysis 13

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

15 Medicine Vestibular Function Tests With and without recording Audiologic Function Tests Evaluative and Therapeutic Services Special Diagnostic Procedures Special Otorhinolaryngologic Services ( ) 15

16 Medicine Cardiovascular –Discussed in the Cardiovascular chapter Noninvasive Vascular Diagnostic Studies ( ) –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 Cardiovascular & Noninvasive Vascular Diagnostic Studies 16

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

18 Medicine Allergy Testing –Code allergen testing –Codes drug allergy Allergen Immunotherapy –Codes Allergy and Immunology ( ) 18

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

20 Medicine Nerve Conduction Tests ( ) Intraoperative Neurophysiology ( ) Autonomic Function Tests ( , ) Evoked Potentials and Reflex Tests ( ) Special EEG Tests Neurostimulators, Analysis-Programming Neurology and Neuromuscular Procedures 20

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

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

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

24 Medicine 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 ) Chemotherapy ( ) 24

25 Medicine Paracentesis Thoracentesis Peritoneocentesis Intrathecal Ventricular or Intraventricular Chemotherapy 25

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

27 Medicine Supervised ( ) Constant Attendance ( ) Diathermy, Vasopneumatic devices Therapeutic Procedures ( ) Modalities ( ) 27

28 Medicine Active wound care ( ) – not to be reported with Orthotic management and Prosthetic management –Orthotics –Prosthetics Wound Care Management Orthotic Management and Prosthetic Management 28

29 Medicine 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-service work Acupuncture ( ) 29

30 Medicine 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 Osteopathic Manipulative Treatment Chiropractic Manipulative Treatment 30

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

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

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

34 Medicine All are add-on codes Qualifying Circumstances for Anesthesia ( ) 34

35 Medicine 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 Moderate (Conscious) Sedation 35

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

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

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

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

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

41 Medicine 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” – 2001F is Weight recorded Category II Codes 41

42 Medicine 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 – 0085T Breath test for heart transplant rejection Category III Codes 42

43 Medicine 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 CPT® Appendices 43

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

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

46 Medicine The End


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