1. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Pearson's Comprehensive Medical Assisting Administrative and Clinical Competencies Second Edition CHAPTERCHAPTER CHAPTER 19 Medical Coding Lesson 2: Getting to Know the CPT

2. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Lesson Objectives Upon completion of this lesson, students should be able to … Define and spell the terms to learn for this chapter. Describe the purpose of CPT coding. Discuss basic coding rules for CPT. Correctly apply the principles of CPT coding.

3. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Sections in the CPT Manual Evaluation and Management Anesthesia Surgery Radiology Pathology and Laboratory Medical Services

4. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Codes to Each Section E/M: 99201-99499 Anesthesia: 00100-01999; 99100-99140 Surgery: 10021-69999 Radiology: 70010-79999 Pathology and Laboratory: 80048-89356 Medical Services: 90281-99199; 99500- 99602

5. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Evaluation and Management Section Beginning section in the CPT manual Contains the most commonly used codes Includes codes for office visits and consultations Codes link the procedure or diagnosis with time needed for treatment

6. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Factors Affecting Code Selection Place of service History of the patient Complexity of the examination Degree of difficulty in the medical decision- making

7. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Four Levels of Decision Making Straightforward Low complex Moderate complex High complex

8. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Distinguishing Patient Types New patient: –New to practice –Has not seen regular physician in at least 3 years Established patient: –Has been seen by the physician in the last 3 years

9. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Use of Modifiers Provides further clarification of services and procedures Follows the 5-digit CPT code Is a two-digit code preceded by a hyphen Most common modifier is -50 Use of multiple modifiers requires the use of modifier -99 first

10. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Codes Found in the Medicine Section Codes for noninvasive procedures and treatment procedures Codes for many diagnostic tests, such as an ECG, and many procedures (noninvasive) performed in a physician’s office If the procedure is invasive, meaning that it enters the skin (other than by injection) or a body cavity, it is found in the surgical section of the manual

11. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Critical Thinking Question 1.What items might you need to properly code a patient’s visit?

12. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Items Needed to Accurately Code Patient’s medical record Computer Medical billing software Current CPT coding book Superbill with procedure marked

13. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps to Accurate Coding Locate the completed procedure on the superbill If the only procedure done was a physician visit, locate the E/M code 99201–99499 in the front of the CPT coding book Determine if the patient is new or established Determine if the patient was seen by an attending physician or a consulting physician

14. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps to Accurate Coding Note where the visit took place (nursing home, hospital, emergency room, office, etc.) Locate the code for the level of the visit

15. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps to Properly Coding If there was a surgical procedure, locate the CPT code in the index by using the procedure name or anatomical site; then look up the suggested codes which will be between 10021 and 69999 of the CPT book Some equipment used in surgery is billable under the 10000 to 69999 codes, while other equipment is billed separately

16. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Steps to Properly Coding Any radiological procedure is billed under the codes 70010 to 79999 If a laboratory test was run, or a specimen was sent to the laboratory for inspection look under 80048 to 89356 Before finalizing the bill, always compare the final CPT codes with the ICD codes to ensure that the diagnosis supports the procedure or service

17. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Symbols Used in the CPT Manual Used to indicate changes or provide instructions when coding Add information to certain procedure codes Symbols include: –Ø –+ –▲ –● –►◄

18. Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pearson's Comprehensive Medical Assisting: Administrative and Clinical Competencies, 2/e Beaman Fleming-McPhillips Routh Gohsman Reagan Questions?