1. Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CHAPTER 25 MEDICINE

2. 2 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Medicine Section Diagnostic and Therapeutic ProceduresDiagnostic and Therapeutic Procedures Most procedures noninvasive (not entering body)Most procedures noninvasive (not entering body) Contains invasive proceduresContains invasive procedures –Example: 92973, Percutaneous thrombectomy Numerous notes throughoutNumerous notes throughout

3. 3 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Subsections Wide variety servicesWide variety services Many specialized testsMany specialized tests –Example: AudiologyAudiology BiofeedbackBiofeedback

4. 4 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Immunizations Often usedOften used Two types immunizationsTwo types immunizations –Activeand passive –Active and passive Correct coding includesCorrect coding includes –Supplyinjected –Supply injected –Administrationof injection –Administration of injection(Cont’d…)

5. 5 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Active—Bacteria or Viruses (…Cont’d) Bacteria that cause disease made nontoxic (toxoid)Bacteria that cause disease made nontoxic (toxoid) –Injected to build immunity Small dose active virus injected (vaccine)Small dose active virus injected (vaccine) –Injected to build immunity Example: PoliovirusExample: Poliovirus(Cont’d…)

6. 6 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Passive Immunization (…Cont’d) Does not cause immune responseDoes not cause immune response Contains antibodies against certain diseases—immune globulinsContains antibodies against certain diseases—immune globulins

7. 7 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Immune Globulins (90281-90399) Identifies immune globulin productIdentifies immune globulin product –Example: Botulism antitoxin Report administration separatelyReport administration separately(Cont’d…)

8. 8 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Immune Globulins (90281-90399) (…Cont’d) Codes divided by:Codes divided by: –Type e.g., Rabies, hepatitis Be.g., Rabies, hepatitis B –Method e.g., Intramuscular, intravenous, subcutaneouse.g., Intramuscular, intravenous, subcutaneous –Dose e.g., Full dose, mini-dosee.g., Full dose, mini-dose From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders.

9. 9 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Immunization Administration for Vaccines/Toxoids (90465-90474) Administration (performing the injection) of substanceAdministration (performing the injection) of substance –Reported with substance given (Cont’d…)

10. 10 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Immunization Administration (90465-90468) (…Cont’d) 90465 -90468 Patients under 8 years of age when physician counsels regarding immunization90465 -90468 Patients under 8 years of age when physician counsels regarding immunization 90465, +90466 = Percutaneous, intradermal, subcutaneous, or intramuscular injection90465, +90466 = Percutaneous, intradermal, subcutaneous, or intramuscular injection 90467, +90468 = Oral or intranasal90467, +90468 = Oral or intranasal 90471-90474 = Patients 8 years of age or over90471-90474 = Patients 8 years of age or over –Patients of all ages (including under 8) if physician does not counsel regarding immunization 90471, +90472 = Percutaneous, intradermal, subcutaneous, or intramuscular injection90471, +90472 = Percutaneous, intradermal, subcutaneous, or intramuscular injection 90473, +90474 = Oral or intranasal90473, +90474 = Oral or intranasal

11. 11 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Methods of Administration PercutaneousPercutaneous –Intradermal –Subcutaneous –Intramuscular IntranasalIntranasal OralOral (Cont’d…) From Bonewit-West K: Clinical Procedures for Medical Assistants, ed 7, St. Louis, 2008, Saunders.

12. 12 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Report Administration for Each Dose—Single or Combination Example: Patient (over age 8) receives three separate administrations:Example: Patient (over age 8) receives three separate administrations: 90471 tetanus90471 tetanus 90472 rubella90472 rubella 90472 diphtheria (add modifier -51 to indicate not a duplicate)90472 diphtheria (add modifier -51 to indicate not a duplicate) –OR depending on payer: 90471 tetanus90471 tetanus 90472 x 2 rubella and diphtheria90472 x 2 rubella and diphtheria

13. 13 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Vaccines, Toxoids (Vaccine Product Codes) (90476-90749) Many codes age specificMany codes age specific –Example: 90658, influenza virus vaccine, for ages 3 and over90658, influenza virus vaccine, for ages 3 and over Codes for products for single diseasesCodes for products for single diseases –Example: 90703, tetanustoxoid90703, tetanus toxoid Codes for combination of diseasesCodes for combination of diseases –Example: 90701, diphtheria, tetanus, and whole cell pertussis ( DTP )90701, diphtheria, tetanus, and whole cell pertussis ( DTP ) Caution: There are numerous code combinations of diphtheriaCaution: There are numerous code combinations of diphtheria(Cont’d…)

14. 14 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Vaccines, Toxoids (…Cont’d) Some vaccines given on scheduleSome vaccines given on schedule –Example: 90633, 2-dose hepatitis A vaccine90633, 2-dose hepatitis A vaccine –First dose, first visit –Second dose, second visit 90633 is reported for each visit90633 is reported for each visit

15. 15 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Remember Do not assign modifier -51Do not assign modifier -51 with Vaccine/Toxoid codes with Vaccine/Toxoid codes –Rather, depending on payer: List each code multiple times orList each code multiple times or Use times (  ) symbol and indicate numberUse times (  ) symbol and indicate number Modifier -51 should not be reported for the vaccines, toxoids when performed with these administration codes (90465- 90474)Modifier -51 should not be reported for the vaccines, toxoids when performed with these administration codes (90465- 90474)

16. 16 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Important Reporting Rules If vaccine administered during office visit (not related to E/M)If vaccine administered during office visit (not related to E/M) –Report E/M service (with modifier -25) + Vaccine + administration Depends on local carrierDepends on local carrier Office visit for vaccine only, code only vaccine, NO E/MserviceOffice visit for vaccine only, code only vaccine, NO E/M service –Depends on local carrier

17. 17 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Routine Vaccinations InfluenzaInfluenza –Administration G0008HCPCS (Medicare only)G0008 HCPCS (Medicare only) 90471/9047290471/90472 –Substance (vaccine) 90657, 90658 PneumococcalPneumococcal –Administration G0009HCPCS (Medicare only)G0009 HCPCS (Medicare only) 90471/90472 administration90471/90472 administration –Substance (vaccine) 90732

18. 18 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Psychiatry (90801-90899) Psychiatric treatment at same time as E/M service, reportPsychiatric treatment at same time as E/M service, report –One code for therapy with E/M –Example: 90805, psychotherapy and E/M Time major billing factorTime major billing factor –Codes divided on time –Medical record indicates session time (Cont’d…)

19. 19 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. When selecting a psychotherapy code ask these questions:When selecting a psychotherapy code ask these questions: 1.Where is the service taking place? 2.How much face-to-face time is spent with the patient? 3.Does documentation support an evaluation & management code in addition to psychotherapy? 4.If rendering psychotherapy, is the approximate “time” of the psychotherapy noted in the medical record? Psychiatry (90801-90899)

20. 20 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Psychiatry (…Cont’d) Many services provided in partial hospital settingsMany services provided in partial hospital settings –Patient in hospital during day, returns to home for evenings and weekends Interactive psychotherapy is typically furnished to childrenInteractive psychotherapy is typically furnished to children It uses play equipment, physical aides, nonverbal communications, or other mechanisms of communicationIt uses play equipment, physical aides, nonverbal communications, or other mechanisms of communication

21. 21 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Biofeedback (90901, 90911) Used to help patients gain control over body processesUsed to help patients gain control over body processes –Example: High BP or manage chronic pain Medicare Coverage Issues Manual 35- 27 restricts the use of biofeedbackMedicare Coverage Issues Manual 35- 27 restricts the use of biofeedback Medicare doesn’t cover biofeedback for the treatment of psychiatric disordersMedicare doesn’t cover biofeedback for the treatment of psychiatric disorders(Cont’d…)

22. 22 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Biofeedback (…Cont’d) Patient training in biofeedback by professionalPatient training in biofeedback by professional –Continues on own Services often part of psychophysiologic (mind/body) therapyServices often part of psychophysiologic (mind/body) therapy

23. 23 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Dialysis (90935-90999) Cleanses bloodCleanses blood –Temporary (non-ESRD) –Permanent (ESRD) Two parts to report ESRD dialysis services:Two parts to report ESRD dialysis services: –Physicianservice –Physician service –Hemodialysis procedure Patient receiving hemodialysis. (From Lewis SM, Heitkemper MM, Dirksen SR: Medical-Surgical Nursing: Assessment and Management of Clinical Problems, ed 6, St. Louis, 2004, Mosby.) Figure: 25.4

24. 24 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. End Stage Renal Disease Services (90951-90970) IncludeInclude –Establishment of dialyzing cycle –Physicianservices –Physician services –E/M outpatientdialysis visits –E/M outpatient dialysis visits –Patient managementduring dialysis –Patient management during dialysis Reported for month: 90951- 90966Reported for month: 90951- 90966 –Less than full month of service: 90967-90970per day –Less than full month of service: 90967-90970 per day –Codes divided on ageand number of visits –Codes divided on age and number of visits

25. 25 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Hemodialysis Service (90935-90940) Hemodialysis is the procedureHemodialysis is the procedure –Used for ESRD and non-ESRD Billed per day for inpatients receiving ESRD + non-ESRDBilled per day for inpatients receiving ESRD + non-ESRD Includes all physician E/M services related to procedureIncludes all physician E/M services related to procedure –Use modifier -25 if separate E/M service provided

26. 26 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Miscellaneous Dialysis Procedures (90945-90999) Describes other dialysis proceduresDescribes other dialysis procedures –Example: Peritonealdialysis in which toxins are passively absorbed into dialysis fluidPeritoneal dialysis in which toxins are passively absorbed into dialysis fluid(Cont’d…)

27. 27 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Peritoneal Dialysis Services billed on per day basis for inpatient ESRD patientsServices billed on per day basis for inpatient ESRD patients(Cont’d…) (…Cont’d) From Goldman L, Ausiello D, editors: Cecil Textbook of Medicine, ed 22, Philadelphia, 2004, Saunders.

28. 28 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Peritoneal Dialysis (…Cont’d) Patients can receive training in self-dialysisPatients can receive training in self-dialysis –Reported with 90989, 90993 –Codes divided by completeor partial training program –Codes divided by complete or partial training program

29. 29 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Gastroenterology (91000-91299) For tests and treatments of esophagus, stomach, and intestineFor tests and treatments of esophagus, stomach, and intestine Codes usually reported with E/Mor consultationservice codeCodes usually reported with E/M or consultation service code Caution: Many bundled servicesCaution: Many bundled services

30. 30 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Ophthalmology (92002-92499) Contains E/M codesContains E/M codes –Not E/M codes from front of CPT Definitions for new and established patients same as for E/MsectionDefinitions for new and established patients same as for E/M section Most codes are for bilateralservicesMost codes are for bilateral services –If only one eye, use modifier -52 (reduced service) Read the definitions of intermediate and comprehensive services in the CPT!Read the definitions of intermediate and comprehensive services in the CPT!

31. 31 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Example, Intermediate: Review of history, external examination, ophthalmoscopy, biomicroscopy for an acute complicated condition (e.g., iritis) not requiring comprehensive ophthalmological servicesExample, Intermediate: Review of history, external examination, ophthalmoscopy, biomicroscopy for an acute complicated condition (e.g., iritis) not requiring comprehensive ophthalmological services Intermediate and comprehensive ophthalmological services constitute integrated services in which medical decision making cannot be separated from the examining techniques usedIntermediate and comprehensive ophthalmological services constitute integrated services in which medical decision making cannot be separated from the examining techniques used Ophthalmology (92002-92499)

32. 32 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Special Otorhinolaryngologic Services (92502-92700) For special evaluations of audiologic systemFor special evaluations of audiologic system Go beyond those usually provided in evaluationGo beyond those usually provided in evaluation May be reported in addition to basic audiologic serviceMay be reported in addition to basic audiologic service(Cont’d…)

33. 33 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Special Otorhinolaryngologic Services (…Cont’d) Special treatments and diagnostic servicesSpecial treatments and diagnostic services –Example: Nasal function tests ( rhinomanometry ) or audiometric testsNasal function tests ( rhinomanometry ) or audiometric tests All hearing tests bilateral unless indicated one ear in descriptionAll hearing tests bilateral unless indicated one ear in description Use modifier -52 for 1 earUse modifier -52 for 1 ear Nasal function test equipment. From Cummings CW, Flint PW, Harker LA, Haughey BH, Richardson MA, Robbins KT, Schuller DE, Thomas JR, editors: Cummings Otolaryngology-Head & Neck Surgery, ed 4, Philadelphia, 2005, Mosby. Audiometric equipment. From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders.

34. 34 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Cardiovascular Therapeutic Services PTCA (92950-92998)PTCA (92950-92998) Two catheters placedTwo catheters placed –Central venous access inserted through the femoral or brachial artery –Catheter with balloon tip threaded up to heart Balloon is expanded and widens vesselBalloon is expanded and widens vessel If an angioplasty and an athrectomy are performed during the same session, only the athrectomy is billedIf an angioplasty and an athrectomy are performed during the same session, only the athrectomy is billed If a stent is placed in a coronary vessel, the stent placement takes hierarchy over both the angioplasty and athrectomyIf a stent is placed in a coronary vessel, the stent placement takes hierarchy over both the angioplasty and athrectomy

35. 35 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Cardiography (93000-93278) Implantable and Wearable Cardiac Device Evaluations (93279-93299)Implantable and Wearable Cardiac Device Evaluations (93279-93299) And Echocardiography (93303-93352)And Echocardiography (93303-93352) –Reviewed in Chapter 16 of this text

36. 36 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Cardiac Catheterization Diagnostic medical procedureDiagnostic medical procedure Three componentsThree components –93501-93533Catheterization –93539-93545Injection –93555-93556Imaging If the cardiac catheterization is performed in a facility setting, modifier -26 is placed on 93501-93533 series and on the imaging codes 93555-93556If the cardiac catheterization is performed in a facility setting, modifier -26 is placed on 93501-93533 series and on the imaging codes 93555-93556 Reviewed in Chapter 16 of textReviewed in Chapter 16 of text

37. 37 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Noninvasive Vascular Diagnostic Studies (93875-93990) Vascular codes for procedures on noncoronary veins and arteriesVascular codes for procedures on noncoronary veins and arteries IncludesIncludes –Patientcare –Patient care –Supervision and interpretation (S&I) –Copy of results Reviewed in Chapter 16 of textReviewed in Chapter 16 of text

38. 38 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Pulmonary (94002-94799) For ventilation management, therapies, and diagnostictestsFor ventilation management, therapies, and diagnostic tests Includes procedure and interpretationof test resultsIncludes procedure and interpretation of test results –Additional E/M service reported separately Ventilator management codesVentilator management codes –Further divided by place of service –Facility is billed perday –Facility is billed per day –Home billed by timeonce per month –Home billed by time once per month Spirometer. (From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders.) Exhaling into spirometer. (From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders.)

39. 39 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Allergy and Clinical Immunology (95004-95199) Divided into two subheadings:Divided into two subheadings: –AllergyTesting (95004-95075) –Allergy Testing (95004-95075) –Allergen Immunotherapy (95115-95199) –Should not report both together Allergy testing—consists of performance, evaluation, and interpretation of allergens placed under the skinAllergy testing—consists of performance, evaluation, and interpretation of allergens placed under the skin Immunotherapy—indicated for patients with allergic rhinitis due to seasonal pollinosis caused by trees, grasses, weeds, etc.Immunotherapy—indicated for patients with allergic rhinitis due to seasonal pollinosis caused by trees, grasses, weeds, etc.

40. 40 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Allergy Testing (95004-95075) Sensitivity testing using various types of testsSensitivity testing using various types of tests –Example: Percutaneous, intracutaneous, inhalationPercutaneous, intracutaneous, inhalation Tests use numerous substancesTests use numerous substances –Example: Extracts, venoms, biologics, and foodsExtracts, venoms, biologics, and foods Typeand number of tests based on physician’s judgmentType and number of tests based on physician’s judgment(Cont’d…)

41. 41 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Coding Allergy Testing (…Cont’d) Medical record will indicate theMedical record will indicate the –Numberof tests –Number of tests –Typeof test –Type of test –Methodof testing –Method of testing

42. 42 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Allergen Immunotherapy (95115-95199) Codes divided into three types services:Codes divided into three types services: –Injectiononly –Injection only –Prescriptionand injection –Prescription and injection –Provision antigen (substance) only Codes 95115 & 95117 are payable in an office settingCodes 95115 & 95117 are payable in an office setting(Cont’d…)

43. 43 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Allergen Immunotherapy (…Cont’d) Physician service bundled into immunotherapy codesPhysician service bundled into immunotherapy codes –If separate E/M service provided, report separately with -25

44. 44 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Neurology and Neuromuscular Procedures (95803-96020) Contains codes to report tests, such as:Contains codes to report tests, such as: –Sleep testing –Muscle and range of motion testing –Electroencephalography (EEG) –Neurostimulator procedures –Functional brain mapping Many bundled servicesMany bundled services Services usually provided in addition to E/M serviceServices usually provided in addition to E/M service These are often consultative services (e.g., 99241-99242)These are often consultative services (e.g., 99241-99242)

45. 45 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Central Nervous System (CNS) Assessments/Tests (96101-96125) Used to report:Used to report: –Psychological tests –Speech/language assessments –Developmental progress assessments –Thinking/reasoning examinations (Cont’d…)

46. 46 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CNS Assessments/Tests (…Cont’d) Codes based on per hour basisCodes based on per hour basis –Except for basic developmental testing Includes written report of resultsIncludes written report of results

47. 47 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Hydration (96360, 96361) 96360-9637696360-96376 Infusion: Therapeutic procedure to introduce fluid into bodyInfusion: Therapeutic procedure to introduce fluid into body –Example: Fluid into vein for patient rehydrationFluid into vein for patient rehydration Codes represent infusion service and “pre- packaged fluid and electrolytes”Codes represent infusion service and “pre- packaged fluid and electrolytes” –Other than pre-packaged, report separately

48. 48 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Hydration, Therapeutic Infusions, and IV Pushes Only one initial service per encounterOnly one initial service per encounter Patient presents for hydration (initial service)Patient presents for hydration (initial service) –Has drug therapy while being hydrated –Drug therapy is subsequent Report with add-on codeReport with add-on code –Example: 3 hours hydration with antiemetic by IV push for 15 minutes 96360 = hydration, 1 hr96360 = hydration, 1 hr 96361  2 = hydration, hr 2 and 396361  2 = hydration, hr 2 and 3 96375 antiemetic IV push96375 antiemetic IV push

49. 49 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration) (96365-96379) Types of Drug Administration Therapeutic Prophylactic DiagnosticTherapeutic Prophylactic Diagnostic Codes divided by administration method Subcutaneous Intramuscular IV PushSubcutaneous Intramuscular IV Push Intra-arterial Intravenous push Intra-arterial Intravenous push –A Push takes 15 minutes or less –Over 15 minutes is an infusion –Also report the substanceadministered (J code) –Also report the substance administered (J code)

50. 50 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Chemotherapy Administration (96401-96549) Represents only preparation and administration chemotherapyRepresents only preparation and administration chemotherapy –If separate E/M service provided, report E/M code and -25 Chemical can be administered (injected into)Chemical can be administered (injected into) –Lesion –Vein –Tissue –Muscle –Artery –Cavity –Nerve (Cont’d…)

51. 51 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Chemotherapy Administration (…Cont’d) Intravenously injected chemicals two methods of delivery of chemicalIntravenously injected chemicals two methods of delivery of chemical –IV push quickly puts into vein (15 minutes or less) –IV infusion delivers over longer period time (15 minutes or more) Chemotherapy administration codes are covered only when drug being used is an antineoplastic and diagnosis is cancerChemotherapy administration codes are covered only when drug being used is an antineoplastic and diagnosis is cancer(Cont’d…)

52. 52 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Chemotherapy Administration (…Cont’d) Codes often divided on time of infusion/injection procedureCodes often divided on time of infusion/injection procedure –Example: 96413, Chemotherapy administration, intravenous infusion, up to 1 hour, single or initial substance/drug96413, Chemotherapy administration, intravenous infusion, up to 1 hour, single or initial substance/drug When multiple drugs are given by different routes of administration, a separate fee will be paid for each route of administrationWhen multiple drugs are given by different routes of administration, a separate fee will be paid for each route of administration(Cont’d…)

53. 53 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Chemotherapy Administration (…Cont’d) Chemical agent (substance) reported separatelyChemical agent (substance) reported separately Special supplies (e.g., special needles) reported separately using 99070 or Level II HCPCS codeSpecial supplies (e.g., special needles) reported separately using 99070 or Level II HCPCS code(Cont’d…)

54. 54 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Chemotherapy Administration (…Cont’d) Report any intra-arterial catheter placement (cutdown) with 36640Report any intra-arterial catheter placement (cutdown) with 36640 Intra-arterial route has coverage restrictions for Medicare (e.g., coverage is for patients with liver cancer, diagnosis codes 155.0-155.2 and 197.7) and colon cancer that is metastatic to the liverIntra-arterial route has coverage restrictions for Medicare (e.g., coverage is for patients with liver cancer, diagnosis codes 155.0-155.2 and 197.7) and colon cancer that is metastatic to the liver

55. 55 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Injections with Chemotherapy Report separately any analgesic or antiemetic (for vomiting)Report separately any analgesic or antiemetic (for vomiting) –Before or after chemotherapy –Report both the administration and J-code

56. 56 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Photodynamic Therapy (96567-96571) Used in addition to bronchoscopy or gastrointestinal codesUsed in addition to bronchoscopy or gastrointestinal codes Injected agent remains in cancerous cells longer than normal cellsInjected agent remains in cancerous cells longer than normal cells –After agent dissipates from normal cells, patient exposed to laser light –Agent absorbs light –Light produces oxygenand cancer cell destroyed –Light produces oxygen and cancer cell destroyed

57. 57 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Special Dermatological Procedures (96900-96999) Usually specialized procedures provided on consultation basisUsually specialized procedures provided on consultation basis –Separate E/M consultation code then appropriate Treatment of skin conditions:Treatment of skin conditions: –Actinotherapy—with ultraviolet light –Photochemotherapy—with light-sensitive chemicals and light rays

58. 58 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Physical Medicine and Rehabilitation (97001-97799) (…Cont’d) Used by physicians and therapists to report services for variety of treatmentsUsed by physicians and therapists to report services for variety of treatments –Traction –Electrical stimulation (used to help heal fractures) –Therapeutic exercise Patient training:Patient training: –Gait training –Functionalactivities –Functional activities(Cont’d…)

59. 59 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Physical Medicine and Rehabilitation (…Cont’d) Codes often have time componentsCodes often have time components –Example: 97761 reports orthotics fitting and training, per 15 minutes Codes divided by type of therapyCodes divided by type of therapy –Example: physical or occupational Modalities are divided by supervised or constant attendanceModalities are divided by supervised or constant attendance

60. 60 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Active Wound Care Management (97597-97606) DebridementDebridement –Nonselectivehealthy tissue removed along with necrotic tissue (97602) –Nonselective healthy tissue removed along with necrotic tissue (97602) –Selectiveremoval of necrotic tissue (97597, 97598) –Selective removal of necrotic tissue (97597, 97598) –Negative pressure wound therapy (NPWT) is controlled application of subatmospheric pressure to a wound (97605, 97606) Each code for ongoing care reported on per session basisEach code for ongoing care reported on per session basis

61. 61 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Must document debridement was performed, level of tissue debrided, method of debridementMust document debridement was performed, level of tissue debrided, method of debridement Document the size and character of wound before and after debridementDocument the size and character of wound before and after debridement Document a treatment plan and patient educationDocument a treatment plan and patient education Direct (one-to-one) patient contactDirect (one-to-one) patient contact Active Wound Care Management (97597-97606)

62. 62 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Osteopathic and Chiropractic Services (98925-98943) Both inpatient and outpatient settingsBoth inpatient and outpatient settings Physician services bundled into codesPhysician services bundled into codes Codes divided by number of body regions involvedCodes divided by number of body regions involved

63. 63 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Online/Telephone Services (98966-98969) and Special Services, Procedures, and Reports (99000-99091) Non-Face-to-Face Nonphysician Services (98966-98969) report telephone and online E/M services by nonphysiciansNon-Face-to-Face Nonphysician Services (98966-98969) report telephone and online E/M services by nonphysicians Handling and conveyance laboratory specimensHandling and conveyance laboratory specimens –99000-99002 Postoperative follow-up visits included in surgical packagePostoperative follow-up visits included in surgical package –99024 Office visits after posted hours or in locations other than officeOffice visits after posted hours or in locations other than office –99053 (24-hour facility) Medicare bundles most of the Special Services proceduresMedicare bundles most of the Special Services procedures(Cont’d…)

64. 64 Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Special Services, Procedures, and Reports (…Cont’d) Supplies and materials (99070)Supplies and materials (99070) Hospital mandated on-call services (99026, 99027)Hospital mandated on-call services (99026, 99027) Medication Therapy Management Services (99605-99607) report pharmacist services in medication managementMedication Therapy Management Services (99605-99607) report pharmacist services in medication management

65. Copyright © 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Conclusion CHAPTER 25 MEDICINE