Chapter 6 CPT Codes

CPT Codes What are they used for? What are they? Who uses them? 5 digit numbers What are they used for? to replace service descriptions Who uses them? Anyone billing for service will use a procedure code. Could be CPT, HCPCS, or other service codes. Outpatient services provided by a doctor use CPT codes.

CPT Book Updated every year in October updates could include new technology or new way of performing a procedure Examples: 2013 new codes 24370 Revision of total elbow arthroplasty, including allograft when performed, humeral or ulnar component 24371 Revision of total elbow arthroplasty, including allograft when performed, humeral and ulnar component

CPT Nomenclature Symbols Revised code =  New Code =  New or revised text =  Add-on code =  32506 is an add on code, it can only be used with 32505

Guidelines Just like ICD-9, read guidelines for each chapter to get instruction for coding that chapter’s codes Surgery Guideline: Surgical destruction is a part of a surgical procedure and different methods of destruction are not ordinarily listed separately unless the technique substantially alters the standard management of a problem or condition. Exceptions under special circumstances are provided for by separate code numbers.

Modifiers Two-digit numbers added to a CPT code to modify the code description Examples: -25 significant, separate E/M performed on same day -50 bilateral procedure -62 two surgeons -LT and –RT left and right side (HCPCS modifiers)

Factors for E/M Place of Service (hospital, nursing facility, critical care, office, ER) Type of Service (consultation, office visit, newborn care, preventive medicine) Patient Status (new/established patient, inpatient/outpatient, referral)

Levels of Service Look at E/M codes for Office or Other Outpatient Services Patient Status Chief Complaint, history of present illness (PI); review of systems (ROS); past, family, and social history (PFSH) Level of Service (key components) Problem focused, expanded problem focused, detailed, comprehensive

Assigning CPT Codes Identify main term Probably a verb indicating what service was performed Discection Repair Anesthesia (administration) graft

Assigning CPT Codes Look up main term in Alphabetic Index If the word you identify is not directing you to the code you need, think of another way to say what was done Example: Dead tissue around a burn is removed = debridement by body part

Assigning CPT Codes Verify the code suggested in the Alpha index Pay attention to indents and ; Look at code 47561 or 21401

Global Charges Many surgical procedures include Preop Intra op Post op Complications to that surgery supplies

Anesthesia and Radiology There may be two service codes One code for administering the anesthesia or taking the x-ray Different code for the surgery or for reading the x-ray

Practice What would be the code used to report the administration of anesthesia for a procedure on the esophagus? Main term? Anesthesia, esophagus 00500

Anesthesia, Achilles tendon repair Practice What would be the code used to report the administration of anesthesia for repair of a ruptured Achilles tendon? Main term? Anesthesia, Achilles tendon repair 01472