 Welcome, during the seminar, the chat feature will be disabled so that I am able to complete my agenda for the evening! Be sure to have your CPT coding manual out for tonight! I will answer questions at the end. Thanks, Professor Campbell

 Final Project  Unit 5 Overview  Introduction to HCPCS Coding  Introduction to CPT Coding

 For your Final Project, you are to write a paper that addresses why the ICD-10-CM has not yet been adopted in the United States, the reasons it is needed, and whether or not the ICD-10-CM is a classification or a nomenclature. You will also be asked to describe the layout and the major conventions used in ICD-10-PCS as well as include a table that will show the mapping of ten ICD-9-CM codes to their ICD-10-PCS counterpart.

 Read Chapters 7 & 8  Participate in Discussion  Participate in Seminar  Practice on your own using your workbook.  Complete Assignment ◦ Access dates:  8/3/ :00:00 AM to 8/9/ :59:59 PM ◦ Can be reviewed in Gradebook on:  8/16/ :59:59 PM ◦ Number of times can be taken:  1 ◦ Time allowed to complete:  1hour

 CPT Modifiers  CPT Symbols  CPT Guidelines  Unlisted Procedures & Special Reports  Identifying the main term  National Correct Coding Initiative  CPT Coding (multiple choice)

 Moe Howard is a patient in Acme Alcohol Rehabilitation Hospital. He has just received an injection of methadone. The code used to report the service will be:  Correct answer is ◦ H0020

 Define key terms in Chapters 7 and 8  Differentiate between HCPCS Level I and Level II codes  Assign accurate HCPCS Level I and Level II codes  Identify situations where both Level I and Level II codes will be assigned  Interpret CPT guidelines  Explain modifiers and assign to CPT codes as appropriate

 Level 1 ◦ Current Procedural Terminology (CPT)  Maintained by AMA, updated every year January 1 st  Level 2 ◦ National Codes (HCPCS manual)  Maintained by CMS, updated every year January 1 st

Introduction to HCPCS Level 2-National Codes (HCPCS)

 Medicare patients and other payers  Updated every by CMS  A0000–V9999  Services and supplies, such as: ◦ Drugs ◦ Durable medical equipment (DME)

 Either two alpha characters or alphanumeric  Modifiers may be used with any level of HCPCS code E1: upper left, eyelid LT: left side NU: new equipment

 Sections- examples ◦ A: ambulance ◦ D: dental ◦ E: Walkers, Wheelchairs ◦ J: drugs (medications)  Index  Table of drugs  Instructions

 Evaluation and Management (E/M)  Anesthesiology  Surgery  Radiology  Pathology and Laboratory  Medicine

 Office visit codes  Consultation codes  Emergency Department Services  Critical Care  Nursing Facility Care  Preventative Medicine  Hospital Visits

 Anatomic format  Include general, regional, supplementation of local anesthesia  Includes preop and postop visits, monitoring, administration of fluids and/or blood  Some insurance carriers use time for reimbursement

 Largest section and most difficult  Note section divided into: ◦ Section (Surgery) ◦ Subsection/category (Urinary system) ◦ Subcategory (Kidney) ◦ Heading (Incision) ◦ Procedure codes (50010)

 Four subsections ◦ Diagnostic radiology ◦ Diagnostic ultrasound ◦ Radiation oncology ◦ Nuclear medicine

 Most hospitals maintain codes in computerized file (chargemaster)  Physicians maintain list of common procedures performed (superbill or computer file)

 Specialized section  Types of codes ◦ Psychiatric services ◦ Physical therapy ◦ Ophthalmological services ◦ Cardiac catheterization

 Added in 2004  Performance measurements  For data collection  End with letter F  Use is optional  Example: 4002F Statin therapy, prescribed

 Emerging technology  Alphanumeric codes  Used for data collection  Temporary  Updates available on AMA’s Web site  Payment depends on the payer Example: 0085T Breath test for heart transplant rejection

 A service or procedure has both a professional and technical component.  A service or procedure was performed by more than one physician and/or in more than one location.  A service or procedure has been increased or reduced.  Only part of a service was performed.  An adjunctive service was performed.  A bilateral procedure was performed.  A service or procedure was provided more than once.  Unusual events occurred.

 Complete list of CPT modifiers with definitions  List of selected modifiers (CPT and HCPCS) approved for Hospital Outpatient Use

37600 Ligation; external carotid artery internal or common carotid artery  Code stands alone, meaning it needs no interpretation.  Because code is indented, it relies on the description before the semicolon in the preceding entry to complete the code description.  Therefore, Code reads as: Ligation; internal or common carotid artery

 Indicates a new code for the current year  Listed in Appendix B

Indicates a revised code for the current year Listed in Appendix B

Indicates new or revised text Used throughout CPT

◦ Designed as an add-on code ◦ Must be used in addition to the primary procedure code ◦ Summary of codes in Appendix D

11200Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions each additional ten lesions, or part thereof (List separately in addition to code for primary procedure) Note: is used in conjunction with

 Exemption to modifier 51  ◦ Alerts coders to the fact that the code cannot be appended with modifier 51 ◦ Applies to physician coding only ◦ All exempt codes listed in Appendix E

Example  Destruction (eg. laser surgery, electrosurgery, cryosurgery, surgical curettement), premalignant lesions (eg. Actinic keratoses), 15 or more lesions

Indicates that CPT code includes conscious sedation as an inherent part of providing the procedure Example:  Pericardiocentesis; initial

Identifies codes for vaccines that are pending FDA approval

 CPT codes do not appear in numeric sequence  For example: Hemorrhodectomy; internal, by rubber band ligation(s) #46945 Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group 35

 Allows the coder to assign a code to a procedure not listed in CPT  Assigned as a last resort  Payers want documentation (operative report) Note: The Alphabetic Index lists all unlisted procedures.

 Appendix A: List of modifiers  Appendix B: Summary of additions, deletions, and revisions  Appendix C: Clinical examples for E/M coding  Appendix D: Summary of add-on codes  Appendix E: Summary of CPT codes exempt from modifier 51

 Appendix F: Summary of CPT Codes exempt from modifier 63  Appendix G: Summary of CPT Codes which include conscious sedation  Appendix H: Alphabetic index of performance measures by clinical condition or topic  Appendix I: Genetic testing code modifiers

 Appendix J: Electrodiagnostic medicine listing of sensory, motor and mixed nerves  Appendix K: Product pending FDA approval  Appendix L: Vascular families  Appendix M: Crosswalk for deleted CPT codes  Appendix N: Summary of Resequenced CPT codes

 CPT Assistant—authoritative reference  CMS Medicare/Medicaid Transmittals ◦ Contains payer advice ◦ Can be confusing if it contradicts CPT guidelines

 Put puzzle together  CPT codes contain 5 digits, HCPCS Level II codes are alphanumeric  Modifiers are two digits appended to code to explain special circumstance

 Section  Subsection  Parenthetical Notes

 Locate codes in Alphabetical Index under: ◦ Name of procedure ◦ Name of service ◦ Eponym ◦ Anatomic site ◦ Medical abbreviation ◦ Diagnosis

 Range of codes given in Alphabetical Index must be narrowed down through search of Tabular Listing  Tabular Listing is in numerical order  Each code has precise meaning, allows code to “stand alone”  Coders must never code from the index!

 Main Term ◦ Repair  Subterm ◦ Abdomen  Secondary Subterm ◦ Suture  Final Code

 Main Term ◦ Femur  Subterm ◦ Abscess  Secondary Subterm ◦ Incision  Final Code

 Main Term ◦ Fracture  Subterm ◦ Ankle  Secondary Subterm ◦ With manipulation  Final Code

 Main Term ◦ Skin  Subterm ◦ Excision  Secondary Subterm ◦ Lesion, Benign, leg, 4.1 cm  Final Code

Operative Report Procedure: Esophagogastroduodenoscopy Esophagus: This area was well visualized in its entirety and appeared macroscopically normal. A 1.5 to 2-cm hiatus hernia was present. No macroscopic abnormalities were noted in the distal esophagus. A biopsy was taken approximately 5-cm proximal to the macroscopic gastroesophageal junction. Stomach: The antrum was normal. On retroflexion, the cardia was minimally incompetent. The body of the stomach was normal. Biopsies were taken from the antrum and body of the stomach. Duodenum: There was a moderate degree of duodenitis in the bulb. The postbulbar and descending duodenal areas appeared normal. A biopsy was taken from the bulb.