1. TEST REVIEW

2. Outside agencies use ICD-9 codes for:
FIRST STEP IN REIMBURSEMENT PROCESS OF HEALTH CLAIMS IS – reading and understanding the physicians reports
DX codes submitted on insurance claims age generally used to determine benefit coverage
Outside agencies use ICD-9 codes for:
Conducting studies and trends in a disease
Forecast healthcare needs
Review costs

3. London Bill of Morality was first introduced mainly to warn about plaque epidemics
PURPOSE OF ICD-9 PAGE 66
Use of Date Page 66
WHEN ARE THE UPDATES FOR ICD 9 available?

4. LATE EFFECT CODES (residual)
Code the late effect followed by the cause of the late effect

5. E Codes
Examples:
Accidental falls
Assaults
poisonings

6. Neoplasms 3 choices from table under Malignant Primary Secondary
Carcinoma in situ

7. CPT used 5 digit codes CPT – CURRENT PROCEDURAL TERMINOLOGY
Published by the AMA
CPT manual is organized numerically and alphanumerically in sections by type of service
Used to code services and procedure
Updated yearly, updates are available on January 1st
CPT used 5 digit codes

8. CPT has 8 sections:
Category I is 6 sections
Category II 1 section
Category III 1 section
To use CPT manual
1st look up the service/procedure
in the INDEX in the back of the manual
Commonly accepted descriptions of the code are
located after the code number
ONLY codes that STAND ALONE have a full description
Procedures and services are listed under:
the condition/disease
service/procedure
anatomic site

9. CPT Category I Describe procedures and services
Restricted to clinically recognized and generally accepted services

10. Category II
Optional tracking codes (developed principally for performance measurement)
Facilitate data collection , codes certain test and services that contribute to positive health outcomes and quality patient care
May be included in Category I coding
Do not have relative value associated with them
Are assigned a numeric-alpha identifier with the letter ‘F’ in the last field
These are optional codes

11. Category III Category III Temp codes for emerging technologies
Services that are in for FDA approval
Not intended for use with services/procedures that have not been accepted by the CPT
Assigned a numeric-alpha with a ‘T’
Located in a separate section, following the CPT Category II code section
HIPPA supports deleting tis section

12. Category I Contains 6 sections
Evaluation and Management E/M – – 99499
Anesthesia – – 01999, – 99140
Surgery – 69990
Radiology – 79999
Pathology and Laboratory – 89356
Medicine – 99199, – 99607

13. Look up CPT codes in index by:
Classes of main entry CC
Organ/anatomical site
Synonyms/eponyms/abbreviations
first code (parent code)
Appears left-justified in a series of codes

14. SYMBOLS:
BOLD Upper Case = code sections or chapter headings Bullet = New Code Plus -Sign = Add on Code Parenthesis = Encloses Additional Information Triangle = Revised Code Circle with line though it = Modifier 51 Exempt CPT hierarchy (from the largest to the smallest) Section, subsection, subheading, category Locate the main terms by service or procedure, anatomic site, condition or disease.

15. Modifiers
Used to indicate that the description of the service is prolonged or altered
50- bilateral (most commonly used modifier)
47 – anesthesia by a surgeon
Used properly will increase reimbursement

16. HCPCS Acronym for: HCPCS Level II codes
Healthcare Common Procedural Coding System
Level 1 codes (CPT codes)
HCPCS Level II codes
DME durable medical equipment, prosthetics, orthotics, injections, ambulance services, dental procedures, surgical supplies, etc
CMS updates annually
Consists of alphanumeric code – ex – E0745