Seminar #1-Medical Coding I

• Welcome, during the seminar, the chat feature will be disabled so that I am able to complete my agenda for the evening! I will answer questions at the end. Thanks, Professor Campbell

Agenda

• Communicating with Professor Campbell• Availability• Grading Schedule• Unit 1 Overview

Communication with Professor Campbell

• Email-Primary – Please start your subject lines in email

correspondence with Course & section username: SUBJECT_OF_MESSAGE (for example, HS-200-3-TAllen: Question regarding project)

• Telephone-Secondary– 877-517-8581– Monday-Friday (1:00pm-5:00pm)

Instructor Availability• Online learning enables a great deal of time flexibility; you may prefer

working late at night or early in the morning and, either way, that's okay!   Just like face-to-face classes, I am here to help you and support your learning.   I will work hard to be responsive to your communications and engaged in the online classroom.  

• However, as in a conventional class, it is imperative that you plan ahead and submit questions and concerns well ahead of any deadlines. Online doesn't imply on demand. I am not online 24 hours a day, 7 days per week.   If I am online when you post or e-mail a concern, I may answer you very quickly. On the other hand, if I have already logged on for the day, I will not log on and respond until sometime the next day.

• I am not available on Sundays

Unit 1 Overview

• Read Chapters 1 & 2 Introduce Yourself• Participate in Seminar• Practice on your own using your workbook• Quiz 1

Introduction to CPT Coding

CPT Category I—Major Sections• Evaluation and Management (E/M) • Anesthesiology• Surgery• Radiology• Pathology and Laboratory• Medicine

Evaluation and Management (99201–99499): An overview

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

Anesthesiology (00100–01999)

• 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

Surgery (10021–69990)• Largest section and most difficult• Note section divided into:

– Section (Surgery)– Subsection/category (Urinary system) – Subcategory (Kidney)– Heading (Incision)– Procedure codes (50010)

Radiology (70010–79999)• Four subsections

– Diagnostic radiology– Diagnostic ultrasound– Radiation oncology– Nuclear medicine

Pathology and Laboratory (80048–89399)

• Most hospitals maintain codes in computerized file (chargemaster)

• Physicians maintain list of common procedures performed (superbill or computer file)

Medicine (90281–99199)• Specialized section• Types of codes

– Psychiatric services– Physical therapy– Ophthalmological services– Cardiac catheterization

Category II Codes• Added in 2004• Performance measurements • For data collection• End with letter F• Use is optional• Example:

4002F Statin therapy, prescribed

Category III Codes• 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

Format: Conventions and Characteristics of CPT

• Stand alone and semicolon ( ; )

• Bullet • Triangle • Facing triangles • Plus sign +

• Circled bullet • Null Symbol • Pending FDA Approval

Symbol • # Resequenced Code

Symbols: Stand Alone and Semicolon—Example

37600 Ligation; external carotid artery37605 internal or common carotid artery

• Code 37600 stands alone, meaning it needs no interpretation.

• Because code 37605 is indented, it relies on the description before the semicolon in the preceding entry to complete the code description.

• Therefore, Code 37605 reads as: Ligation; internal or common carotid artery

Symbols: Bullet

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

Symbols: Triangle ▲

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

Symbols: Facing triangles

• Indicates new or revised text• Used throughout CPT

Symbols: Plus sign +

– Designed as an add-on code– Must be used in addition to the primary procedure

code– Summary of codes in Appendix D

Symbols: Plus Sign—Example 11200 Removal of skin tags, multiple fibrocutaneous

tags, any area; up to and including 15 lesions+ 11201 each additional ten lesions, or part thereof

(List separately in addition to code for primary procedure)

Note: 11201 is used in conjunction with 11200.

Symbols: Null Symbol

• 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

Symbols: Null Symbol

Example

17004 Destruction (eg. laser surgery, electrosurgery, cryosurgery, surgical curettement), premalignant lesions (eg. Actinic keratoses), 15 or more lesions

Symbols: Circled bullet

Indicates that CPT code includes conscious sedation as an inherent part of providing the procedure

Example: 33010 Pericardiocentesis; initial

Symbols: Pending FDA Approval Symbol

• Identifies codes for vaccines that are pending FDA approval

Symbols: # Resequenced Code

• CPT codes do not appear in numeric sequence• For example:

46221 Hemorrhodectomy; internal, by rubber band ligation(s)

#46945 Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group

27

Unlisted Procedure• 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.

Appendices• 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

Appendices - continued

• 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

Appendices - continued

• 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

Modifiers

• Modifiers are two digits appended to code to explain special circumstance

• Complete list of CPT modifiers with definitions

• List of selected modifiers (CPT and HCPCS) approved for Hospital Outpatient Use

• A surgeon performs a carpal tunnel release under a regional nerve block, which is personally administered by the surgeon.– 64721-47

Modifiers

• 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.

Alphabetical Index

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

Tabular Listing

• 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!

Basic Steps of CPT CodingStep OneIdentify the main term of the service or procedure

Step TwoLocate the main term in the index

Step ThreeLocate the code number(s) displayed in the CPT index

Step FourFollow any instructional notes or guidelines

Step FiveSelect Code

Cystourethroscopy with biopsy

• Main term • Subterm• Range of Codes• Final Answer

Simple anterior nasal packing for epistaxis

• Main term • Subterm• Range of Codes• Final Answer

Blepharoplasty of the upper eyelid

• Main term • Subterm• Range of Codes• Final Answer

Excision of vaginal papilloma

• Main term • Subterm• Range of Codes• Final Answer

Closed treatment of two rib fractures

• Main term • Subterm• Range of Codes• Final Answer

Questions