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TABLE OF CONTENTS

FOR

NATIONAL CORRECT CODING POLICY MANUAL

FOR PART B MEDICARE CARRIERS

CPT codes Copyright© 2003 American Medical Association.

All Rights Reserved.

The Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration, is responsible for the content of this product. No endorsement by the American Medical Association (AMA) is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any uses, non-use, or interpretation of information contained or not contained in this product. These Correct Coding Policies do not supersede any other specific Medicare coding, coverage, or payment policies.

TABLE OF CONTENTS

Introduction

Introduction vii

Purpose vii

Correct Coding viii

Policy Manual Conditions and Format ix

Edit Development and Review Process x

Sources of Information about NCCI xi

Correspondence to CMS about NCCI and its Contents xi

Chapter I - General Correct Coding Policies

A. Introduction IA-1

B. Coding Based on Standards of Medical/Surgical IA-2

Practice

C. Medical/Surgical Package IA-5

D. Evaluation and Management Services IA-9

E. Modifiers and Modifier Indicators IA-9

F. Standard Preparation/Monitoring Services IA-14

G. Anesthesia Service Included in the Surgical

Procedure IA-14

H. HCPCS/CPT Procedure Code Definition IA-15

I. HCPCS/CPT Coding Manual Instruction/Guideline IA-16

J. Separate Procedure IA-16

K. Family of Codes IA-17

L. More Extensive Procedure IA-17

M. Sequential Procedure IA-18

N. Laboratory Panel IA-19

O. Misuse of Column 2 Code with Column 1 Code IA-19

P. Mutually Exclusive Procedure IA-20

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Q. Gender-Specific Procedure (formerly Designation IA-20

of Sex)

R. Add-on Codes IA-21

S. Excluded Service IA-22

T. Unlisted Service or Procedure IA-23

U. Modified, Deleted, and Added Code Pairs/Edits IA-23

Chapter II - Anesthesia Services(CPT codes 00000 - 09999)

A. Introduction IIA-1

B. Standard Anesthesia Coding IIA-1

C. Radiologic Anesthesia Coding IIA-8

D. Monitored Anesthesia Care IIA-9

E. Anesthesiologists and CRNAs IIA-9

Chapter III - Surgery: Integumentary System (CPT Codes 10000 - 19999)

A. Introduction IIIA-1

B. Evaluation and Management IIIA-1

C. Anesthesia IIIA-2

D. Incision and Drainage IIIA-3

E. Lesion Removal IIIA-4

F. Repair and Tissue Transfer IIIA-7 G. Grafts and Flaps IIIA-7 H. Breast (Incision, Excision, Introduction, IIIA-8 Repair and Reconstruction)

I. Add-on Codes IIIA-9

J. General Policy Statements IIIA-10

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TABLE OF CONTENTS (Continued)

Chapter IV - Surgery: Musculoskeletal System (CPT Codes 20000 - 29999)

A. Introduction IVA-1

B. Anesthesia IVA-1

C. Biopsy IVA-1

D. Fractures IVA-2

E. General Policy Statements IVA-3

Chapter V - Surgery: Respiratory, Cardiovascular, Hemic and Lymphatic Systems (CPT Codes 30000 - 39999)

A. Introduction VA-1

B. Respiratory System VA-1

C. Cardiovascular System VA-5

D. Hemic and Lymphatic Systems VA-9

E. General Policy Statements VA-9

Chapter VI - Surgery: Digestive System (CPT Codes 40000 - 49999)

A. Introduction VIA-1

B. Endoscopic Services VIA-1

C. Abdominal Procedures VIA-4

D. General Policy Statements VIA-5

Chapter VII - Surgery: Urinary, Male Genital, Female Genital, Maternity Care and Delivery Systems (CPT Codes 50000 - 59999)

A. Introduction VIIA-1

B. Urinary System VIIA-1

C. Male Genital System VIIA-4

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D. Female Genital System VIIA-5

E. Maternity Care and Delivery VIIA-6

F. General Policy Statements VIIA-6

Chapter VIII - Surgery: Endocrine, Nervous, Eye and Ocular Adnexa, Auditory Systems (CPT Codes 60000 - 69999)

A. Introduction VIIIA-1

B. Endocrine and Nervous Systems VIIIA-1

C. Ophthalmology VIIIA-4

D. Auditory System VIIIA-6

E. General Policy Statements VIIIA-6

Chapter IX - Radiology Services (CPT Codes 70000 - 79999)

A. Introduction IXA-1

B. Non-interventional Diagnostic Imaging IXA-1

C. Interventional/Invasive Diagnostic Imaging IXA-2

D. Evaluation and Management IXA-4

E. Nuclear Medicine IXA-4

F. Radiation Oncology IXA-5

G. General Policy Statements IXA-5

Chapter X - Pathology and Laboratory Services (CPT Codes 80000 - 89999)

A. Introduction XA-1

B. Organ or Disease Oriented Panels XA-2

C. Evocative/Suppression Testing XA-2

D. General Policy Statements XA-2

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Chapter XI - Medicine, Evaluation and Management Services (CPT Codes 90000 - 99999)

A. Introduction XIA-1

B. Therapeutic or Diagnostic Infusions/Injections and XIA-1

Immunizations

C. Psychiatric Services XIA-3

D. Biofeedback XIA-3

E. Gastroenterology XIA-4

F. Ophthalmology XIA-4

G. Otorhinolaryngologic Services XIA-4

H. Cardiovascular Services XIA-5

I. Pulmonary Services XIA-7

J. Allergy Testing and Immunotherapy XIA-8

K. Neurology and Neuromuscular Procedures XIA-9

L. Chemotherapy Administration XIA-10

M. Physical Medicine and Rehabilitation XIA-12

N. Osteopathic Manipulative Treatment XIA-13

O. Chiropractic Manipulative Treatment XIA-13

P. Miscellaneous Services XIA-13

Q. Evaluation and Management XIA-13

R. General Policy Statements XIA-15

Chapter XII - Supplemental Services (HCPCS Level II Codes A0000 - V9999)

A. Introduction XIIA-1

B. General Policy Statements XIIA-1

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Chapter XIII – Category III Codes (CPT Codes 0001T – 0099T)

A. Introduction XIIIA-1

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