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Weekly Overview

Week Three

Overview

Current Procedural Terminology (CPT) is a coding set used to describe surgical, medical, and diagnostic procedures and services to health care entities. There are three types of CPT codes: Category l codes provide a description of the procedure; Category ll codes are used to track performance measures; and Category lll codes are for emerging technology, procedures, and services. The CPT codes are maintained and owned by the American Medical Association.

In Week Three, you will explore the three categories of the CPT code set and identify CPT modifiers used to communicate special or specific circumstances related to the performance of a procedure or service.

What you will cover

1. Procedure Coding: Introduction to (CPT)

a. Describe CPT coding categories.

1)

2) Category 1 codes

a) Five-digit numeric codes in the main body of CPT

b) Coders use to identify when talking about CPT

c) Represent procedures consistent with contemporary medical practice

d) Have met certain criteria and approved by the Food and Drug Administration (FDA)

e) Used for a significant portion of services and procedures by physicians and outpatient providers

f) Updated annually and are broken down into six sections

1) Evaluation and Management (99201-99499)

a) The extent of the history documented

b) The extent of the examination documented

c) The complexity of the medical decision making

2) Anesthesia (00100-01999)

a) Indicated by the patient’s health

b) P1: Normal and healthy

c) P2: Mild systemic disease

d) P3: Severe systemic disease

e) P4: Severe systemic disease that is a constant threat to the patient’s life

f) P5: Not expected to survive without the operation

g) P6: Declared brain-dead and organs are being removed for donation

3) Surgery (10021 – 69990)

a) Surgical package (all usual services in addition to the operation)

b) Usual services are not coded in addition to the surgery code

c) Codes considered separate procedures can be reported if not included in the surgical package

4) Radiology (70010–79999)

a) Procedures performed by or supervised by a physician

5) Pathology and Laboratory (80047–89398)

a) Single codes that represent a specific battery of test

6) Medicine (90281–99607)

a) Two codes required for immunizations

a. One code assigned for administering and one for the vaccine given

3) Category II codes

a) Supplemental tracking codes

b) Used for performance measurement

c) Used to collect information about the quality of care being delivered to the patient

d) Services or test results support performance measures

e) Alphanumeric

f) Consist of four digits followed by the alpha ‘F’

g) Use of these codes is optional

h) Not a substitute for Category I codes

4) Category III codes

a) Used for emerging technologies, services, and procedures

b) Created for data collection and to track new procedures or services

c) Identify services not performed by many health care professionals across the country

d) Do not have FDA approval

e) Does not have proven clinical efficacy

f) Procedure must be in ongoing or planned research to be included in this category

5) Steps to assign correct CPT codes

a) Review complete medical documentation

b) Abstract medical procedures from the visit documentation

c) Determine the correct term for each procedure

d) Locate the terms in the CPT Index

e) Verify the code in the CPT main text

f) Determine the need for modifiers

6) Importance of CPT coding

a) Used by insurers to determine reimbursement amounts

b) Used by insurers to determine if a procedure is considered to be wellness or illness related

c) Used by the patient to determine what type of workup the physician requested

d) Used by the patient to determine medical billing errors

b. Demonstrate the use of code symbols in the CPT manual

1) ▲ Description has been substantially altered

2) ● Appears the first year the code is added to the manual

3) + Add on codes that never stand alone; code primary procedure first, then add on code

4) ►◄ New or revised text

5) Ө Codes exempt from the modifier, but that do not have designated add-on procedures or services

c. Identify CPT Modifiers

1) Used in addition to the base CPT code

2) Provides additional information to the insurance company about the services performed

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