medicine. cpt® cpt® copyright 2011 american medical association. all rights reserved. fee...
TRANSCRIPT
Medicine
CPT®CPT® copyright 2011 American Medical Association. All rights reserved. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. CPT® is a registered trademark of the American Medical Association.
Objectives
• Overview of Medicine section of CPT• Highlights from specific sections• Emphasis on carefully reading instructions and
guidelines with individual sections• Category II, Category III Codes• Appendices• Index
Medicine
• Immunizations • Vaccines, Toxoids• Psychiatry• Biofeedback• Dialysis• Gastroenterology• Ophthalmology• Otorhinolaryngology
• Cardiovascular• Pulmonary• Endocrinology• Neurology• Genetics• Nutritional Therapy• Acupuncture• Moderate Sedation
Medicine - continued
• Non-invasive Diagnostic Vascular Studies• Allergy & Clinical Immunology• Special Dermatological Procedures• Physical Medicine & Rehabilitation• Qualifying Circumstances for Anesthesia• Home Health Procedures/Services
Medicine and ICD-9-CM
• Alphabetic Index to Diseases
• Tabular List
• Official Guidelines for Coding and Reporting
Medicine Guidelines
• Multiple Procedures• Add-on Codes• Separate Procedures• Unlisted Service or Procedure• Special Report• Materials Supplied by Physician
Immune Globulins (90821-90399)
• Immune globulins• Botulinum antitoxin• Cytomegalovirus (CMV) immune globulin• Diphtheria antitoxin• Hepatitis B immune globulin• Rabies immune globulin• Tetanus immune globulin
Vaccines and Toxoids(90476-90749 )
• Vaccines• Vaccination• Immunization• Toxins• Toxoids
Psychiatry (90801-90899)
• Outpatient, inpatient• Providers psychiatrist (MD) psychologist (PhD) clinical social workers (LCSW)• Modifier 22 Increased procedural services• Modifier 52 Reduced services
Psychiatry• Consultation (99241-99255)• Follow-up by consultant office visits (99211-99215) rest home, domicile (99334-99337) home (99347-99350)• Transfer of care – new or established pt.• Diagnostic psychiatric evaluations (90801-90802)
Dialysis• Hemodialysis• Miscellaneous Dialysis Procedures• End-Stage Renal Disease Services (ESRD) • Other Dialysis Procedures• Age-specific, reported once per month (90951-90962) outpatient; (90963-90966)
home services
Dialysis
• Miscellaneous Dialysis Procedures (90945-90947)
• Peritoneal dialysis• Hemofiltration• Patient and helper training (90989-90993)
Ophthalmological Services
• E/M codes (92002-92014) New and Established patients• Special Ophthalmological Services
Special Otorhinolaryngologic Services (92502-92700)
• Vestibular Function Tests With and without recording• Audiologic Function Tests• Evaluative and Therapeutic Services• Special Diagnostic ProceduresCardiovascular Services
Noninvasive Vascular Diagnostic Studies (93880-93990)
• Cerebrovascular Arterial Studies• Extremity Arterial Studies (Including Digits)• Extremity Venous Studies (Including Digits)• Visceral and Penile Vascular Studies• Extremity Arterial-Venous Studies• Duplex and Doppler
Allergy and Immunology (95004-95199)
• Allergy Testing Code 95004 allergen testing Code 95010 drug allergy• Allergen Immunotherapy Codes 95115-95199
Pulmonary Studies
Neurology and Neuromuscular Procedures
• Sleep testing (95800-95811) sleep studies vs. polysomnography• Routine Electroencephalography (EEG)• Muscle and Range of Motion Testing• Electromyography (EMG)• Guidance for Chemodenervation and Ischemic
Muscle Testing
Neurology and Neuromuscular Procedures
• Nerve Conduction Tests (95900-95905)• Intraoperative Neurophysiology (95920)• Autonomic Function Tests (95921-95923)• Evoked Potentials and Reflex Tests (95925-
95937)• Special EEG Tests• Neurostimulators, Analysis-Programming
Medical Genetics and Genetic Counseling Services
• Chromosome• Gene• Genetics• Genetic counseling
Hydration
• Hydration, Therapeutic,Prophylactic, Diagnostic Injections and Infusions, and
Chemotherapy and Other Highly complex Drug or Highly Complex Biologic Agent Administration.
• Time based codes (96360-96361)
Non-Chemotherapy Complex Drugs and Substances
• Infusions – therapeutic, prophylactic or diagnostic
• Specific to time, technique, substances added, and additional set-up
• Multiple drugs
Chemotherapy(96401-96549)
Services included with chemotherapy:• Use of local anesthesia• IV start• Access to indwelling IV, subcutaneous catheter or
port• Flush at conclusion of infusion• Standard tubing, syringes and supplies• Preparation of chemotherapy agent(s)
Chemotherapy
• Paracentesis• Thoracentesis• Peritoneocentesis• Intrathecal• Ventricular or Intraventricular
Physical Medicine and Rehabilitation
Treatment plan• Problem list• Goals• Physician review progress each 30 days Progress made – recorded Modify or discontinue therapy
Modalities(97010-97039)
• Supervised 97010-97028 • Constant Attendance 97032-97039Diathermy, Vasopneumatic devicesTherapeutic Procedures (97110-97546)
Wound Care ManagementOrthotic Management and Prosthetic
ManagementActive wound care (97597-97606)• Not to be reported with (11042-11047)
Orthotic management and Prosthetic management
• Orthotics• Prosthetics
Acupuncture(97810-97814)
• Face-to-face time• E/M services reported separately using
modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) above the usual pre-service and post-service work
Osteopathic Manipulative TreatmentChiropractic Manipulative Treatment
Osteopathic physician – D.O.Chiropractic Manipulative Treatment – CMT• Five spinal regions: cervical, thoracic, lumbar,
sacral, and pelvic• Five extraspinal regions: head,
temporomandibular, lower & upper extremities, rib cage, and abdomen
Education and Training for Patient Self-Management
Education and training• Self Management• How many in the group?Telephone services – patient, parent, or
guardian• 24 hours• 7 days
On-line Medical Evaluation(98969)
• On-line encounter or other electronic communication mode of the medical kind
• Includes all services provided
Special Services, Procedures and Reports (99000-99091)
Miscellaneous services• 99024 – “tracking”• Mandatory on-call hospital personnel• Patient encounters outside the normal posted
business hours or special circumstances at the request of the patient.
Qualifying Circumstances for Anesthesia (99100-99140)
• All are add-on codes +99100 +99116 +99135 +99140
Moderate (Conscious) SedationServices included with Moderate Sedation (not
reported separately)• Assessment of the patient• Establishment of IV access and fluids• Administration of agent• Maintenance of sedation• Monitoring of oxygen saturation, H.R., BP• Recovery
Other Services and Procedures
• 99183 Physician attendance and supervision of hyperbaric oxygen therapy, per session
Home Health Procedures/Services
Define home setting:• Patient’s residence• Assisted living apartments• Group homes• Nontraditional private homes• Custodial care facilities or schools
Home Health Procedures/Services
Prenatal services (99500)
Postnatal assessment and follow-up care (99501)
Home visit for newborn care and assessment (99502)
Home Infusion Procedures/Services
• Home Infusion Code 99601 – up to 2 hours Code 99602 – each additional hour of infusion
Medication Therapy Management Services
Performed by a pharmacistDocumentation required:• Patient history• Current medications• Recommendations
Category II Codes
• Used for performance measurement• Facilitate data collection • Use of these codes is optional• Used to evaluate quality of care• Alphanumeric: example: four digits and letter
“F” – 2001F is Weight recorded
Category III Codes
• Data collection regarding new technology• It is preferable to use these codes rather than
an unlisted code.• Alpha numeric listings, four digits and the
letter “T” Example – 0085T Breath test for heart transplant rejection
CPT® Appendices
• Appendix A – modifiers and description• Appendix B – summary of additions and
deletions• Appendix C – clinical examples• Appendix D, E F and G are summary lists• Appendix H – go to www.ama-assn.org/go/cpt
CPT® Appendices
• Appendix I – Genetic Testing Code Modifiers• Appendix J – Electrodiagnostic Medicine
Listing of Sensory, Motor, and Mixed Nerves• Appendix K – products pending FDA approval
CPT® Appendices
• Appendix L – Vascular families• Appendix M – crosswalk to deleted CPT®
codes
Index – back of CPT® Book
The End