medicine. cpt® cpt® copyright 2011 american medical association. all rights reserved. fee...

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