Coding with the CPT. By: Amber M. Baylor, M.S.

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1 Coding with the CPT By: Amber M. Baylor, M.S.

2 Before You Begin It is advised that you purchase the most up-to-date CPT code book before watching this movie

3 Outline History of the CPT Who uses CPT Coding? CPT Sections How to Code in the CPT Sections Use of Modifiers

4 History of the CPT CPT first published in 1966 by the AMA 1970 = 5 digit codes replaces 4 digit codes HCPCS adopts CPT codes in = CPT codes reported for outpatient procedures 2000 = DHS designates CPT National Coding System 2004 = New codes revised each January 1st

5 Who Uses CPT Codes? Ambulatory Surgical Centers Community Mental Health Centers Dialysis Centers Emergency Department Home Health Agencies Hospice Centers Hospitals (Acute Care) Hospital Outpatient Physicians Skilled Nursing Facilities Keyword = Outpatient

6 Category I Codes codes within the traditional 6 sections of the CPT code book 3 Categories of Codes Category II Codes Contain performance measures located after the medicine section Category III Codes Emerging Technology codes that are also located after the medicine section

7 Getting Familiar with the CPT Code Book Front cover = 1) Symbols - 9 main 2) Modifiers 3) POS 6 Main Sections Appendices Index Back Cover = Common Abbreviations

8 CPT Codes There are over 9000 codes for medical services. There are six main sections of CPT codes and descriptors 1) Evaluation & Management (E/M) Service 2) Anesthesia 3) Surgery 4) Radiology 5) Pathology & Laboratory 6) Medicine

9 Evaluation & Management Codes These codes form the basis of physician and patient interaction. The codes are based on the: Place of Service New vs. Established Patient Nature of the Presenting Problem Content of Service Time Requirement for Services Needed Counseling & Coordination of care Each component contributes to the code you will use to bill a patient for services rendered.

10 Organization of Evaluation & Management Codes The section is organized by Categories Subcategories New Patient 3 5 levels of E & M codes Established Patient 3 5 levels of E & M codes

11 Evaluation & Management Codes Place of Service located in green font in the E & M section find first New vs. Established Patient the AMA provides a decision tree in the E & M guidelines to help you determine if the patient is new or established Content of Service (Examination, & History, & Medical Decision Making) Nature of the Presenting Problem Time Requirement for Services Needed Counseling & Coordination of Care

12 Steps to Code with the Evaluation & Management Codes 1. Select the POS review special instructions 2. Determine if the Patient is New or Established refer to the decision tree in the E/M guidelines 3. Review the Nature of Presenting Problem 4. Evaluate the Level of History Obtained 5. Review the Extent of the Physical Examination 6. Determine the Level of Complexity of the Medical Decision Made 7. Check the amount of time accounted for 8. Apply any counseling or coordination of care needed

13 Evaluation & Management Codes Assignment: Please read through Appendix C in the CPT code book for clinical examples that relate to each level of the E/M codes.

14 Anesthesia Codes Organization Categories = Anatomical place where anesthesia is delivered Codes

15 Anesthesia Codes Major considerations: Time reporting Materials provided by the physician Number & complexity of procedure(s) Anesthesia modifiers

16 General Surgery Codes Subsections = Body System Categories = Anatomical Site Subcategories = Procedures Codes

17 General Surgery Codes The procedure subsection is organized in the following order: Incision Excision Introduction or Removal Repair, Endoscopy Revision or Reconstruction Destruction Grafts Suture Other Procedures

18 General Surgery Coding Guidelines Surgical Package Follow-Up Care Materials Supplied by the Physician Multiple Procedures Separate Procedures Unlisted Procedures

19 Radiology The CPT Radiology Section is further divided into the following types of procedures: Diagnostic Radiology/Diagnostic Imaging Diagnostic Ultrasound Radiation Oncology Nuclear Medicine

20 Radiology Organization Subsection Anatomical Site Code This section differs from other sections because the coder will need to first identify the type of procedure and then identify the body system targeted by the procedure

21 Pathology & Laboratory Codes Physicians will order certain tests to be performed to verify or identify why the patient has come to see the physician. Careful attention should be noted to determine if the physician performed the pathology or laboratory analysis or sent the samples out to another physician or lab. There are different codes for procedures completed in house versus results obtained from an outside service.

22 Pathology & Laboratory Codes Type of Pathology or Laboratory Procedure Performed Code

23 Medicine Codes These codes are more related to specialists and Primary Care Doctors Codes range from special services, immunizations, and chemotherapy Depending on the office services offered will determine how often you will use codes in this section The codes in the Medicine section are classified as noninvasive or minimally invasive diagnostic and therapeutic services and procedures

24 Medicine Codes are Divided By: Procedure-related codes Medical specialties Differing Health Care Providers

25 CPT Modifiers Modifiers are included in Appendix A of the CPT code book. Modifiers are 2 digit codes that are added to the main CPT code to indicate that a procedure has been changed. If you are not sure if the modifier should be used, please refer to appendix A.

26 Thank you for your time! Wishing you the best in your Billing & Coding Career! By: Amber M. Baylor, M.S.

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