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BB - Module 2 - Current Procedural Terminology 01-20-06
BB - Module 2 - Current Procedural Terminology 01-20-06
Current Procedural Terminology (CPT) is copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT is a trademark of the American Medical Association.
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Learning Outcomes
At the end of this module, participants will be able to:
identify which CPT manuals and tools will be most beneficial to their practice effectively navigate the CPT manuals/tools to quickly locate codes of choice effectively utilize the CCI tools to understand correct coding methodologies select CPT code ranges by service description describe E/M codes documentation requirements
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CPT Manual
Developed and maintained by AMA Listing of 5-digit procedure codes Divided into 6 sections
Evaluation and Management (99201-99499) Anesthesiology (00100-01999; 99100-99140) Surgery (10040-69979) Radiology (70010-79999) Pathology & Laboratory (80049-89399) Medicine (90701-99199)
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Current Procedural Terminology 2006 American Medical Association. All Rights Reserved.
identifies service performed If no procedure code exists, report appropriate unlisted code Medical record documentation must support service billed
Add-on Codes
Describe additional intra-service work
associated with primary procedure Codes must be reported with primary procedure
interphalangeal joint
Represents add-on code List separately in addition to code for primary procedure
Current Procedural Terminology 2006 American Medical Association. All Rights Reserved.
not found in CPT manual Service represented by unlisted procedure code must be described on claim
grace period for billing discontinued HCPCS codes was eliminated. Providers must bill using HCPCS code that is valid for date of service Purchase AMA CPT-4 coding book (available in October) Level II codes posted at the end of October at: http://www.cms.hhs.gov/HCPCSReleas eCodeSets/
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Level I codes are copyrighted by the American Medical Associations Current Procedural Terminology, Fourth Edition (CPT-4) Level II codes are 5-position alpha-numeric codes maintained by the Health Insurance Association of American and BCBS Association
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ordered through: American Medical Association P. O. Box 10946 Chicago, IL 60618-0946 Telephone: 1.800.621.8335 Online: www.amapress.org
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be ordered from: Superintendent of Documents U. S. Government Printing Office Washington, D.C. 20402 Telephone: 1.202.783.3238
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for appropriate use of CPT coding Developed by AdminaStar Federal under contract with CMS
based upon review of CPT code descriptors, CPT coding instructions, existing local and national coding edits, and Medicare billing history
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Services or procedures that are included as part of a more extensive procedure Services or procedures that would not or could not be performed at the same time based on the CPT code description or standard of medical practice
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Bill CPT code 19240, modified radical mastectomy which includes removal of all breast tissue Procedure code 19120, excision of breast lesions such as cysts, etc., should not be billed as this service is included in 19240
Current Procedural Terminology 2006 American Medical Association. All Rights Reserved.
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high density barium and air contrast and a small bowel follow-through, bill 74249. If the follow-through was not performed, bill 74246 or 74247. Never report CPT code 74249 and 74246 (or 74247) together as it is not possible to perform the exam with and without the follow-through
Current Procedural Terminology 2006 American Medical Association. All Rights Reserved.
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Use of Modifier 59
Defined as Distinct procedural service Use to indicate service was distinct or separate from other services performed on the same day Use modifier 59 to report a:
Different session Different procedure or surgery Different site Separate lesion Separate injury
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Internet:
http://www.cms.hhs.gov/NationalC orrectCodInitEd/
For concerns about CCI policy, write: National Correct Coding Initiative Correct Coding Solutions P. O. Box 907
Carmel, IN 46082-0907
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services:
History Examination Medical Decision Making Counseling Coordination of Care Nature of Presenting Problem Time
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Medical necessity Individual requirements of CPT code Documentation must support level of service billed
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coding tools are available to Medicare providers to assist in choosing and billing appropriate procedure codes? Review question. In which section of the CPT manual (e.g. Evaluation & Management, Surgery, etc.) would you find the CPT code 72010?
Current Procedural Terminology 2006 American Medical Association. All Rights Reserved.
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Chapter References/Citations
Current Procedural Terminology (CPT)
2005 Professional Edition CMSManual System, Pub 100-4, Medicare Claims Processing Manual, Chapter 23, Section 20, Healthcare Common Procedure Coding System (HCPCS) CMSManual System, Pub 100-4, Medicare Claims Processing Manual, Chapter 12, Section 30, Correct Coding Policy
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Chapter References/Citations
CMS Manual System, Pub 100-9,
Medicare Contractor Beneficiary and Provider Communications Manual, Chapter 5, Section 20, Correct Coding Initiative CMS Manual System, Pub 100-4, Medicare Claims Processing Manual, Chapter 12, Section 30.6, Evaluation and Management Service Codes
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