CPC Study Guide

CPC Study Guide The CPT® coding manual divides Category I CPT codes into six main section titles; - ANS Evaluation and Management, Anesthesiology, Surgery, Radiology, Pathology and Laboratory, and Medicine. Sections are presented in numeric order with the exception of the Evaluation and Management section. The evaluation and management section is found at the beginning of the listed sections because it contains codes most commonly used. Specific guidelines presented at the beginning of each section identify correct coding protocols. The guidelines define which codes are used together and may direct coders to information that is necessary for accurate coding. - ANS ... Category II CPT® - ANS codes are recognized by their alphanumeric format, with the letter "F" in the last position, for example, 0001F. They are located near the back of the CPT® codebook after the Medicine Section, and are reported in addition to evaluation and management (E/M) services or clinical service CPT® Category I codes. Category II CPT® - ANS codes are optional "performance measurement" tracking codes designed to facilitate data collection by the AMA and CMS regarding quality of care. They are also used for the Physician Quality Reporting Initiative (PQRI) to provide outcome measurements for certain medical conditions. Category III CPT® - ANS codes are classified as temporary codes. They are used for data collection in the Food and Drug Administration (FDA) approval process regarding new and emerging technology, services, and procedures. The Category III CPT® - ANS codes have an alphanumeric structure, with a "T" in the last position. Category III codes can be reported alone, without an additional Category I code and are located after the Category II code section. An example of a Category III code is 0157T which represents a patient who has gastric stimulation electrodes implanted in the lesser curvature of the stomach via laparotomy for the treatment of morbid obesity. Category III CPT - ANS codes are updated twice a year, January 1 and July 1, and are implemented six months later. The updates are published on AMA's website. The CPT® Coding Manual is organized by CPT® Sections - ANS which contain Category I codes. The six sections include services and surgical procedures separated into subsections. Within each section there are section guidelines, and a table of contents for that section. At the end of each section, there is a place for the professional coder to add notes to help them with accurate and efficient coding. After the CPT Sections, Category II and Category III codes are listed, followed by Appendices A-N and the Alphabetic Index. ; The semicolon and the conventional use of indentions - ANS The use of the semicolon divides the description of a code into two parts: The "stand-alone" code or the "common procedure" code descriptor. The indented descriptor is dependent on the preceding "stand-alone" code + The "add-on" code symbol - ANS - Add-on codes are never reported alone Example: +43283 Laparoscopy, surgical, esophageal lengthening procedure (eg, Collis gastroplasty or wedge gastroplasty) (List separately in addition to code for primary procedure) (Use 43283 in conjunction with 43280, 43281, 43282) The red circle - ANS new procedure code Example: l 33620 Application of right and left pulmonary artery bands (eg, hybrid approach stage 1) p The (blue) triangle - code revision Example: p 47480 Cholecystotomy or cholecystostomy,open, with exploration, drainage, or removal of calculus (separate procedure) The facing triangles - ANS indicate new and revised text other than the procedure descriptors Example: Endoscopy uWhen performing an endoscopy on a patient who is scheduled and prepared for a total colonoscopy, if the physician is unable to advance the colonoscope beyond the splenic flexure, due to unforeseen circumstances, report the colonoscopy code with modifier 53 and appropriate documentation. t 46020 Placement of Seton u (Do not report 46020 in addition to 46060, 46280, 46600, 0249T) t The circle with a line through it - ANS - exempt from the use of modifier 51 Example: W 93612 Intraventricular pacing The bulls eye - ANS - includes moderate sedation Example: 43200 Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) The lightening bolt symbol - ANS - codes for vaccines that are pending FDA approval. Example: 90661 Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use AMA CPT® "Category I Vaccine Codes" website: # The number symbol - ANS - Resequenced and are out of numerical order National Correct Coding Initiative (CCI) - ANS Implemented by CMS Promotes correct coding methodologies Controls the improper assignment of codes that results in inappropriate reimbursement Sequencing - ANS Based on RBRVS Physician Work Practice Expense Professional Liability/Malpractice Insurance Appendix A - Modifiers categorized as: - ANS Modifiers applicable to CPT® codes Anesthesia Physical Status Modifiers CPT® Level I Modifiers approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use Level II (HCPCS/National) Modifiers Appendix B - ANS - changes and additions to the CPT® codes from the previous year Appendix C - ANS - clinical E/M examples for different specialties Appendix D - ANS - Add-on Codes Appendix E - ANS Exempt from the use of modifier 51 (multiple procedures) Appendix F - ANS - Exempt from the use of Modifier 63 (procedures performed on infants less than 4kg) Appendix G - ANS - Include Moderate (Conscious) Sedation Appendix H - ANS - Alphabetic Index of Performance Measures by Clinical Condition or Topic Available only on the AMA website Appendix I - ANS - Genetic Testing Code Modifiers Molecular laboratory procedures related to genetic testing Use in conjunction with CPT® and HCPCS codes to provide diagnostic granularity of service Appendix J - - ANS Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves Assigns each sensory, motor, and mixed nerve with its appropriate nerve conduction study code Table containing maximum number of studies Appendix K - ANS - Product Pending FDA Approval Identified throughout the CPT® book with a lightening bolt symbol Appendix L - - ANS Vascular Families Based on the assumption that a vascular catheterization has a starting point of the aorta Illustrates vascular "families" that emerge from the aorta using brackets to identify the order of vessels Appendix M - - ANS Crosswalk to Deleted CPT® Codes Crosswalks noting the deleted CPT® codes and descriptors from the previous year to the current year. Essential when updating charge masters, charge capture documents, etc. Appendix N - - ANS Summary of Resequenced CPT® Codes - This listing is a summary of CPT® codes not appearing in numeric sequence. This allows for existing codes to be relocated to an appropriate location.