INTRODUCTION TO CPT CODING

1. INTRODUCTION TO CPT CODING

2. OBJECTIVES • Learn the purpose of CPT coding • Describe the content of the six sections of the Current Procedural Terminology coding references • Define the two levels of codes • Interpret the symbols used in the CPT coding • Illustrate the use of modifiers • Accurately assign a code

3. INTRODUCTION • Understanding the terms associated with medical billing is similar to learning a new language. • A huge part of medical billing lingo is comprised primarily of numbers and letters called codes (assigned letters, numbers, or a combination of both used to report procedures, services, supplies, durable medical equipment.

4. PURPOSE OF CPT • These codes represent descriptions of: • Procedures • Services • Supplies • Medicine • Durable medical equipment (DME)

5. STRUCTURE OF CPT CODING • The Healthcare Common Procedure Coding System or HCPCS (pronounced “hickpicks”) is a procedure-based coding system used by physicians to document what was done to and for a patient. • This coding system has two levels: • Level I–CPT Codes • Level II–national codes

6. LEVEL I CODES • Current Procedural Terminology or CPT codes, also known as level I codes, are five-digit numeric codes that are assigned for the following services and procedures: • Evaluation and Management (E/M) (99201–99499) • Anesthesia (00100–01999, 99100–99499) • Surgery (10021–69990) • Radiology (70010–79999) • Pathology and Laboratory (80048–89356) • Medicine (90281–99199, 99500–99602)

7. LEVEL II CODES • HCPCS national codes, or level II codes, are five-digit alphanumeric codes. The codes always begin with a letter followed by four numbers. Level II codes cover: • Supplies • Durable medical equipment • Materials • Injections/drugs • Services

8. CPT LEVEL I CODING

10. STRUCTURE OF ALPHABETIC INDEX • The CPT Alphabetic index is organized by main terms printed in bold. • There are four types of main terms: • Procedure or service – repair, laparoscopy • Organ or anatomic site – heart, skin • Condition – fracture, decubitus • Synonyms, eponyms, abbreviations – Caldwell- luc procedure • You must not assign the code from the alphabetic index.

11. SYMBOLS • Semicolon ;used to identify the common part or main entry for indented modifying term • Colonoscopy, flexible, proximal to splenic flexure; is common description shared by codes 45378 to 45382. • Code 45380 is Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple

12. SYMBOLS • A bullet • placed behind a CPT code identifies the code as a new addition or rare code • A triangle ∆ placed before a code identifies a revision in the narrative description of a code • Facing triangles are used to set off new or revised information

13. SYMBOLS • Plus sign † placed in front of a five digit CPT code identifies an add on code. • An add on codes are define as codes that must be used with related procedure code • Example • Dr. Romero debrides the eczema from Jack’s body. • 11000 Debridement of eczematous or infected skin; up to 10% of body surface • + 11001 each additional 10% of the body surface • 11000, 11001, 11001 is the correct code

14. SYMBOLS • Circled bullet ⓿ is placed before a CPT code to indicate that the service or procedure includes the use of conscious sedation – use of sedatives or pain relievers.

15. MODIFIERS • There are occasions in medical billing when specific or additional information is needed when billing with a CPT or HCPCS national code. • In these instances, the medical assistant must attach a modifier (a two-character alphabetic, numeric, or alphanumeric descriptor used to signify that a procedure or service has been altered by an unusual or specific circumstance, although the code itself has not changed) to the appropriate code.

16. MODIFIERS • It is extremely important that the medical biller use the most accurate CPT modifier – a two character numeric descriptor used only with CPT codes- in a given situation. Incorrect modifier usage can result in denial of the claim or worse, an audit by the insurance company. An audit is a formal examination of an individual’s or organization’s accounts It is extremely important that the medical biller use the most accurate CPT modifier – a two character numeric descriptor used only with CPT codes- in a given situation. Incorrect modifier usage can result in denial of the claim or worse, an audit by the insurance company. An audit is a formal examination of an individual’s or organization’s accounts

17. Modifiers are used when: • A service or procedure has a technical component • A service or procedure has a professional component • A service or procedure was performed by more than one physician • A service or procedure was increased or reduced • Only part of a service was performed • An additional service was performed • A bilateral procedure was performed more than once • Referencing a specific body site • Unusual events occurred

18. GUIDELINES OF HOW TO USE CPT • Become familiar with the CPT book. You have to read introduction to the book. • Find the service listed on the patient’s encounter form. • Look up the procedure codes. • Start with the index to locate the main term

19. GUIDELINES • Example: Repair of a fracture of a femur • Repair is the main term • Underline the main term repair • Locate the subterm femur and than look for subterm fracture. • You wouldn’t find fracture because listed under repair are the anatomical parts that can be repaired.

20. GUIDELINES • Determine appropriate modifiers. • Record the code on the claim.