04.04.2011 uei interview cpt coding

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Medical Billing & Insurance Coding Unlocking the Mystery of CPT Coding Loretta Pinkowski, Instructor

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Page 1: 04.04.2011 UEI Interview CPT Coding

Medical Billing & Insurance Coding

Unlocking the Mystery of CPT Coding

Loretta Pinkowski, Instructor

Page 2: 04.04.2011 UEI Interview CPT Coding

Insurance Coding Systems Overview

The three main coding systems that are used within the United States and throughout most of the world are:

1. Current Procedural Terminology (CPT)2. International Classification of Diseases,

9th Revision, Clinical Modification (ICD-9-CM)

3. Healthcare Common Procedural Coding System (HCPCS)

Page 3: 04.04.2011 UEI Interview CPT Coding

What is CPT?

– The Current Procedural Terminology coding system or CPT is a registered trademark of the American Medical Association (AMA) and is copyrighted by the physician’s organization.

– The code sets are HIPAA compliant for procedures and services provided by physicians, ambulatory surgical centers (ASCs), and hospital outpatient (OP) services.

Page 4: 04.04.2011 UEI Interview CPT Coding

The Six Sections of the CPT

Evaluation & Management (E/M) Anesthesia Surgery Radiology/ Nuclear Medicine Pathology & Laboratory Tests Medicine

Page 5: 04.04.2011 UEI Interview CPT Coding

Using the CPT

Read each section’s specific instructions in order to properly code the procedures contained in a history & physical report or in a medical chart.

It may be necessary to consult a medical dictionary for alternate terminology for a specified procedure.

Page 6: 04.04.2011 UEI Interview CPT Coding

Using the CPT Index

The Index lists all main procedures by the procedure done, then (indented below) by the site of the procedure.

– For example- when a surgical report states that “an angioplasty was performed on the right coronary artery” you first look for the procedure “angioplasty” in the CPT Index.

Page 7: 04.04.2011 UEI Interview CPT Coding

Using the CPT Index (con’t)

When you find “Angioplasty”. Look in the indented section for “right coronary artery”.

You will find “coronary artery”, then indented further is “Percutaneuos Transluminal” with codes

“92982, 92984”. You should look up any words that do not

match the procedure report OR words for which you do not know the meaning.

Page 8: 04.04.2011 UEI Interview CPT Coding

CPT Numeric Section

We now go to the numeric section to look up the numeric CPT codes given-

“92982- 92984” We see by the heading that we are in

the “Medicine” section: “92982- 92984 Percutaneuos Transluminal Angioplasty and Stent Placement”.

Page 9: 04.04.2011 UEI Interview CPT Coding

Double Check

Go back to your report or medical chart and double check the procedure you are to code.

Look at the numeric headings and write the appropriate code on the CMS-1500 claim form or select the appropriate code from your computer’s practice management software program.

Page 10: 04.04.2011 UEI Interview CPT Coding

Semicolons in the CPT

Some descriptions are subprocedures of other descriptions. They will be indented under the main procedure.

To properly understand an indented procedure, read the description of the main procedure up to the semicolon (;)

Next, add the remaining description found in the indented section.

Page 11: 04.04.2011 UEI Interview CPT Coding

Signs & Symbols used in CPT

***Hint: Look at the bottom of each page in the numerical section for these signs & symbols and their definition****

(●) This code is new to this edition of CPT

(▲) This code has been revised (+) Add-on code must be used with

another code; Cannot be used alone

Page 12: 04.04.2011 UEI Interview CPT Coding

Modifiers

Modifiers more fully describe the procedure that was performed and alter the monetary value of the procedure.

Two-digit codes which are added to the end of CPT codes to denote unusual circumstances. I.e.: “-25 means significant, separately identifiable E/M service by the same physician on the same day as another service.

Page 13: 04.04.2011 UEI Interview CPT Coding

Most Common Modifiers -21 Prolonged E/M -22 Unusual procedure -24 Unrelated E/M by same physician during

postop period -25 Additional E/M service on same day as

office procedure by the same physician -26 Professional Component -32 Mandated Service -47 Anesthesia by surgeon

Page 14: 04.04.2011 UEI Interview CPT Coding

Most Common Modifiers con’t

-50 Bilateral procedure -51 Multiple procedures -52 Reduced services -57 Decision for surgery -59 Additional separately billable

procedure -62 Two surgeons -80 Assistant surgeon

Page 15: 04.04.2011 UEI Interview CPT Coding

Unlisted Codes

“Unlisted codes” are at the end of each CPT section and subsection. They are unusual or new types of services not common enough to have a code yet. They require a report attached to the claim to identify exactly what services or procedures were performed in order to determine payment.

These codes are selected by body system or type of service and typically end in a “9”.

Page 16: 04.04.2011 UEI Interview CPT Coding

CPT vs HCPCS

Level I= CPT developed by the AMA Level II = HCPCS National Codes (A-V)

– Additional codes & modifiers to report non-physician medical services and supplies to Medicare & Medicaid

Level III = Local HCPCS codes (W-Z)– Codes assigned & maintained by your local

Medicare carriers– HCPCS codes are alphanumeric

Page 17: 04.04.2011 UEI Interview CPT Coding

Professional Coding Organizations

American Academy of Professional Coders (AAPC; www.aapc.com)

AAPC is the nation's largest training and credentialing organization for the business side of medicine. AAPC certified members

in medical coding and medical auditing represent the highest level of expertise in

the industry.

Page 18: 04.04.2011 UEI Interview CPT Coding

Professional Coding Organizations

American Health Information Management Association

(AHIMA; www.ahima.org) AHIMA is committed to lifelong learning in HIM; certification distinguishes an individual as competent, knowledgeable, and committed to quality healthcare through quality information.

Page 19: 04.04.2011 UEI Interview CPT Coding

Questions & Answers ?

Page 20: 04.04.2011 UEI Interview CPT Coding

Classroom Assignment

Count off “1”, “2”, and “3” and move into three groups.

Using the CPT coding books provided, each group will look up the following procedure or service that corresponds with the number of your group in the index and write the proper code from the numeric section on a piece of paper.

Page 21: 04.04.2011 UEI Interview CPT Coding

Coding Assignment

1. Manual therapy techniques, 1 or more regions , each 15 minutes (hint-Medicine section)

2. Hips and thighs, liposuction

3. Swine flu shot with administration (hint- “with” indicates two codes used)

Page 22: 04.04.2011 UEI Interview CPT Coding

Answer Key

1. 97140 – manual therapy techniques, 1 or more regions , each 15 minutes

2. 15877 - Hips and thighs, liposuction

3. 90663 - H1N1=Swine flu, and 90470- Administration