1. Chapter Two Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 1

2. Chapter 2: Medicine  90281-99607  Wide variety of services Examples: Cardiac catheterization, chemotherapy, and home health Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 2

3. Immunization Administration  Report substance administered  Report administration Number of administrations, NOT number of substances Example (patient younger than 7): Tetanus and diphtheria (90702, substance) Administration (90460) Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 3

4. Medicare/Medicaid Immunizations  Administration reported with G code G0008: Influenza (Z23/V04.81) G0009: Pneumonia (Z23/V03.82) Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 4

5. Infusions  96365 (up to hour) and 96366 (each additional hour) when physician present  96367 (additional sequential) and 96368 (concurrent)  HCPCS, Q0081, administration, other than chemotherapy  Substances reported with HCPCS (such as J1265, Dopamine)  Prepackaged solutions for hydration are bundled into hydration codes Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 5

6.  Excludes Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration  96365-96379  Physician portion of service  Divided by type:  Subcutaneous  Intramuscular  Intravenous  Intra-arterial Therapeutic, Prophylactic, and Diagnostic Injections and Infusions Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 6

7. Psychiatry  90791-90792  Diagnostic evaluation  Psychotherapy (90832-90840)  Therapeutic treatment  Time based codes (30, 45, or 60 minutes)  Codes subdivided based on if in addition to a primary procedure  Provided to patient and/or family member  Time must be documented Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 7

8. Dialysis  End-stage renal disease (ESRD) Patient will not recover without transplant Physician services reported monthly (90951-90966) Dialysis service reported separately Less than month, report per day (90967-90970) Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 8

9. Peritoneal Dialysis  Continuous ambulatory peritoneal dialysis (CAPD)—90945-90947 Solution placed into peritoneal cavity (cleans blood)  Codes selected dependent on single or multiple physician evaluation Figure: 2.1 Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 9

10. Noninvasive Vascular Diagnostic Studies  93880-93998  Noninvasive vascular studies (e.g., Doppler, scans)  Reports: Supervision Interpretation Written report Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 10

11. Central Nervous System Assessments  Psychological testing  Speech assessments  Developmental assessment  Reported per hour Documented in medical record Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 11

12. Chemotherapy Administration  96401-96549  Administration ONLY  Chemotherapy agent HCPCS J code, such as oxaliplatin, J9263  Antiemetics for nausea reported separately  Analgesic for pain reported separately Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 12

13. Photodynamic Therapy  Photodynamic agent injected into tumor (96567-96571) Agent dissipates from noncancerous tissue first Tumor then exposed to laser Destroys cancerous cells Reported first 30 minutes Then 15-minute increments Figure: 2.2 Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 13

14. Physical Medicine and Rehabilitation  97001-97799  Physician or therapist can report  Services usually based on time documented in medical record  97001-97006: Reports evaluations Physical therapy, occupational, athletic Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 14

15. Active Wound Care Management  97597-97606  Negative pressure wound therapy (NPWT)  Controlled application of subatmospheric pressure to a wound  Nonselective debridement: healthy tissue removed along with necrotic tissue  Each code for ongoing care reported on per session basis  Provider is required to have direct patient contact Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 15

16. Medical Nutritional Therapy (MNT)  97802-97804  Nonphysician medical nutritional services: Medical nutrition Therapy assessment Intervention  Reported in 15-minute segments for individuals  Reported in 30-minute segments for groups Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 16

17. Special Services  99000-99091  Miscellaneous services 99070: Supplies and material 99024: Postoperative follow-up visit included in global service Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 17

18. Conclusion Elsevier items and derived items Copyright © 2013, 2012, 2011, 2010, 2009, 2008, 2005, 2004 by Saunders, an imprint of Elsevier Inc. Slide 18