1. Intro to CPTs By Alex Munoz, CPC, NCICS

2. CPT CODING  Current Procedural Terminology  Published annually by the AMA  1 st published in 1966  5-digit codes  Transforms services/procedures/ supplies/drugs into CPT/HCPCS codes

3. Levels of Service Codes  Level I CPT—(Category 1: 99201-99607, Category III: 0016T-0196t)  Level II HCPCS, National Codes—(A0021- V5364)  Level III Local Codes—phased out due to HIPAA

4. Why we code?  Computers understand numbers  Specific descriptions attached to each code  It’s fun!

5. Why code? How many levels of service codes? How many digits?

6. CPT Codes Allow For..  Communication that is both effective and efficient  A mechanism to report a service not described by a specific CPT or Level II code

7. Consider this:  Renal endoscopy through nephrostomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, and insertion of endopyelotomy stent)  Vs 50575

8. CPT Format  Symbols in CPT  Used to convey information  Bullseye, moderate (conscious) sedation included (full list in Appendix G, CPT)  Example 45391, Colonoscopy with endoscopic ultrasound examination  Lightning bolt, pending FDA approval (Appendix K, CPT)  Example 90650, Human Papilloma virus (HPV) vaccine, types 16, 18, bivalent, 3 dose schedule, for intramuscular use

9. Bullet = New Code Circle (○) = Reinstated or recycled code

10. ▲Triangle = Revised Code

11. + Plus = Add-On Code  Never use alone!!

12. Add-On Code  Can only be used with another specific code  Never used alone  No reduction for multiple services  Full list in Appendix D of CPT

13. What does a bullet mean? What does a triangle mean?

14. Appendices of CPT  Appendix A: Modifiers  Appendix B: Additions, Deletions, Revisions  Appendix C: Clinical Examples, E/M Codes  Appendix D: Add-On Codes  Appendix E: -51 Exempt Codes  Appendix F: -63 Exempt Codes  Appendix G: Include Moderate (Conscious) Sedation

15. Six CPT Sections 1. Evaluation & Management (E/M) 2. Anesthesia 3. Surgery 4. Radiology 5. Pathology & Laboratory 6. Medicine  Category II Codes  Category III Codes  Appendices  Index

16. What are the six sections of the CPT book?

17. Categorized By  Sections  Subsections  Subheadings  Categories

18. Categorized By  Anatomy  Knee or Shoulder  Procedure  Incision or Excision  Condition  Fracture or Dislocation  Description  Cast or Strap  Surgical Approach  Anterior Cranial Fossa or Middle Cranial Fossa

19. Guidelines  Section-specific information begins each section

20. Notes  Must-reading located throughout the CPT

21. Two Types of Codes  Stand-alone: Full description  Indented: Dependent on preceding stand-alone  Verbiage before the semicolon applies to all indented codes that follow

22. Two Types of Codes, cont.

23. What is a “stand alone code”? What is an “indented code”?

24. Semicolon  Indicates full description in preceding code  You must return to the stand-alone for full description

25. Unlisted Services  Codes ending in “99” = “no specific Category I or III code”  Used if no more specific code  Special report must accompany submission

26. The Index!  Used to locate service/procedure terms and codes  Speeds up code location  Like a dictionary  First entries and last entries

27. Can we code from the (alphabetical) Index?

28. CPT Index

29. Presentation of Codes in Index  Single code: 38115  Multiple codes: 26645, 26650 - Note comma  Range of codes: 22305-22325 - Note hyphen

30. Location Methods With Examples 1. Service/procedure: repair, excision 2. Anatomic site: medial nerve, elbow 3. Condition or disease: cleft lip, clot 4. Synonym: toe and interphalangeal joint 5. Eponym: Jones procedure, Heller operation 6. Abbreviation: ECG, PEEP (Pressure Breathing, Positive)

31. Always…  Reference index  Locate code in main portion of CPT  Read the entire description and any notes

32. “See” in Index  Cross-reference terms  “Look here for code”  Index: Stem, Brain: See Brainstem

33. References: Buck, C. (2010). Step by step. Elsevier