1. CHAPTER 26
MEDICINE 1

2. Medicine Section Diagnostic and Therapeutic Procedures
Most procedures noninvasive (not entering body)
Contains invasive procedures
Example: 92973, Percutaneous transluminal coronary thrombectomy
Numerous notes throughout
The Medicine Section includes codes and is used for coding diagnostic and therapeutic services that are generally noninvasive.
Some invasive procedures, such as cardiac catheterization and percutaneous thrombectomy, are included in this section.
The various subsections contain many specific notes to be used with certain groups of codes; these notes are important for coders to read so they can code services appropriately. 2

3. Subsections Wide variety of services Many specialized tests Examples:
Audiology
Biofeedback
The subsections cover a wide variety of services and many specialized diagnostic tests, such as audiologic function tests, electrocardiograms, and biofeedback.
The codes in the Medicine section usually do not include the supplies used in testing, therapy, or diagnostic treatment, unless specifically stated in the code description. 3

4. Immunizations Often used Two types of immunizations
_____ and ______
Correct coding includes
_____ injected
____________ of injection
Active
passive
Supply
Active immunization is given when it is anticipated that the person will be in contact with the disease.
Passive immunization does not cause an immune response. What happens instead? (Injected material [i.e., immune globulins] contains a high level of antibody against a disease.)
Administration
(Cont’d…) 4

5. Active—Bacteria or Viruses
(…Cont’d)
Bacteria that cause disease made nontoxic (_____)
Injected to build immunity
Small dose active virus injected (______)
Example: Poliovirus
(Cont’d…)
toxoid
vaccine
Active immunizations can be toxoids or vaccines.
Toxoids are bacteria that have been made nontoxic.
Vaccines are viruses that are given in small doses and cause an immune response. 5

6. Passive Immunization Does not cause immune response
(…Cont’d)
Does not cause immune response
Contains antibodies against certain diseases—immune _______
globulins
Name a disease for which passive immunization is used. (Rabies, hepatitis B, or tetanus) 6

7. Immune Globulins (90281-90399) Identifies immune globulin product
Example: Botulism antitoxin
Report ___________ separately
(Cont’d…)
administration
The Immune Globulin subsection is relatively new to the CPT manual.
The codes in this subsection report only the immune globulin product and must be reported in addition to the appropriate administration code from the appropriate subsection. 7

8. Immune Globulins (90281-90399) Codes divided by: Type Method Dose
(…Cont’d)
Codes divided by:
Type
e.g., Rabies, hepatitis B
Method
e.g., Intramuscular, intravenous, subcutaneous
Dose
e.g., Full dose, mini-dose
Codes in this subsection are divided by type of immune globulin, method of injection, and type of dose. 8

9. Immunization Administration for Vaccines/Toxoids (90460-90474)
Administration (performing the injection) of substance
Reported with substance given
(Cont’d…)
Codes in the Immunization Administration subsection are reported with the code for the substance given. In which subsection are these codes found? (Vaccines/Toxoids subsection) 9

10. Immunization Administration for Vaccines/Toxoids (90460-90474)
(…Cont’d)
_____, Patients through age 18 when physician counsels regarding immunization
= Patients __ years of age or over
Patients of all ages (including under 19) if physician does not _______ regarding immunization
_____, = Percutaneous, intradermal, subcutaneous, or intramuscular injection
90473, = ____ or intranasal
90460 19
counsel
Immunization administration codes are divided by patient age and administration method.
Make sure you code for each injection that is administered.
Be careful when a combination immunization (DTP) is given. This is all combined in one injection even though there are 3 immunizations; they are given in one injection so only one administration code is used.
90471
Oral 10

11. Methods of Administration
Percutaneous
Intradermal
Subcutaneous
Intramuscular
Intranasal
Oral
Administration codes are divided according to method of administration and some by age of patient. Read descriptions carefully.
From Bonewit-West K: Clinical Procedures for Medical Assistants, ed 8, St. Louis, 2012, Saunders. 11

12. Report Administration for Each Dose—Single or Combination
Example: Patient (over age 8) receives three separate administrations:
90471 tetanus
90472 rubella (add-on code)
90472 diphtheria (add-on code)
OR depending on payer:
90472 x 2 rubella and diphtheria
Each administered dose must be reported.
For example, multiple injections can be reported for a patient over age 8 by using for the first injection and for each injection thereafter. 12

13. Vaccines, Toxoids (Vaccine Product Codes) (90476-90749)
Many codes age specific
Example:
90658, trivalent (IIV3) influenza virus vaccine, for ages _ and over
Codes for products for single diseases
90479, unlisted vaccine/toxoid
Codes for combination of diseases
90700, diphtheria, tetanus, and acellular pertussis (_____)
Caution: There are numerous code combinations of diphtheria
(Cont’d…) 3
The Vaccines/Toxoids subsection lists vaccine products given in immunizations.
Coders must carefully review the description of the vaccine product code to determine which disease is specified.
When is the combination code used? (When one code is available to describe multiple products given)
Be careful to select the correct code. For example, there are 8 combination codes for diphtheria.
DTaP 13

14. Vaccines, Toxoids Some vaccines given on schedule Example: (…Cont’d)
90633, 2-dose hepatitis _ vaccine
First dose, first visit
Second dose, second visit
90633 is reported for each visit A
What is a schedule based on? (The number of doses provided and the timing of administration)
Each time the vaccine is administered, the code is reported, along with the date the injection was given. 14

15. Remember -51 Do not assign modifier ___ with Vaccine/Toxoid codes
Rather, depending on payer:
List each code multiple times or
Use times (x) symbol and indicate number
Modifier -51 should not be reported for the vaccines, toxoids when performed with these administration codes ( )
List the codes multiple times, or use the “times” (x) symbol and indicate the number of injections given. 15

16. Important Reporting Rules
If vaccine administered during office visit (not related to E/M)
Report E/M service (with modifier ___) + Vaccine + administration
Depends on local carrier
Office visit for vaccine only, code only ______, NO ____ service
-25
vaccine
E/M
If the office visit takes place only because of the immunization, report the immunization administration code first and the vaccine/toxoid code second. 16

17. Routine Vaccinations Influenza Pneumococcal Administration
______ HCPCS (Medicare only)
90471/_____
Substance (trivalent (IIV3) influenza virus vaccine) 90657, _____
Pneumococcal
90471/90472 administration
Substance (23-trivalent pneumoccal polysaccharide vaccine) _____
G0008
90472
90658
These two vaccinations are commonly provided. (Influenza and pneumococcal)
What does trivalent mean? (3 viruses)
The third-party payer may require CPT codes or CPT with HCPCS codes for the service.
For Medicare patients, the coder reports only an administration code for an immunization if no E/M service is reported; E/M office visits include the administration of an immunization.
G0009
90732 17

18. Psychiatry ( )
Psychiatric treatment at same time as E/M service, report
One code for therapy with E/M
Example: 90833, psychotherapy and E/M
____ major billing factor
Codes divided on time
Medical record indicates session time
(Cont’d…)
Time
The Psychiatry section has a lengthy note under the heading that details the use of psychiatric codes in conjunction with hospital and clinic E/M services.
If psychiatric treatments are rendered on the same day as E/M service, both are reported with one code from the Psychiatry section.
If these treatments are provided on a different day from the E/M service, a code from the E/M section is listed.
Some codes reflect evaluation or diagnostic services, some reflect therapeutic procedures, and some reflect psychological testing. 18

19. Psychiatry ( )
(…Cont’d)
When selecting a psychotherapy code ask these questions:
How much face-to-face time is spent with the patient?
Does documentation support an evaluation & management code in addition to psychotherapy?
If rendering psychotherapy, is the approximate “time” of the psychotherapy noted in the medical record?
(Cont’d…)

20. Psychiatry Many services provided in partial hospital settings
(…Cont’d)
Many services provided in partial hospital settings
Patient in hospital during day, returns to home for evenings and weekends
Interactive psychotherapy is typically furnished to children
It uses play equipment, physical aides, nonverbal communications, or other mechanisms of communication
E/M Initial Hospital Care and Subsequent Hospital Care codes ( ) are used to report inpatient stays. 20

21. Biofeedback (90901, 90911)
Used to help patients gain control over body processes
Example: High BP or chronic pain
Medicare Coverage Issues Manual restricts the use of biofeedback
Medicare doesn’t cover biofeedback for psychosomatic disorders
(Cont’d…)
Biofeedback is a process by which individuals can monitor and manage physiological processes that are normally out of their control. 21

22. Biofeedback Patient training in biofeedback by professional
(…Cont’d)
Patient training in biofeedback by professional
Continues on own
Services often part of _______________ (mind/body) therapy
psychophysiologic
When biofeedback is part of individual psychophysiological therapy, codes are listed for both the biofeedback and the individual psychophysiological therapy. 22

23. Dialysis (90935-90999) Cleanses blood
Figure: 26.4
Cleanses blood
________ (non-ESRD)
_________ (ESRD)
Two parts to report ESRD dialysis services:
________ service
___________ procedure
Temporary
Permanent
Physician
What is the specific purpose of dialysis? (It removes waste products from the blood when the body [the kidneys] cannot perform this function adequately.)
End-stage renal disease (ESRD) requires permanent, ongoing dialysis.
Hemodialysis
Patient receiving hemodialysis. (From Lewis SL, Dirksen SR, Heitkemper MM, Bucher L, Camera IM: Medical-Surgical Nursing: Assessment and Management of Clinical Problems, ed 8, St. Louis, 2011, Mosby.) 23

24. End Stage Renal Disease Services (90951-90970)
Include
Establishment of dialyzing ____
________ services
E/M ________ dialysis visits
Patient ___________ during dialysis
Reported for month: _____
Less than full month of service: ___________ per day
Codes divided on ___ and number of visits
cycle
Physician
outpatient
management
90966
Dialysis services are usually billed as a monthly fee and are performed on an outpatient basis.
How are physician services for dialysis reported? (By the type of dialysis the patient is receiving, the number of doctor visits)
age 24

25. Hemodialysis Service (90935-90940)
Hemodialysis is the procedure
Used for ESRD and non-ESRD
Billed ______ for inpatients receiving ESRD + non-ESRD
Includes all physician E/M services related to procedure
Use modifier ___ if separate E/M service provided
per day
What is the function of hemodialysis? (To route blood outside of the body for filtration of waste products)
How long does a patient suffering from ESRD need to be on dialysis? (Forever or until he or she can have a kidney transplant.)
-25 25

26. Miscellaneous Dialysis Procedures (90945-90947)
Describes other dialysis procedures
Example:
________ dialysis in which toxins are passively absorbed into dialysis fluid
(Cont’d…)
Peritoneal
Peritoneal dialysis uses the peritoneal cavity as a filter.
Peritoneal dialysis is a continuous renal replacement therapy.
If a physician sees a patient during the dialysis session, how would this be coded? (If the physician sees a patient during the dialysis session for something other than what pertains to the function of his/her kidneys, for example the patient has a cough and is diagnosed with an upper respiratory infection, you would code a separate E/M code with a -25 modifier attached.) 26

27. Peritoneal Dialysis
(…Cont’d)
From Goldman L, Ausiello D, editors: Cecil Textbook of Medicine, ed 22, Philadelphia, 2004, Saunders.
Peritoneal dialysis is reported monthly or if less than a month, for each day the service is provided.
How is peritoneal dialysis reported for Medicare? (Monthly or per day, using temporary HCPCS codes)
Services billed on per day basis for inpatient ESRD patients 27

28. Dialysis Training Patients can receive training in self-dialysis
Reported with _____, 90993
Codes divided by ________ or partial training program
90989
complete
Where are dialysis teaching codes located? (Under Miscellaneous Dialysis Procedures)
Most third-party payers allow training to be billed for one time only. 28

29. Gastroenterology (91013-_____)
91299
For tests and treatment of _________, stomach, and _______
Codes usually reported with ___ or __________ service code
Caution: Many bundled services
esophagus
intestine
E/M
consultation
Several intubation codes are listed in the Gastroenterology subsection; coders must carefully review the code descriptions to determine which services are bundled into the code. 29

30. Ophthalmology (92002-92499) Contains E/M codes
Not E/M codes from front of CPT
Definitions for new and established patients same as for ___ section
Most codes are for _______ services
If only one eye, use modifier ___ (reduced service)
Read the definitions of intermediate and comprehensive services in the CPT!
E/M
bilateral
-52
Extensive subsection notes explain levels of service and present examples to clarify the codes.
Codes are based on whether the patient is new or established, and on the complexity of service received.
For coding purposes, what is the definition of a new patient? (One who has not received any professional service within the past 3 years from the physician or another physician of the same specialty in the same group practice)
It is important to note the difference between intermediate and comprehensive as it pertains to this subsection.
(Cont’d…) 30

31. Ophthalmology ( )
(…Cont’d)
Example, Intermediate: Review of history, external examination, ophthalmoscopy, biomicroscopy for an acute complicated condition (e.g., iritis) not requiring comprehensive ophthalmological services
Intermediate and comprehensive ophthalmological services constitute integrated services in which medical decision making cannot be separated from the examining techniques used

32. Special Otorhinolaryngologic Services (92502-92700)
For special evaluations of audiologic system
Go beyond those usually provided in evaluation
May be reported in addition to basic audiologic service
(Cont’d…)
The services in this subsection deal with special testing or studies for the ears, nose, and larynx.
Who can perform an audiology test? (A physician or trained audiologist) 32

33. Special Otorhinolaryngologic Services
(…Cont’d)
Special treatments and diagnostic services
Example:
Nasal function tests (_____________) or audiometric tests
All hearing tests _______ unless indicated one ear in description
Use modifier -52 for 1 ear
Nasal function test equipment. (From Flint PW, Haughey BH, Lund VJ, Niparko JK, Richardson MA, Robbins KT, Thomas JR: Cummings Otolaryngology-Head & Neck Surgery, ed 5, Philadelphia, 2010, Mosby.)
rhinomanometry
bilateral
Otorhinolaryngologic diagnostic and treatment services are usually reported using codes from the Surgery section; only special services are reported using codes from the Medicine section.
How would a test be coded if the procedure was only performed on one ear and the description did not state one ear or unilateral? (With a -52 modifier) 33

34. Coronary Therapeutic Services and Procedures
PTCA ( )
Access through the ______ or brachial artery
_______ with balloon tip threaded up to heart
Balloon is expanded and widens vessel
If an angioplasty and an atherectomy are performed during the same session, only the atherectomy is billed
If a stent is placed in a coronary vessel, the stent placement takes precedence over the atherectomy
Stent(s) placement(s) includes coronary angioplasty when performed (92928, 92929)
femoral
Catheter
PTCA codes are found under the Coronary Therapeutic Services and Procedures category.
There are three main vessels that can be coded. They are the left anterior descending (-LD), right coronary artery (-RC), and the left circumflex (-LC).
What is the purpose of an angioplasty? (To open up a vessel of the heart that is blocked with plaque [ASHD]) 34

35. Cardiography ( )
Implantable and Wearable Cardiac Device Evaluations ( )
And Echocardiography ( )
Reviewed in Chapter 17 of this text
Echocardiograms are ultrasounds of the heart that aid in diagnosing valvular disorders.
The echocardiograms are selected by either complete exam or follow-up (limited) study.
When coding for a full echocardiogram by a physician, code shows the complete echo. 35

36. Cardiac Catheterization
Diagnostic medical procedure
Three components included in most Cardiac Catheterization Codes:
____________
_______
Congenital cardiac catheterization codes ( ) do not include injection or imaging
Reviewed in Chapter 17 of text
Catheterization
Injection
Imaging
Cardiac Catheterization is a diagnostic procedure that includes the introduction, positioning, and repositioning of a catheter to aid in diagnoses of the heart. Also included is recording of pressures, obtaining blood samples, and cardiac output measures.
The first component of coding heart catheterization is the positioning of the catheter. Code selection is made based on where the catheter will be placed. (LHC), (RHC), (BHC)
The second component is the injections. These are coded by what vessel is being injected.
Last is the imaging. Only 2 codes. Read the description carefully. 36

37. Noninvasive Vascular Diagnostic Studies (93880-93998)
Vascular codes for procedures on noncoronary veins and arteries
Includes
______ care
________________________ (S&I)
Copy of ______
Reviewed in Chapter 17 of text
Patient
Supervision and interpretation
These procedures use the same devices as those used in heart and great vessel echocardiography.
What distinguishes these procedures from coronary procedures? (The divisions are based on the location of the vein or artery that is being studied.)
results 37

38. Pulmonary (94002-94799) diagnostic
For ventilation management, therapies, and ________ tests
Includes procedure and ___________ of test results
Additional E/M service reported _________
Ventilator management codes
Further divided by _____ of service
Facility is billed ___ day
Home billed by ____ once per month
interpretation
separately
place
per
time
What modifier should you add when reporting the physician interpretation of the test? (-26)
What pulmonary therapy might be used? (Nebulizer treatments, incentive spirometry)
Several tests might be administered to help the physician form a diagnosis. Each test should be reported separately unless otherwise indicated in the code description. 38

39. Allergy and Clinical Immunology (95004-95199)
Divided into three subheadings:
______ Testing ( )
Ingestion Challenge Testing (95076, 95079)
_______ Immunotherapy ( )
Allergy Testing—consists of performance, evaluation, and interpretation of allergens
Ingestion Challenge—test for sensitivity to food, drugs, and other substances
Immunotherapy—indicated for patients with allergic rhinitis due to seasonal pollinosis caused by trees, grasses, weeds, etc.
Allergy
Allergen
You are strongly encouraged to read the notes that appear at the beginning of the Allergy and Clinical Immunology subsection ( ). 39

40. Allergy Testing (95004-95071) (Cont’d…)
Sensitivity testing using various types of tests
Example:
Percutaneous, ____________, inhalation
Tests use numerous substances
Extracts, venoms, biologics, and foods
____ and number of tests based on physician’s judgment
Medical record will indicate the
Number of tests
Type of test
Method of testing
(Cont’d…)
intracutaneous
Type
Allergy Testing describes testing by various methods and defines the types of tests.
Why must the number of tests always be specified for billing purposes? (Because payment is made per test for most of these codes.)
What are some types of allergy testing? (Allergenic extracts, venoms, biologicals, food)
What are some methods of allergy testing? (Percutaneous, intracutaneous, inhalation) 40

41. Ingestion Challenge Testing (95076, 95079)
Sensitivity to food, drugs, and other substances
95076 reports initial 120 minutes testing time
95079 reports each additional 60 minutes
Services less than 60 minutes, report E/M code
What are some types of allergy testing? (Allergenic extracts, venoms, biologicals, food)
What are some methods of allergy testing? (Percutaneous, intracutaneous, inhalation) 41

42. Allergen Immunotherapy (95115-95199)
Codes divided into three types of services:
_______ only
__________ and injection
Provision ______ (substance) only
Codes & are payable in an office setting
(Cont’d…)
Injection
Prescription
antigen
All codes for allergen immunotherapy have specific notes that describe the service.
How are these codes divided out? (Injection only, prescription and injection, and substance only) 42

43. Allergen Immunotherapy
(…Cont’d)
Physician service bundled into immunotherapy codes
If separate E/M service provided, report separately with -25
An office visit code is not usually reported. When is it reported? (When the physician provided another identifiable service at the time of immunotherapy) 43

44. Neurology and Neuromuscular Procedures (_____-96020)
95782
Contains codes to report tests, such as:
Sleep testing
Muscle and range of motion testing
Electroencephalography (EEG)
Neurostimulator procedures
Functional brain mapping
Many bundled services
Services usually provided in addition to E/M service
These are often consultative services (e.g., )
These codes are usually used by neurologists.
To code sleep tests accurately, the coder must know the parameters (what is being measured during the sleep test) and the stages of testing. In addition, many codes include a time component.
What is polysomnography? (Measurement of the brain waves during sleep with the added feature of recording the various stages of sleep, i.e., excited, relaxed, drowsy, asleep, or deep sleep) 44

45. Central Nervous System (CNS) Assessments/Tests ( )
Used to report:
Psychological tests
Speech/language assessments
Developmental progress assessments
Thinking/reasoning examinations
(Cont’d…)
Codes from this section are used for psychological tests, speech/language assessments, developmental progress assessments, and thinking and reasoning examinations. 45

46. CNS Assessments/Tests
(…Cont’d)
Codes based on _______ basis
Except for basic ____________ testing
Includes ___________ of results
per hour
developmental
written report
These codes are mainly billed on a per hour basis.
The results are put on a report that goes in the patient’s record. 46

47. Hydration (96360, 96361)
Infusion: Therapeutic procedure to introduce fluid into body
Example:
Fluid into vein for patient rehydration
Codes represent infusion service and “_______________ and electrolytes”
Other than prepackaged, report ________
An infusion is the introduction of a liquid into the body over a long time.
The physician must administer or supervise administration of the infusion.
What are the codes based on? (The time it takes for the infusion to be completed)
The drug that is infused would be reported using an HCPCS code or CPT code
If an infusion lasts 90 minutes, the service is reported as (first hour). The additional time over 60 minutes would need to be 31 minutes or greater to count for an additional hour,
prepackaged fluid
separately 47

48. Hydration, Therapeutic Infusions, and IV Pushes
one
Only ___ initial service per encounter
Patient presents for hydration (initial service)
Has drug therapy while being hydrated
Drug therapy is subsequent
Report with _______ code
Example: 3 hours hydration with antiemetic by IV push for 15 minutes
_____ = hydration, 1 hr
_____ × 2 = hydration, hr 2 and 3
_____ = antiemetic IV push
add-on
The key to billing for hydration, therapeutic infusions, and IV pushes is that only one initial service is billable per encounter. All others must be coded with an add-on code listed as each additional hour or sequential push.
Remember the subsequent infusions or pushes are add-on codes and do not require a -51 modifier.
Watch the notes carefully as they are a good indicator of what can be billed together and what is bundled.
96360
96361
96375 48

49. Types of Drug Administration Codes divided by administration method
Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration) ( )
Types of Drug Administration
Therapeutic • Prophylactic • Diagnostic
Codes divided by administration method
Subcutaneous • Intramuscular • IV Push
• Intra-arterial • Intravenous push
A push takes __ minutes or less
Over 15 minutes is an _______
Also report the _________ administered (J code)
Infusions are based on time. The second hour must be 31 minutes or more.
Sequential means a second drug given is after the first.
Concurrent means an additional drug is given at the same time as the first drug.
Injections are divided based on the method of injection. A physician must be present for these injections.
Less than 15 minutes is a push; 15 minutes or more is an infusion. 15
infusion
substance 49

50. Chemotherapy Administration (96401-96549)
Represents only preparation and administration ____________
If separate E/M service provided, report E/M code and ___
Chemical can be administered (injected) into
Lesion
Vein
Tissue
Muscle
Artery
Cavity
Nerve
chemotherapy
-25
Chemotherapy may be provided by several modalities.
Coders should read the patient record carefully before coding to ensure that the correct modality is identified.
(Cont’d…) 50

51. Chemotherapy Administration
(…Cont’d)
Intravenously injected chemicals: two methods of delivery of chemical
IV push quickly puts into vein (__ minutes or less)
IV infusion delivers over longer period time (__ minutes or more)
Chemotherapy administration codes are covered only when drug being used is an antineoplastic and diagnosis is cancer
(Cont’d…) 15 15
Why should a coder be familiar with the coding requirements of third-party payers for chemotherapy? (Some third-party payers will pay for both an IV push and an infusion on the same day; others will not. Knowing this helps to assure the correct reimbursement.) 51

52. Chemotherapy Administration
(…Cont’d)
Codes often divided on time of infusion/injection procedure
Example:
96413, Chemotherapy administration, intravenous infusion, __________, single or initial substance/drug
When multiple drugs are given by different routes of administration, a separate fee will be paid for each route of administration
(Cont’d…)
up to 1 hour
What determines the code to be used? (The method of treatment and the length of time taken to complete the treatment)
Some codes include several hours of treatment time, and others specify each hour of treatment time.
Unit billing or multiple coding may be necessary to accurately reflect the services provided. 52

53. Chemotherapy Administration
(…Cont’d)
Chemical agent (substance) reported _________
Special supplies (e.g., special needles) reported separately using _____ or Level II HCPCS code
(Cont’d…)
separately
99070
When are codes from the Chemotherapy Administration subsection used? (In a clinical setting)
Are both the drug and the administration billable? (Yes)
Where would you find the codes for the drugs? (HCPCS book, J codes) 53

54. Chemotherapy Administration
(…Cont’d)
Report any intra-arterial catheter placement (cutdown) with _____
Intra-arterial route has coverage restrictions for Medicare (e.g., coverage is for patients with liver cancer) and colon cancer that is metastatic to the liver
36640
What is meant by intra-arterial placement? (The injection is made into the artery.) 54

55. Injections with Chemotherapy
Report separately any ________ or ________ (for vomiting)
Before or after chemotherapy
Report both the ___________ and J-code
analgesic
antiemetic
administration
If the patient is given an additional medication before or after chemotherapy, such as an analgesic or antiemetic, administration of this medication is reported separately.
Only one initial code can be billed per session so if a patient had chemotherapy infusion, 1 hour (96413), and an IV push of an antiemetic, you would not use the code for the push as you have already used an initial code The correct codes to use would be for the chemotherapy agent administration and for the IV push of the antiemetic. The drugs would also be billed with the proper J codes.
The drugs given are also coded separately. 55

56. Photodynamic Therapy (96567-96571)
Used in addition to bronchoscopy or gastrointestinal codes
Injected agent remains in cancerous cells longer than normal cells
After agent dissipates from normal cells, lesion is exposed to ____ light
Agent absorbs light
Photosensitizing agent produces ______ and cancer cells are destroyed
laser
How are codes for endoscopic application divided? (On the basis of time—the first 30 minutes and then each additional 15 minutes)
External application is based on each exposure session.
oxygen 56

57. Special Dermatological Procedures (96900-96999)
Usually specialized procedures provided on consultation basis
Separate ___ consultation code then appropriate
Treatment of skin conditions:
___________—with ultraviolet light
________________—with light-sensitive chemicals and light rays
E/M
Actinotherapy
What common dermatological condition is treated with actinotherapy? (Acne)
By what means is actinotherapy delivered? (With ultraviolet light)
Contact third-party payers regarding reimbursement as some of these procedures may be deemed cosmetic and not reimbursable.
Photochemotherapy 57

58. Physical Medicine and Rehabilitation (97001-97799)
Used by physicians and therapists to report services for variety of treatments
Traction
Electrical stimulation (used to help heal fractures)
Therapeutic exercise
Patient training:
___ training
________ activities
(Cont’d…)
Codes report treatments and patient training.
What is another modality of treatment that may be provided in addition to traction and electrical stimulation? (Whirlpool)
Gait
Functional 58

59. Physical Medicine and Rehabilitation
(…Cont’d)
Codes often have ____ components
Example: reports prosthetic training, per __ minutes
Codes divided by type of therapy
Example: physical or occupational
________ are divided by supervised or constant attendance
time 15
Codes are reported on the basis of time or treatment area, as stated in the code description.
When is unit coding necessary? (When the time spent administering the treatment exceeds the time listed in the code)
How are test and measurement codes listed? (By type of testing and by time the testing takes)
Modalities 59

60. Active Wound Care Management (97597-97610)
Debridement
__________ healthy tissue removed along with necrotic tissue (97602)
Removal of necrotic tissue without anesthesia (97597, 97598)
___________________________ (NPWT) is controlled application of subatmospheric pressure to a wound (97605, 97606)
Each code for ongoing care reported on ___ session basis
Nonselective
Negative pressure wound therapy
Allied health professionals perform these procedures—not physicians.
Codes are not used with, or to replace, the surgical debridement codes What determines the codes that can be used? (The area [number of square centimeters] treated)
per
(Cont’d…) 60

61. Active Wound Care Management (97597-97610)
(Cont’d…)
Must document debridement was performed, level of tissue debrided, method of debridement
Document the size and character of wound before and after debridement
Document a treatment plan and patient education
Direct (one-to-one) patient contact

62. Osteopathic and Chiropractic Services (98925-98943)
Both inpatient and outpatient settings
Physician services bundled into codes
Codes divided by number of ___________ involved
body regions
What is osteopathic manipulative treatment? (A form of manual treatment applied by a physician to eliminate bodily dysfunction and related disorders)
Codes are categorized on the basis of the number of body regions treated.
What is chiropractic manipulation? (Manipulation of the spinal column and other structures)
The Chiropractic Manipulative Treatment subsection is broken down according to the number of regions manipulated.
If a separate identifiable service is provided, an E/M code with modifier -25 may be reported.
Codes are specifically for reporting whose services? (Nonphysicians) 62

63. Telephone/Online Services (98966-98969) and Special Services, Procedures, and Reports (99000-99091)
Non-Face-to-Face Nonphysician Services ( ) report telephone and online E/M services by nonphysicians
Handling and conveyance of laboratory specimens
99000-_____
Postoperative follow-up visits included in surgical package
_____
Office visits after posted hours or in locations other than office
_____ (24-hour facility)
Medicare bundles most of the Special Services procedures
(Cont’d…)
99002
99024
99053
This is a miscellaneous section that includes codes that do not fit into other sections.
This includes postoperative follow-up visits. When a patient comes in for a routine postop E/M visit and is in a global period, would be the correct code to use if there were no complications or other complaints. This has no reimbursement value. It just states that the patient was there and was seen. 63

64. Special Services, Procedures, and Reports
(…Cont’d)
Supplies and materials (_____)
Hospital mandated on-call services (___________)
Medication Therapy Management Services ( ) report pharmacist’s services in medication management
99070
99026, 99027
Other codes include medical testimony, the completion of complicated reports, education services, and unusual travel. 64

65. Conclusion CHAPTER 26
MEDICINE 65