1. Medicine
The Medicine Section

2. CPT®
CPT® copyright 2016 American Medical Association. All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT® is a registered trademark of the American Medical Association.

3. Objectives Overview of Medicine section of CPT®
Highlights from specific sections
Emphasis on carefully reading instructions and guidelines with individual sections
Category II, Category III Codes
Appendices
Index
For this lecture, we will look at the codes in the Medicine section of CPT®. The Medicine section contains codes for multiple anatomic sections, such as Cardiology and Pulmonary to name a few. Some of the sections have been discussed in prior chapters. We will go through and highlight sections not previously discussed.

4. Medicine Immunizations Vaccines, Toxoids Psychiatry Biofeedback
Dialysis
Gastroenterology
Ophthalmology
Otorhinolaryngology
Cardiovascular
Pulmonary
Endocrinology
Neurology
Genetics
Nutritional Therapy
Acupuncture
Moderate Sedation
The Medicine section of CPT® is very large. This discussion comes at the end because it contains all those topics not covered in other sections. Due to the large size of this section, not every code or section will be covered in this lecture. The highlights and difficult areas will be considered.

5. Medicine - continued Non-invasive Diagnostic Vascular Studies
Allergy & Clinical Immunology
Special Dermatological Procedures
Physical Medicine & Rehabilitation
Qualifying Circumstances for Anesthesia
Home Health Procedures/Services
The list of topics on the previous slide and this one show many of the topics listed in this section in CPT®. Remember, look at the guidelines, instructions and parenthetical statements in these sections. It can be helpful to review the codes by section noting how one code compares to another listed before or after it.

6. Medicine and ICD-10-CM Alphabetic Index to Diseases and Injuries
Tabular List
Official Guidelines for Coding and Reporting
Diagnostic listings in ICD-10-CM for this section are scattered through multiple chapters. Remember to begin with the Alphabetic Index to Diseases and Injuries before going to the Tabular List. It is also a good idea to review the “Official Guidelines for Coding and Reporting” listed at the beginning of ICD-10-CM.

7. Medicine Guidelines Multiple Procedures Add-on Codes
Separate Procedures
Unlisted Service or Procedure
Special Report
Materials Supplied by Physician
At the beginning of this section are useful guidelines. When multiple procedures are performed on the same date, it is appropriate to list these as separate entries. Become more aware of add-on codes that are designated with the “plus-sign.” Add-on codes cannot stand alone and are exempt from use of modifier 51. When a code is listed as a “separate procedure” it is performed independently and is unrelated to other services or procedures.

8. Immune Globulins (90281-90399) Immune globulins Botulinum antitoxin
Cytomegalovirus (CMV) immune globulin
Diphtheria antitoxin
Hepatitis B immune globulin
Rabies immune globulin
Tetanus immune globulin
Immune globulins are proteins given to protect against or prevent infections. These globulins are made from human blood or products created in a lab from human or animal protein. Infections are caused by bacteria, viruses, and fungi. When these products are given, administration codes are listed with product codes. Pay close attention to the method of delivery of the product. When delivery is by infusion (or IV), codes listed later in the Medicine section ( ) are used for reporting.
Examples of use of these agents include immune globulin for exposure to hepatitis, cytomegalovirus, or rabies. Rh immune globulin is used during pregnancy events (such as normal pregnancy, miscarriage, or ectopic) to prevent sensitization when an Rh-negative mother is carrying an Rh-positive baby.
Remember to use specific ICD-10-CM codes to substantiate medical necessity. Also, recall that all CPT® codes for vaccines or toxoids are modifier 51 exempt.

9. Vaccines and Toxoids (90476-90749)
Vaccination
Immunization
Toxins
Toxoids
Exposure to infectious agents and vaccines stimulates the immune system to make antibodies. Antibodies fight the current infection and future attacks by these foreign substances or “germs.” Vaccines are preparations of killed or attenuated strains of microbes such as bacteria, fungi, or viruses. Vaccines are given to stimulate an immune response with the production of antibodies. Vaccination is the administration of a vaccine. The flu (or influenza) vaccine is an example of a vaccine. Immunization is used as a synonym for vaccination; both are given to protect susceptible individuals from communicable diseases.
A toxoid is a toxin that has been treated to destroy its toxic or harmful property and is capable of stimulating the production of antibodies against the toxin. An example is tetanus toxoid.

10. Psychiatry (90785-90899) Outpatient, inpatient Providers
psychiatrist (MD)
psychologist (PhD)
clinical social workers (LCSW)
Modifier 22 Increased procedural services
Modifier 52 Reduced services
Psychiatric services can be both outpatient and inpatient. This section contains several paragraphs of instructions and guidelines for review. Review these guidelines carefully: In some instances it is okay to use an E/M code for services provided in the office; however, some codes stipulate this is not appropriate.
These code listings can be used by several types of healthcare providers. This includes a psychiatrist, psychologist, or clinical social workers, depending on the service. Some patients receive hospital evaluation and management services only, and others receive E/M services and other procedures. There are additional HCPCS codes required by some payers to clearly identify the type of provider of the services.
Modifier 22 (Increased procedural services) may be used to report a more extensive service. Modifier 52 (Reduced services) may be used to report a service that is reduced or less extensive than the usual procedure.

11. Psychiatry Consultation (99241-99255) Follow-up by consultant
office visits ( )
rest home, domicile ( )
home ( )
Transfer of care – new or established pt.
Diagnostic psychiatric evaluations
( )
Psychiatric services can include psychotherapy, behavior modification, and addictive disease treatment.
Consultation for psychiatric evaluation of a patient includes the exam of the patient and exchange of information with the primary physician, nurses, or family members. It also includes preparation of a report; these services do not include psychiatric treatment.
Follow-up visits initiated by the physician consultant or patient are reported using E/M codes for established patients.
When services constituting transfer of care are reported, new or established patient codes are reported.
Psychiatrists often report instead of E/M codes. Diagnostic psychiatric evaluations are done to determine if there is a treatable diagnosis. The code is chosen based on whether medical services are performed in addition to the diagnostic evaluation.

12. Dialysis Hemodialysis Miscellaneous Dialysis Procedures
End-Stage Renal Disease Services (ESRD)
Other Dialysis Procedures
Age-specific, reported once per month
( ) outpatient; ( ) home services
Dialysis is a form of filtration to remove toxins from blood; This function is usually performed by the kidneys. A semi-permeable membrane between blood and another solution is used to “filter” toxins out of blood. Patients with renal failure (acute or chronic) often require dialysis as often as three times per week. End stage renal disease (ESRD) patients generally are awaiting a kidney transplant. Services for ESRD patients are age-specific and are reported once per month if provided in an outpatient setting.
There are several possible areas of problems or complications with dialysis: It requires a lot of time (several hours per session, three times per week), and may cause infection, I.V. access site problems, hypotension, anemia, and embolism.
This section contains a lot of instructions and guidelines. There are some example scenarios in the instructional notes. Examples relate treatment when outpatient treatment is interrupted by hospital admission.

13. Dialysis Miscellaneous Dialysis Procedures (90945-90947)
Peritoneal dialysis
Hemofiltration
Patient and helper training ( )
Dialysis is generally hemodialysis, filtering of the blood. Other types of dialysis include peritoneal dialysis or hemofiltration. Peritoneal dialysis is placement of a needle or catheter into the peritoneal space in the abdomen. Sterile fluid is placed into the peritoneal cavity and left to allow absorption of waste products. The fluid is then removed from the peritoneal cavity in the abdomen.
Hemofiltration is similar to hemodialysis; Blood is pumped through a hemofilter and no dialysate is used. Salts and water lost through this process are replaced with substitution fluid.
There are two codes for reporting dialysis training for the patient and also for helper dialysis training. Code (90989) reports complete training. Incomplete training is reported using (90993) for each training session. Training can take several weeks.

14. Ophthalmological Services
E/M codes ( )
New and Established patients
Special Ophthalmological Services
The Ophthalmologic section begins with E/M listings. The distinction is made between New and Established patients. A new patient is one that has not received any professional services from the physician or another physician of the same specialty who belong to the same group practice within the last three years. An established patient is one who has received services from the physician or another physician of the same specialty who belongs to the same group practice within the past three years.
These services are not surgical.
Special ophthalmological services include things such as fluorescein angiography, prescription and fitting of lenses, assessment of eye muscles, contact lens services and spectacle (eyeglasse) services.

15. Special Otorhinolaryngologic Services (92502-92700)
Vestibular Function Tests
With and without recording
Audiologic Function Tests
Evaluative and Therapeutic Services
Special Diagnostic Procedures
Special Otorhinolaryngologic (or ENT) services include procedures which normally are not included in a comprehensive ENT evaluation or office visit. Codes in this section are used to report the evaluation of speech and hearing. Codes listed here are diagnostic and treatment services not normally included in a comprehensive ENT evaluation or office visit. Some of these codes include the technical portion of the procedure. But, the technical portion is not the service itself.

16. Cardiovascular & Noninvasive Vascular Diagnostic Studies
Discussed in the Cardiovascular chapter
Noninvasive Vascular Diagnostic Studies ( )
Cerebrovascular Arterial Studies
Extremity Arterial Studies (Including Digits)
Extremity Venous Studies (Including Digits)
Visceral and Penile Vascular Studies
Extremity Arterial-Venous Studies
Duplex and Doppler
Cardiovascular Services is listed next. This includes heart catheterization, stent placement, thrombectomy, atherectomy and balloon angioplasty with a balloon of the coronary arteries, EKGs, echocardiograms and electrophysiological evaluations. These codes are covered in the Cardiovascular section.
This section contains a lot of instructions to review carefully.
These studies are reported for evaluations of blood flow in the head, extremities, viscera and penis. These are tests done outside the body, no catheters or dyes are used. The types of studies done are duplex scans and Doppler studies.
Duplex scans are performed with ultrasound and confirm patterns and direction of blood flow. The scan produces real time, two-dimensional images of the arteries and veins.
A Doppler is a diagnostic instrument that emits an ultrasonic beam into the body. This signal is reflected from moving structures (like blood in vessels) and a computer generated image is created.
These vascular studies include patient care required to perform the study, supervision of the study and interpretation of study results. This includes copies for patient records and analysis of data. If a simple hand-held Doppler device that does not produce a hard copy output, or does not permit analysis of bidirectional vascular flow is used, it is considered part of the physical exam and is not reported separately.

17. Pulmonary Studies
Covered in the Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Systems
Pulmonary Studies are covered in the Respiratory, Hemic, Lymphatic, Mediastinum and Diaphragm Systems. It includes Ventilator management and other procedures.

18. Allergy and Immunology (95004-95199)
Allergy Testing
Code allergen testing
Codes drug allergy
Allergen Immunotherapy
Codes
An allergy is hypersensitivity caused by exposure to a particular antigen (or allergen) resulting in an increase in reactivity to that antigen upon subsequent exposure. Anaphylaxis is an immediate, severe hypersensitivity reaction, sometimes fatal.
Allergen testing (95004) takes place with allergenic extracts such as dust, pollen from plants, mold, and dog dander. Drug allergy testing ( )  can include drugs, venoms, and biological agents. Biological agents are made from living organisms including vaccines, serums, and antitoxins.
Immunotherapy, also called desensitization, is administration of allergenic extracts at periodic intervals with increasing dosage. It seeks to boost immune system function. Rapid desensitization (code 95180) involves injection of an allergen in gradually increasing doses. It must be done under well controlled conditions due to possible reactions.
 Needs to be re-recorded if she states the codes in the audio.

19. Neurology and Neuromuscular Procedures (95803-96020)
Sleep testing
sleep studies vs. polysomnography
Routine Electroencephalography (EEG)
Muscle and Range of Motion Testing
Electromyography (EMG)
Guidance for Chemodenervation and Ischemic Muscle Testing
Sleep studies or polysomnography is becoming more and more commonly used. These tests involve continuous and simultaneous monitoring and recording of various physiological and pathophysiological parameters of sleep for 6 or more hours. This includes physician review and interpretation with a report. Although terms sleep studies and polysomnography are sometimes used interchangeably, there is a distinction. Polysomnography includes sleep staging which includes a 1-4 lead electroencephalogram (or EEG), an electro-oculogram (or EOG), and a submental electromyogram (or EMG). The codes are selected based on the study performed, additional parameters performed, and for some codes, the age of the patient. This section includes instructional notes that should be reviewed.
EEG (or electroencephalography) is recording of the electric potentials of the brain, it is derived from electrodes attached to the scalp.
Electromyography (or EMG) is recording of electrical activity generated in muscle for diagnostic purposes. This includes nerve conduction studies.

20. Neurology and Neuromuscular Procedures (95803-96020)
Nerve Conduction Tests
Intraoperative Neurophysiology
Autonomic Function Tests
Evoked Potentials and Reflex Tests
Special EEG Tests
Neurostimulators, Analysis-Programming
With Nerve conduction testing specific nerves are tested using electrodes. This section contains specific instructions regarding testing. Testing can be both sensory and motor; reports must be prepared by the examiner on site.
All of the sections listed of Neurology and Neuromuscular Procedures contain instructions at the beginning of each section.
Special EEG tests (codes and 95956) are used per 24 hours of recording.

21. Medical Genetics and Genetic Counseling Services (96040)
Chromosome
Gene
Genetics
Genetic counseling
A chromosome is a threadlike structure in the nucleus of a cell composed genes or the genetic material DNA. Human cells normally have 46 chromosomes or 23 pairs, one of each pair is contributed by the mother, the other by the father at conception. A gene is the hereditary unit, it occupies a fixed position in the chromosome. Genetics is the science of heredity. Medical genetics is the branch of human genetics concerned with the relationship between heredity and disease. This area of medicine is expanding rapidly as we learn more. Genetic counselors determine the genetic risk of hereditary diseases. This is often done via in-depth family history and can include extensive research. These are time based codes and documentation is key.
Information gained and exchanged in these sessions is not usually exact; more often the discussion is centered around “the chances” or “likelihood” of an abnormality occurring. An example is cystic fibrosis (CF), a congenital (present at birth) disease that is inherited from parents. If both parents are carriers of the gene for CF, their offspring have a 25 percent chance of having CF, a 25 percent chance of not being affected, and a 50 percent chance of being carriers. If parents already have an affected child, they may want to know risks for future offspring.

22. Hydration
Hydration, Therapeutic,Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly complex Drug or Highly Complex Biologic Agent Administration.
Time based codes ( )
Hydration for short, the title of this section is listed here. There aren’t a lot of codes in this section, but there are a lot of instructions. Infusion is the introduction of fluid into the body. When performed, the following services are included and not reported separately: use of local anesthesia; IV start; access to indwelling IV or subQ catheter; flush at the conclusion of infusion; and standard tubing, syringes and supplies. These services cover physician supervision of anyone giving the infusion or injection. E/M codes can be reported with codes from this range.
When multiple drugs are given, report the service(s) and the specific materials or drugs for each. A J code from HCPCS Level II is used to report the drug given. For example, if a patient is seen for strep throat and given a penicillin injection, list an E & M code for the exam, for the administration of the injection and a J code for the penicillin.

23. Non-Chemotherapy Complex Drugs and Substances
Infusions – therapeutic, prophylactic or diagnostic
Specific to time, technique, substances added and additional set-up
Multiple drugs
If more than one infusion or injection is given at the same time, report only a single “initial” service code such as (96360) or (96372). The exception to this is if the substances being administered have protocol requiring that separate IV lines and sites are to be used.
These infusions can be therapeutic, prophylactic, or diagnostic. When fluid is used for the administration of the drug, the administration of the fluid is not separately reportable. These codes are very specific as to time, technique, substances added during the infusion time, and additional set-up. They should not be reported by a physician when performed in a facility setting.
If multiple drugs are infusing at the same time through the same IV line, they are considered to be concurrent. If protocol indicates that two separate IV lines must be used, then the infusions are not concurrent.
A sequential infusion occurs when a different drug is infused through the same access site after the completion of the initial infusion. Documentation supporting these issues is important.

24. Chemotherapy (96401-96549) Services included with chemotherapy:
Use of local anesthesia
IV start
Access to indwelling IV, subcutaneous catheter or port
Flush at conclusion of infusion
Standard tubing, syringes and supplies
Preparation of chemotherapy agent(s)
Chemotherapy is treatment of disease by means of chemical substances or drugs; usually this is for malignancy. These codes are specific to time, technique, and additional substances added. Read the notes of explanation and instruction at the beginning of this section. Advanced training is required for the preparation and administration of these agents. This includes the infusion rates, handling, and disposal of chemotherapeutic drugs. There is significant patient risk related to administration of chemotherapy. Substances given are prepared specifically for the patient and require advanced staff training to administer them.
HCPCS level II codes for chemotherapy drugs are listed in J9xxx range.
Techniques other than standard infusion or injection are used to deliver chemotherapy agents. Other techniques used include thoracentesis, peritoneocentesis, intrathecal delivery, and venticular reservoir. Paracentesis is passage into a cavity with a needle or cannula for removal of fluid or placement of medication.

25. Chemotherapy Paracentesis Thoracentesis Peritoneocentesis Intrathecal
Ventricular or Intraventricular
Thoracentesis is a type of paracentesis, sometimes called a pleural tap, which involves entry into the pleural cavity, a potential space between the lung and chest wall. Peritoneocentesis is paracentesis into the peritoneal cavity.
Intrathecal delivery is for treatment of the central nervous system (or CNS).
Ventricular reservoir is for chemotherapy administered into the subarachnoid or intraventricular areas.
If other medications are given during chemotherapy, such as for nausea, report them separately.

26. Physical Medicine and Rehabilitation
Treatment plan
Problem list
Goals
Physician review progress each 30 days
Progress made – recorded
Modify or discontinue therapy
Evaluations
Physical Therapy
Occupational Therapy
Athletic Training
Physical medicine and rehabilitation services are intended to improve functional loss. These services are usually provided to patients who have had a stroke, amputation, major cardiac events, or hip fractures. For some, these services are directed to restore the ability to perform activities of daily living.
A treatment plan outlining problems and goals is developed by a physician. Therapy is implemented at a therapy center. Therapists involved in providing care can include physical, occupational, and speech therapists. Documentation requirements by the provider for the initial evaluation and re-evaluation are extensive.
Evaluations are reported based on the type of evaluation (Physical Therapy, Occupational Therapy, Athletic Training), the complexity of the evaluation, and if it is an evaluation or a re-evaluation.

27. Physical Medicine and Rehabilitation
Modalities ( )
Supervised
Constant Attendance
Diathermy, Vasopneumatic devices
Therapeutic Procedures ( )
Modalities include physical agents applied to the patient to produce therapeutic changes. Treatments include hot or cold packs, traction, whirlpool, paraffin bath, vasopneumatic devices, diathermy, infrared, ultraviolet and some types of electric stimulation. These modalities may be supervised – not requiring one-on-one contact by the therapist. They also may be with constant attendance – the provider has direct one-on-one patient contact. More than one modality can be utilized during the therapy session.
Diathermy is therapeutic use of short waves of electromagnetic energy to heat muscular tissue.
Vasopneumatic devices reduce edema or swelling by applying pressure.
Therapeutic procedures improve function through use of clinical skills or services and require direct contact by the physician or therapist. These therapies include exercise, aquatic therapy, manual manipulation, and sensory processing. An important therapy listed here is fitting and training of wheelchair use.

28. Wound Care Management, Orthotic Management, and Prosthetic Management
Active wound care ( )
not to be reported with
Orthotic management and Prosthetic management
Orthotics
Prosthetics
Active wound care management is not just putting a piece of gauze on a wound and waiting for it to heal. Certain wounds and certain patients have wounds that don’t heal well. A good example of patients requiring active wound management is those with diabetes.
Debridement is excision of devitalized tissue and the removal of all foreign matter from a wound surface. Necrotic tissue is dead tissue. For a wound to heal, this tissue must be removed. Certain types of bacteria thrive in dead tissue. There are various techniques used to clean wounds – this must be documented and is one-on-one care by the provider. These codes are not listed if surgical debridement is performed.
Orthotics is the science of making and fitting of orthopedic appliances.
A prosthesis is a fabricated substitute for a diseased or missing part of the body. Prosthetics is the art and science of making and adjusting artificial parts of the body.

29. Acupuncture (97810-97814) Face-to-face time
E/M services reported separately using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) above the usual pre-service and post-service work
Acupuncture is an ancient Asian system of healing using puncture with long, fine needles. It is based on 15-minute time increments of personal or fact-to-face contact; time is not based on the time needles are in place. Acupuncture needles are placed in specific body sites, often for the treatment of pain. Needles may be manipulated or an electric current may be applied.

30. Osteopathic Manipulative Treatment Chiropractic Manipulative Treatment
Osteopathic physician – D.O.
Chiropractic Manipulative Treatment – CMT
Five spinal regions: cervical, thoracic, lumbar, sacral, and pelvic
Five extraspinal regions: head, temporomandibular, lower & upper extremities, rib cage, and abdomen
Osteopathic medicine utilizes a concept of manipulative techniques along with traditional medicine. These techniques are used to treat somatic dysfunction. These listings are categorized by the number of body regions involved. Body regions include: head; cervical; thoracic; lumbar; sacral; pelvic lower extremities; upper extremities; rib cage abdomen and viscera.
Chiropractic medicine is the system using the recuperative powers of the body and the relationship between the musculoskeletal structures and functions of the body. In particular, the spinal column and nervous system in restoring and maintaining health. A chiropractor is one who is licensed and certified to practice chiropractic.

31. Education and Training for Patient Self-Management
How many in the group?
Telephone services – patient, parent, or guardian
24 hours
7 days
These services are prescribed by a physician for a patient for education and self-management. This teaching and training is provided by a non-physician practitioner qualified in the area. A standardized course of study is required, this is provided to an individual or group of patients. The purpose of this training is to teach the patient to self-manage their illness.
Codes are chosen based on the number of patients in the group.
Telephone services are assessment and management services provided over the phone. These codes are based on documented time spent. If the result of the phone call is to see the patient in the next 24 hours or the next available urgent visit appointment the code is not reported. Also, if the call refers to a service performed within the previous seven days or within the postoperative period of a previously completed procedure it is considered part of that previous service or procedure.

32. On-line Medical Evaluation (98969)
On-line encounter or other electronic communication mode of the medical kind
Includes all services provided
A qualified health care provider provides a service to a patient using Internet resources in response to a patient’s on-line inquiry. This must include permanent storage, either electronic or hard copy, of the encounter.
This can be reported only once for the same episode of care during a seven day period.
A reportable service includes all of the communication – telephone calls, prescription provision, orders for lab tests and the on-line encounter.

33. Special Services, Procedures and Reports (99000-99091)
Miscellaneous services
99024 – “tracking”
Mandatory on-call hospital personnel
Patient encounters outside the normal posted business hours or special circumstances at the request of the patient.
Special Services, Procedures and Reports are reported by physicians or other qualified health care providers to report adjunct service along with basic services. Follow-up services after surgery is reported with (99024) as a method to track follow-up visits during the global period of a surgery. It holds no reimbursement value and isn’t usually submitted to payers for reimbursement.
Mandated hospital on-call personnel ( ) include personnel for special procedures, radiology technicians, or support staff for surgery and recovery. This does not include physician stand-by services.

34. Qualifying Circumstances for Anesthesia (99100-99140)
All are add-on codes
+99100
+99116
+99135
+99140
Regular anesthesia services are listed at the beginning of CPT®. There are situations making anesthesia more risky. Such things as age – very young or very old; life-threatening emergency situations; hypothermia or hypotension.
Add-on codes, must be reported with the primary anesthesia code.

35. Moderate (Conscious) Sedation
Services included with Moderate Sedation (not reported separately)
Preservice Work
Intraservice Work
Postservice Work
Moderate sedation is between local and general anesthesia. The patient is still conscious and able to respond to verbal commands, but is in a drug induced depression of consciousness. These patients are breathing on their own and not intubated. Moderate sedation does not include minimal sedation or deep sedation with monitoring.
Your CPT codebook lists the work included in Moderate Sedation which includes preservice, intraservice, and postservice work.
Codes are selected based on the age of the patient, the provider of service, and the intraservice time of the moderate sedation. When the provider of the diagnostic or therapeutic service also performs the moderate sedation, an independent observer is required.

36. Other Services and Procedures
99183 Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session
Hyperbaric oxygen therapy is used to treat infections, burns, embolism, thrombosis, osteomyelitis, necrotizing fasciitis, vascular and crushing injuries, toxic effect of gasses, effect of high altitude and types of surgery. Hyperbaric oxygen therapy is treatment in which oxygen is provided in a sealed chamber at a pressure higher than normal. Put simply, a higher concentration of oxygen is provided to healing or traumatized tissues to improve healing.

37. Home Health Procedures/Services
Define home setting:
Patient’s residence
Assisted living apartments
Group homes
Nontraditional private homes
Custodial care facilities or schools
These codes are reported by non-physician providers giving care in a home setting. A home setting is defined as the environment in which the patient resides. When physicians provide services in a patient’s residence, home visit codes in the E/M section are reported.
Home care for prenatal services could be for a pregnant patient on bed rest. Services provided could be the same as a regular prenatal visit. Codes from ICD-10-CM Chapter 15 – Complications of Pregnancy, Childbirth and the Puerperium.

38. Home Health Procedures/Services
Prenatal services (99500)
Postnatal assessment and follow-up care (99501)
Home visit for newborn care and assessment (99502)
A visit for postnatal follow-up care can be used to assess how the new mom is doing. Is she recovering normally, and able to take care of her baby? This can be an opportunity to check on feeding – breast or bottle. Also, a good time to discuss contraceptive choices. A serious problem often not considered is post-partum depression; this is an opportunity to evaluate mom for this common concern.
Newborn assessments at home can be very valuable and allow evaluation without having to bring a newborn out and exposure to children in the office. The home and social environment, infant nutrition, caregiver skills, parenting skills and resources can all be evaluated.

39. Home Infusion Procedures/Services
Code – up to 2 hours
Code – each additional hour of infusion
In these services a home health provider brings all the supplies and medication to be given. The infusion is given under the direction of this provider. These are time based codes.

40. Medication Therapy Management Services
Performed by a pharmacist
Documentation required:
Patient history
Current medications
Recommendations
Codes in this range report face-to-face patient assessment and intervention by a pharmacist. This is by request when appropriate. A pharmacist reports them following patient assessment, intervention or management of medication questions, interactions or complications. These codes are not used for routine discussions about prescriptions.

41. Category II Codes Used for performance measurement
Facilitate data collection
Use of these codes is optional
Used to evaluate quality of care
Alphanumeric: example: four digits and letter “F” – 2001F is Weight recorded
These codes are used for tracking, not for reimbursement purposes. These codes are not required for correct coding and cannot be used as a substitute for Category I codes. These codes are “alphanumeric” having 4 digits followed by the letter “F.”

42. Category III Codes Data collection regarding new technology
It is preferable to use these codes rather than an unlisted code.
Alpha numeric listings, four digits and the letter “T” Example – 0085T Breath test for heart transplant rejection
Used for reimbursement purposes. Alphanumeric with 4 digits followed by the letter “T.” These are temporary codes used to track new and emerging technology, services and procedures.

43. CPT® Appendices Appendix A – modifiers and description
Appendix B – summary of additions and deletions
Appendix C – clinical examples
Appendix D, E, and F are summary lists
Appendix G – deleted from CPT codebook
Appendix H – go to
Pay particular attention to CPT® Appendix C. It contains clinical examples of the CPT® codes for E/M services. The clinical examples are limited to Office or Other Outpatient Services, Hospital Inpatient Services, Consultations, Critical Care, Prolonged Services, and Care Plan Oversight.

44. CPT® Appendices Appendix I – Genetic Testing Code Modifiers (deleted)
Appendix J – Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves
Appendix K – products pending FDA approval
Take note of Appendix I, Genetic Testing Cod Modifiers was deleted with the creation of new molecular pathology codes. These codes were discussed in the Laboratory and Pathology lecture.

45. CPT® Appendices Appendix L – Vascular families
Appendix M – crosswalk to deleted CPT® codes
Appendix O Multianalytic Assays with Algorithmic Analyses
Appendix P – CPT Codes That May Be Used For Synchronous Telemedicine Services
Index – back of CPT® Book
Note the location of the Index at the back of the CPT® book. Terms can be referenced by procedure or service, organ or anatomic site, condition, or synonyms and abbreviations. This concludes the lecture for the Medicine Section.

46. The End