1. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Introduction to CPT Chapter Six

2. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 6- 2 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Learning Outcomes 6.1 Explain the structure of the CPT manual. 6.2 Identify the information contained within each code section. 6.3 Describe the functions of the index, appendices, and additional information in the CPT manual. 6.4 Describe the uses of Category II CPT codes. 6.5 Differentiate between the Category III CPT codes and the Category I and II codes.

3. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 6- 3 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Key Terms (continued) Place of service Separate procedure Symbols Unlisted procedure Parent code Parenthetical note Performance measurement exclusion modifiers Performance measures

4. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 6- 4 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 6.4 Reporting Category II Codes and Using Category II Modifiers Performance measures Tools that Medicare and other insurance programs use to document the quality of care provided by individual providers and healthcare system, identified by supplementary tracking codes, or Category 2 codes. Performance measurement exclusion modifiers Modifiers used to exclude a patient from the denominator of the performance measure calculation, which can only be added to certain Category 2 codes.

5. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 6- 5 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 6.4 Reporting Category II Codes and Using Category II Modifiers (continued) Category II codes These codes are supplementary tracking codes that are used as performance measures by the Medicare program and other insurance programs. They facilitate quality measurements by documenting certain services and/or test results that contribute to quality patient care. Reporting Category II codes can replace extensive manual chart reviews and record abstraction. Category II codes describe components that are often performed as part of an E/M service.

6. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 6- 6 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 6.4 Reporting Category II Codes and Using Category II Modifiers (continued) Format of Category II Codes Category II codes consist of four numeric characters followed by the letter F. These numbers are not related to placement of these services in the Category I section of the CPT manual. Each Category II code includes an acronym at the end of the code to identify the disease or clinical condition with which the measurement is associated. Category II codes are updated more often than Category I codes. There are three performance measurement exclusion modifiers and one reporting modifier associated with some Category II codes. Exclusion modifiers cannot be added to all Category II codes.

7. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 6- 7 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 6.4 Reporting Category II Codes and Using Category II Modifiers (continued) Types of Category II Performance Measurement Codes Divided into the following sections: Composite Measures codes (0001F–0015F) Patient Management codes (0500F–0575F) Physical Examination codes (2000F–2060F) Diagnostic/Screening Processes or Results codes (3006F–3720F) Therapeutic, Preventive, or Other Interventions Codes (4000F–4400F) Follow-up or Other Outcomes codes (5005F–5200F) Patient Safety codes (6005F–6090F) Structural Measures codes (7010F–7025F)

8. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 6- 8 © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Summary (continued) Learning Outcome 6.4 Category II codes identify performance measures that may be used to measure the quality of services provided by individual providers, large groups of providers, or healthcare systems. These codes are organized according to the types of services measured.