1. 1 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. CHAPTER 13 MEDICINE SECTION AND LEVEL II NATIONAL CODES

2. 2 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Medicine Section and Level II National Codes Most procedures noninvasive (not entering body)Most procedures noninvasive (not entering body) Contains invasive proceduresContains invasive procedures –Example: 92973, Percutaneous thrombectomy Numerous notes throughoutNumerous notes throughout

3. 3 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Subsections Wide variety servicesWide variety services Many specialized testsMany specialized tests –Example: AudiologyAudiology BiofeedbackBiofeedback

4. 4 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Immunizations Often usedOften used Two types immunizationsTwo types immunizations –Active and passive Correct coding includesCorrect coding includes –Supply injected –Administration of injection (Cont’d…)

5. 5 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Active—Bacteria or Viruses (…Cont’d) Bacteria that cause disease made nontoxic (toxoid)Bacteria that cause disease made nontoxic (toxoid) –Injected to build immunity Small dose active virus injected (vaccine)Small dose active virus injected (vaccine) –Injected to build immunity Example: PoliovirusExample: Poliovirus(Cont’d…)

6. 6 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Passive Immunization (Cont’d…) Does not cause immune responseDoes not cause immune response Contains antibodies against certain diseases—immune globulinsContains antibodies against certain diseases—immune globulins

7. 7 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Immune Globulins (90281-90399) Identifies immune globulin productIdentifies immune globulin product –Example: Botulism antitoxin Report administrationseparatelyReport administration separately(Cont’d…)

8. 8 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Immune Globulins (…Cont’d) Codes divided by:Codes divided by: –Type e.g., Rabies, hepatitis Be.g., Rabies, hepatitis B –Method e.g., intramuscular, intravenous, subcutaneouse.g., intramuscular, intravenous, subcutaneous –Dose e.g., Full dose, minidosee.g., Full dose, minidose From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders.

9. 9 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Immunization Administration for Vaccines/Toxoids (90465-90474) Administration (giving substance) of substanceAdministration (giving substance) of substance –Reported with substance given (Cont’d…)

10. 10 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Immunization Administration (…Cont’d) 90465-90468 Patients under 8 years of age when physician counsels regarding immunization90465-90468 Patients under 8 years of age when physician counsels regarding immunization 90465, +90466 = Percutaneous, intradermal, subcutaneous, or intramuscular injection90465, +90466 = Percutaneous, intradermal, subcutaneous, or intramuscular injection 90467, +90468 = Oral or intranasal90467, +90468 = Oral or intranasal 90471-90474 = Patients 8 years of age or over90471-90474 = Patients 8 years of age or over –Patients of all ages (including under 8) if physician does not counsel regarding immunization 90471, +90472 = Percutaneous, intradermal, subcutaneous, or intramuscular injection90471, +90472 = Percutaneous, intradermal, subcutaneous, or intramuscular injection 90473, +90474 = Oral or intranasal90473, +90474 = Oral or intranasal

11. 11 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Methods of Administration PercutaneousPercutaneous IntradermalIntradermal SubcutaneousSubcutaneous IntramuscularIntramuscular IntranasalIntranasal OralOral (Cont’d…) From Bonewit-West K: Clinical Procedures for Medical Assistants, ed 7, St. Louis, 2008, Saunders.

12. 12 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Report Administration for Each Dose—Single or Combination Example: Patient (over age 8) receives three separate administrations:Example: Patient (over age 8) receives three separate administrations: 90471 tetanus90471 tetanus 90472 rubella90472 rubella 90472 diphtheria90472 diphtheria –OR depending on payer: 90471 tetanus90471 tetanus 90472 x 2 rubella and diphtheria90472 x 2 rubella and diphtheria

13. 13 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Vaccines, Toxoids (Vaccine Product Codes) (90476-90749) Many codes age specificMany codes age specific –Example: 90658, influenza vaccine, for ages 3 and over90658, influenza vaccine, for ages 3 and over Codes for products for single diseasesCodes for products for single diseases –Example: 90703, tetanus90703, tetanus Codes for combination diseasesCodes for combination diseases –Example: 90701, diphtheria, tetanus, and whole cell pertussis ( DTP )90701, diphtheria, tetanus, and whole cell pertussis ( DTP ) Caution: There are numerous code combinations of diphtheriaCaution: There are numerous code combinations of diphtheria(Cont’d…)

14. 14 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Vaccines, Toxoids (…Cont’d) Some vaccines given on scheduleSome vaccines given on schedule –Example: 90633, 2-dose hepatitis Avaccine90633, 2-dose hepatitis A vaccine –First dose, first visit –Second dose, second visit

15. 15 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Remember Usually do not use modifier -51with Vaccine/Toxoid codesUsually do not use modifier -51 with Vaccine/Toxoid codes –Rather, depending on payer: List each code multiple times orList each code multiple times or Use times (  ) symbol and indicate numberUse times (  ) symbol and indicate number New in 2008 description how -51 is used with “product (e.g., vaccines)”New in 2008 description how -51 is used with “product (e.g., vaccines)” Modifier -51 should not be reported for the vaccines, toxoids when performed with these administration codes (90465-90474)Modifier -51 should not be reported for the vaccines, toxoids when performed with these administration codes (90465-90474)

16. 16 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Important Reporting Rule If vaccine administered during office visit (not related to E/M)If vaccine administered during office visit (not related to E/M) –Report E/M service (with modifier -25) + Vaccine + administration Depends on local carrierDepends on local carrier Office visit for vaccine only, code only vaccine, NO E/M serviceOffice visit for vaccine only, code only vaccine, NO E/M service –Depends on local carrier

17. 17 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Routine Vaccinations InfluenzaInfluenza –Substance (vaccine) 90657, 90658 –Administration G0008 HCPCS (Medicare only)G0008 HCPCS (Medicare only) 90471/9047290471/90472 PneumococcalPneumococcal –Substance (vaccine) 90732 –Administration G0009 HCPCS (Medicare only)G0009 HCPCS (Medicare only) 90471/90472 administration90471/90472 administration Medicare covers tetanus injections (90703, 90718) when given for an acute injury to person who is incompletely immunizedMedicare covers tetanus injections (90703, 90718) when given for an acute injury to person who is incompletely immunized –When a tetanus booster is given to a patient in absence of an injury, injection does not meet the coverage criteria for Medicare

18. 18 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Hydration, Therapeutic, Prophylactic, and Diagnostic Injections & Infusions 96360-9637996360-96379 Infusion: Therapeutic procedure to introduce fluid into bodyInfusion: Therapeutic procedure to introduce fluid into body –Example: Fluid into vein for patient rehydrationFluid into vein for patient rehydration Codes represent infusion service and “pre- packaged fluid and electrolytes”Codes represent infusion service and “pre- packaged fluid and electrolytes” –Other than pre-packaged, report separately

19. 19 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Hydration, Therapeutic Infusions, and IV Pushes Only one initial service per encounterOnly one initial service per encounter Patient presents for hydration (initial service)Patient presents for hydration (initial service) –Has drug therapy while being hydrated –Drug therapy is subsequent Report with add-on codeReport with add-on code –Example: 3 hours hydration with antiemetic by IV push for 15 minutes 96360 = hydration, 1 hr96360 = hydration, 1 hr 96361  2 = hydration, hr 2 and 396361  2 = hydration, hr 2 and 3 96375 antiemetic IV push96375 antiemetic IV push

20. 20 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration (96365-96379) Types of Drug Administration Therapeutic Prophylactic DiagnosticTherapeutic Prophylactic Diagnostic Codes divided by administration method Subcutaneous Intramuscular IV PushSubcutaneous Intramuscular IV Push Intra-arterial Intravenous push Intra-arterial Intravenous push –A Push takes 15 minutes or less –Over 15 minutes is an infusion –Also report the substance administered (J code)

21. 21 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Psychiatry (90801-90899) Psychiatric treatment at same time as E/M service, reportPsychiatric treatment at same time as E/M service, report –One code for therapy with E/M Time major billing factorTime major billing factor –Codes divided on time –Record indicates session time (Cont’d…)

22. 22 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. When selecting a psychotherapy code, ask these questions:When selecting a psychotherapy code, ask these questions: 1.Where is service taking place? 2.How much face-to-face time is spent with patient? 3.Does documentation support an E/M code in addition to psychotherapy? 4.If rendering psychotherapy, is approximate “time” of psychotherapy noted in medical record? Psychiatry (90801-90899)

23. 23 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Psychiatry (…Cont’d) Many services provided in partial hospital settingsMany services provided in partial hospital settings –Patient in hospital during day, return to home for evenings and weekends Interactive psychotherapy is typically furnished to childrenInteractive psychotherapy is typically furnished to children –It uses play equipment, physical devices, language interpreter, or other mechanisms of communication

24. 24 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Biofeedback (90901, 90911) Used to help patients gain control over body processesUsed to help patients gain control over body processes –Example: High BP or manage chronic pain Medicare Coverage Issues Manual 35- 27 restricts use of biofeedbackMedicare Coverage Issues Manual 35- 27 restricts use of biofeedback Medicare doesn’t cover biofeedback for treatment of psychiatric disordersMedicare doesn’t cover biofeedback for treatment of psychiatric disorders(Cont’d…)

25. 25 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Biofeedback (…Cont’d) Patient training in biofeedback by professionalPatient training in biofeedback by professional –Continues on own Services often part of psychophysiologic (mind/body) therapyServices often part of psychophysiologic (mind/body) therapy

26. 26 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Dialysis (90935-90999) Cleanses bloodCleanses blood –Temporary (non-ESRD) –Permanent (ESRD) Two parts to report ESRD dialysis services:Two parts to report ESRD dialysis services: –Physician service –Hemodialysis procedure Hemodialysis machine. (From Nipro Europe NV: Hemodialysis Machine (website): http://www.nipro-europe.com/hemodialysis_machines.asp. Accessed November 7, 2006.). http://www.nipro-europe.com/hemodialysis_machines.asp

27. 27 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. End Stage Renal Disease Services (90951-90970) IncludeInclude –Establishment dialyzing cycle –Physician services –E/M outpatient dialysis visits –Patient management during dialysis Reported for month: 90951-90966Reported for month: 90951-90966 –Less than full month of service: 90967-90970 per day –Codes divided on age and number of visits –Temporary Level II Gcodes for Medicare patients –Temporary Level II G codes for Medicare patients

28. 28 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Hemodialysis Service (90935-90940) Hemodialysis is the procedureHemodialysis is the procedure –Used for ESRD and non-ESRD Billed per day for inpatients receiving ESRD + non-ESRDBilled per day for inpatients receiving ESRD + non-ESRD Includes all physician E/M services related to procedureIncludes all physician E/M services related to procedure –Use modifier -25 if separate E/M service provided

29. 29 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Miscellaneous Dialysis Procedures (90945-90999) Describes other dialysis proceduresDescribes other dialysis procedures –Example: Peritoneal dialysis in which toxins are passively absorbed into dialysis fluidPeritoneal dialysis in which toxins are passively absorbed into dialysis fluid(Cont’d…)

30. 30 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Peritoneal Dialysis Services billed on per day basis for inpatient ESRD patientsServices billed on per day basis for inpatient ESRD patients(Cont’d…) (…Cont’d) From Goldman L, Ausiello D, editors: Cecil Textbook of Medicine, ed 22, Philadelphia, 2004, Saunders.

31. 31 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Peritoneal Dialysis (…Cont’d) Patients can receive training in self-dialysisPatients can receive training in self-dialysis –Reported with 90989, 90993 –Codes divided by complete or partial training program

32. 32 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Gastroenterology (91000- 91299) For tests and treatments of esophagus, stomach, and intestineFor tests and treatments of esophagus, stomach, and intestine Codes usually reported with E/M or consultation service codeCodes usually reported with E/M or consultation service code Caution: Many bundled servicesCaution: Many bundled services

33. 33 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Ophthalmology (92002-92499) Contains E/M codesContains E/M codes –Not E/M codes from front of CPT Definitions for new and established patients same as for E/M sectionDefinitions for new and established patients same as for E/M section Most codes are for bilateral servicesMost codes are for bilateral services –If only one eye, use modifier -52 (reduced service) Read definitions of intermediate and comprehensive services in the CPT!Read definitions of intermediate and comprehensive services in the CPT!(Cont’d…)

34. 34 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Example, Intermediate: Review of history, external examination, ophthalmoscopy, biomicroscopy for an acute complicated condition (ex., tritis) 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 Ophthalmology (92002-92499)

35. 35 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Special Otorhinolaryngologic Services (92502-92700) For special evaluations of audiologic systemFor special evaluations of audiologic system Go beyond those usually provided in evaluationGo beyond those usually provided in evaluation May be reported in addition to basic audiologic serviceMay be reported in addition to basic audiologic service(Cont’d…)

36. 36 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Special Otorhinolaryngologic Services (…Cont’d) Special treatments and diagnostic servicesSpecial treatments and diagnostic services –Example: Nasal function tests ( rhinomanometry ) or audiometric testsNasal function tests ( rhinomanometry ) or audiometric tests All hearing tests bilateral unless indicated one ear in descriptionAll hearing tests bilateral unless indicated one ear in description Use modifier -52 for 1 earUse modifier -52 for 1 ear From Cummings CW, Flint PW, Harker LA, Haughey BH, Richardson MA, Robbins KT, Schuller DE, Thomas JR, editors: Cummings Otolaryngology-Head & Neck Surgery, ed 4, Philadelphia, 2005, Mosby. From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders

37. 37 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Noninvasive Vascular Diagnostic Studies (93875-93990) Vascular codes for procedures on noncoronary veins and arteriesVascular codes for procedures on noncoronary veins and arteries IncludesIncludes –Patient care –Supervision and interpretation (S&I) –Copy of results

38. 38 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Percutaneous Transluminal Coronary Angioplasty 92950-9299892950-92998 Two catheters placedTwo catheters placed –Central venous inserted through the femoral or brachial artery – Catheter with balloon tip threaded up to heart Balloon is expanded and widens vesselBalloon is expanded and widens vessel

39. 39 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Echocardiography 93303-9335093303-93350 Ultrasound examination of heartUltrasound examination of heart Diagnostic testDiagnostic test High frequency sound wavesHigh frequency sound waves Includes DopplerIncludes Doppler A follow-up or limited study may be performed for special structural and/or functional focusA follow-up or limited study may be performed for special structural and/or functional focus

40. 40 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Cardiac Catheterization Diagnostic medical procedureDiagnostic medical procedure Three componentsThree components –93501-93533Catheterization –93539-93545Injection –93555-93556Imaging If the cardiac catheterization is performed in a facility setting, modifier -26 is placed on 93501-93533 series and on imaging codes 93555-93556If the cardiac catheterization is performed in a facility setting, modifier -26 is placed on 93501-93533 series and on imaging codes 93555-93556

41. 41 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Pulmonary (94002-94799) For ventilation management, therapies, and diagnostic testsFor ventilation management, therapies, and diagnostic tests Includes procedure and interpretation of test resultsIncludes procedure and interpretation of test results –Additional E/M service reported separately Ventilator management codesVentilator management codes –Further divided by place of service –Facility is billed per day –Home billed by time once per month From Young AP, Proctor DB: Kinn's The Medical Assistant, ed 10, St. Louis, 2007, Saunders.

42. 42 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Allergy and Clinical Immunology (95004-95199) Divided into two subheadings:Divided into two subheadings: –Allergy Testing (95004-95075) –Allergen Immunotherapy (95115-95199) –Should not report both together Allergy testing—consists of performance, evaluation, and interpretation of allergens placed under skinAllergy testing—consists of performance, evaluation, and interpretation of allergens placed under skin Immunotherapy—indicated for patients with allergic rhinitis due to seasonal pollinosis caused by trees, grasses, weeds, etc.Immunotherapy—indicated for patients with allergic rhinitis due to seasonal pollinosis caused by trees, grasses, weeds, etc.

43. 43 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Allergy Testing (95004-95075) Sensitivity testing using various types of testsSensitivity testing using various types of tests –Example: Percutaneous, intracutaneous, inhalationPercutaneous, intracutaneous, inhalation Tests use numerous substancesTests use numerous substances –Example: Extracts, venoms, biologics, and foodsExtracts, venoms, biologics, and foods Type and number of tests based on physician’s judgmentType and number of tests based on physician’s judgment(Cont’d…)

44. 44 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Coding Allergy Testing (…Cont’d) Medical record will indicate theMedical record will indicate the –Number of tests –Type of test –Method of testing

45. 45 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Allergen Immunotherapy (95115-95199) Codes divided into three types services:Codes divided into three types services: –Injection only –Prescription and injection –Provision antigen (substance) only Codes 95115 & 95117 (professional service for allergen immunotherapy) are payable in an office settingCodes 95115 & 95117 (professional service for allergen immunotherapy) are payable in an office setting(Cont’d…)

46. 46 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Allergen Immunotherapy (…Cont’d) Physician service bundled into immunotherapy codesPhysician service bundled into immunotherapy codes –If separate E/M service provided, report separately

47. 47 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Neurology and Neuromuscular Procedures (95805-96020) Contains codes to report tests, such as:Contains codes to report tests, such as: –Sleep tests –Muscle and range of motion tests –Electroencephalogram (EEG) –Neurostimulator procedures –Brain mapping Many bundled servicesMany bundled services Services usually provided in addition to E/M serviceServices usually provided in addition to E/M service These are often consultative services (ex., 99241-99242)These are often consultative services (ex., 99241-99242)

48. 48 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Central Nervous System (CNS) Assessments/Tests (96101-96125) Used to report:Used to report: –Psychological tests –Speech/language assessments –Developmental progress assessments –Thinking/reasoning examinations (Cont’d…)

49. 49 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. CNS Assessments/Tests (…Cont’d) Codes based on per hour basisCodes based on per hour basis –Except for basic developmental testing Includes written report of resultsIncludes written report of results

50. 50 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Chemotherapy Administration (96401-96549) Represents only preparation and administration chemotherapyRepresents only preparation and administration chemotherapy –If separate E/M service provided, report E/M code and -25 Chemical can be administered (injected into)Chemical can be administered (injected into) –Lesion –Vein –Tissue –Muscle –Artery –Cavity –Nerve (Cont’d…)

51. 51 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Chemotherapy Administration (…Cont’d) Intravenously injected chemicals two methods of delivery of chemicalIntravenously injected chemicals two methods of delivery of chemical –IV push quickly puts into vein (15 minutes or less) –IV infusion delivers over longer period time (15 minutes or more) Chemotherapy administration codes are covered only when drug being used is an antineoplastic and diagnosis is cancerChemotherapy administration codes are covered only when drug being used is an antineoplastic and diagnosis is cancer(Cont’d…)

52. 52 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Chemotherapy Administration (…Cont’d) Codes often divided on time of infusion/injection procedureCodes often divided on time of infusion/injection procedure –Example: 96413, Chemotherapy administration, intravenous infusion, up to 1 hour, single or initial substance/drug96413, Chemotherapy administration, intravenous infusion, up to 1 hour, 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 administrationWhen multiple drugs are given by different routes of administration, a separate fee will be paid for each route of administration(Cont’d…)

53. 53 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Chemotherapy Administration (…Cont’d) Chemical agent (substance) reported separatelyChemical agent (substance) reported separately Special supplies (e.g., special needles) reported separately using 99070 or HCPCS code (J9000-J9999)Special supplies (e.g., special needles) reported separately using 99070 or HCPCS code (J9000-J9999)(Cont’d…)

54. 54 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Chemotherapy Administration (…Cont’d) Report any intra-arterial catheter placement with 36640Report any intra-arterial catheter placement with 36640 Intra-arterial route has coverage restrictions for Medicare (ex., coverage is for patients with liver cancer, diagnosis codes 155.0-155.2 and 197.7) and colon cancer that is metastatic to the liverIntra-arterial route has coverage restrictions for Medicare (ex., coverage is for patients with liver cancer, diagnosis codes 155.0-155.2 and 197.7) and colon cancer that is metastatic to the liver

55. 55 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Injections with Chemotherapy Report separately any analgesic or antiemetic (for vomiting)Report separately any analgesic or antiemetic (for vomiting) –Before or after chemotherapy –Report both the administration and J-code

56. 56 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Photodynamic Therapy (96567-96571) Used in addition to bronchoscopy or endoscopy codesUsed in addition to bronchoscopy or endoscopy codes Injected agent remains in cancerous cells longer than normal cellsInjected agent remains in cancerous cells longer than normal cells –After agent dissipates from normal cells, patient exposed to laser light –Agent absorbs light –Light produces oxygen and cancer cell destroyed

57. 57 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Special Dermatological Procedures (96900-96999) Usually specialized procedures provided on consultation basisUsually specialized procedures provided on consultation basis –Separate E/M consultation code then appropriate Treatment of skin conditions:Treatment of skin conditions: –Actinotherapy—with ultraviolet light –Photochemotherapy—with light-sensitive chemicals and light rays

58. 58 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Physical Medicine and Rehabilitation (97001- 97799) (…Cont’d) Used by physicians and therapists to report services for variety of treatmentsUsed by physicians and therapists to report services for variety of treatments –Traction –Electrical stimulation (used to help heal fractures) –Therapeutic exercise Patient training:Patient training: –Gait training –Functional activities (Cont’d…)

59. 59 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Physical Medicine and Rehabilitation (…Cont’d) Codes often have time componentsCodes often have time components –Example: 97761 reports orthotics fitting and training, per 15 minutes Codes divided by type of therapyCodes divided by type of therapy –Example: physical or occupational Modalities are divided by supervised or constant attendance Modalities are divided by supervised or constant attendance

60. 60 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Active Wound Care Management (97597-97606) DebridementDebridement –Nonselective healthy tissue removed along with necrotic tissue (97602) –Selective removal of necrotic tissue (97597, 97598) –Negative pressure wound therapy (NPWT) is controlled application of subatmospheric pressure to a wound (97605, 97606) Each code for ongoing care reported on per session basisEach code for ongoing care reported on per session basis

61. 61 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. 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 Active Wound Care Management (97597-97606)

62. 62 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Osteopathic and Chiropractic Services (98925-98943) Both inpatient and outpatient settingsBoth inpatient and outpatient settings Physician services bundled into codesPhysician services bundled into codes Codes divided by number of body regions involvedCodes divided by number of body regions involved Non-Face-to-Face Nonphysician Services (98966-98969) report telephone and online E/M services by nonphysiciansNon-Face-to-Face Nonphysician Services (98966-98969) report telephone and online E/M services by nonphysicians

63. 63 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Special Services, Procedures, and Reports (99000-99091) Handling and conveyance laboratory specimensHandling and conveyance laboratory specimens –99000-99002 Postoperative follow-up visits included in surgical packagePostoperative follow-up visits included in surgical package –99024 Office visits after posted hours or in locations other than officeOffice visits after posted hours or in locations other than office –99053 Medicare bundles most of the Special Services proceduresMedicare bundles most of the Special Services procedures(Cont’d…)

64. 64 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Special Services, Procedures, and Reports (…Cont’d) Supplies and materials (99070)Supplies and materials (99070) Hospital mandated on-call services (99026, 99027)Hospital mandated on-call services (99026, 99027) Medication Therapy Management Services (99605-99607) report pharmacist services in medication managementMedication Therapy Management Services (99605-99607) report pharmacist services in medication management

65. 65 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. HCPCS Healthcare Common Procedure Coding SystemHealthcare Common Procedure Coding System Developed by Centers for Medicare and Medicaid Services (CMS)Developed by Centers for Medicare and Medicaid Services (CMS) –Formerly HCFA HCPCS developed, 1983HCPCS developed, 1983 CPT did not contain all codes necessary for Medicare services reportingCPT did not contain all codes necessary for Medicare services reporting

66. 66 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Levels of Codes Level I: CPTLevel I: CPT Level II: HCPCS, also known as national codesLevel II: HCPCS, also known as national codes Level III: Local codes (phased out) due to HIPAALevel III: Local codes (phased out) due to HIPAA

67. 67 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Level III, Local Codes Developed by Medicare carriers for use at local levelDeveloped by Medicare carriers for use at local level Varied by localeVaried by locale Discontinued December 31, 2003Discontinued December 31, 2003 –Some codes incorporated into HCPCS Level I and II

68. 68 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Level II: National Codes Codes for wide variety providersCodes for wide variety providers –Physicians –Dentists –Orthodontists –Temporary codes for Medicare (Cont’d…)

69. 69 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Level II: National Codes (…Cont’d) Codes for wide variety servicesCodes for wide variety services –Specific drugs –Durable medical equipment (DME) –Ambulance services

70. 70 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. HCPCS Gains Popularity Many payers requireMany payers require Each year increased number of HCPCS codesEach year increased number of HCPCS codes –J0585—Botox, per unit

71. 71 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Format Begins with letter, followed by four digitsBegins with letter, followed by four digits –Example: E0618, apnea monitor Each letter represents group codesEach letter represents group codes –Example: “J” codes used to report drugs and dosage

72. 72 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Temporary Codes Certain letters (G, K, Q, S) indicate temporary codesCertain letters (G, K, Q, S) indicate temporary codes –Example: K0006 heavy duty wheelchair Code books published every JanuaryCode books published every January –But codes added, deleted, and revised throughout the year –Notified through carrier bulletins

73. 73 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Coverage Just because item/service has HCPCS code does NOT mean service coveredJust because item/service has HCPCS code does NOT mean service covered –Example: –V5130, binaural hearing aid –Not covered under Medicare From Cummings CW, Flint PW, Harker LA, Haughey BH, Richardson MA, Robbins KT, Schuller DE, Thomas JR, editors: Cummings Otolaryngology-Head & Neck Surgery, ed 4, Philadelphia, 2005, Mosby.

74. 74 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Where HCPCS Are Used Outpatient settingsOutpatient settings –Including outpatient departments in hospital Level I and II used to report outpatient services to certain payersLevel I and II used to report outpatient services to certain payers

75. 75 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. HCPCS Index Directs to specific codesDirects to specific codes Do not code directly from indexDo not code directly from index Reference main portion text before assigning codeReference main portion text before assigning code(Cont’d…)

76. 76 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. HCPCS Index Alphabetical orderAlphabetical order (…Cont’d) Figure: 13.6 Courtesy U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. (Cont’d…)

77. 77 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. HCPCS Index Main text displayMain text display (…Cont’d) Figure: 13.8 Courtesy U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.

78. 78 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. HCPCS Modifiers CPT and HCPCS modifiers used with both HCPCS and CPT codesCPT and HCPCS modifiers used with both HCPCS and CPT codes Figure: 13.9 Courtesy U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.

79. 79 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Anatomical Modifiers F1Left hand, second digitF1Left hand, second digit F2Left hand, third digitF2Left hand, third digit F3 Left hand, fourth digitF3 Left hand, fourth digit F4 Left hand, fifth digitF4 Left hand, fifth digit FA Left hand, thumbFA Left hand, thumb F5Right hand, thumbF5Right hand, thumb F6Right hand, second digitF6Right hand, second digit F7Right hand, third digitF7Right hand, third digit F8Right hand, fourth digitF8 Right hand, fourth digit F9Right hand, fifth digitF9Right hand, fifth digit

80. 80 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Often Used HCPCS Modifiers LT LeftLT Left RT RightRT Right Example:Example: Right kidney biopsy, 50200-RTRight kidney biopsy, 50200-RT Left kidney biopsy, 50200-LTLeft kidney biopsy, 50200-LT

81. 81 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Ambulance Modifiers Origin and destination used in combination:Origin and destination used in combination: –First letter: Origin –Second letter: Destination –Example: R = ResidenceR = Residence H = HospitalH = Hospital RH: origin (first letter) residence and destination (second letter) hospitalRH: origin (first letter) residence and destination (second letter) hospital

82. 82 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Table of Drugs Listed by generic nameListed by generic name Figure: 13.10 Courtesy U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services.

83. 83 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Durable Medical Equipment DMEDME Medicare and Medicaid pay for some DME itemsMedicare and Medicaid pay for some DME items Physician must attest to need using Certificate of Medical NecessityPhysician must attest to need using Certificate of Medical Necessity

84. 84 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Home Oxygen Therapy Medicare may also pay for oxygen with certain medical conditionsMedicare may also pay for oxygen with certain medical conditions Physician must complete form (CMS- 484) attesting to medical necessityPhysician must complete form (CMS- 484) attesting to medical necessity

85. 85 Copyright © 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. CPT codes are copyright of the American Medical Association. CPT only © 2008. Current Procedural Terminology, 2009, American Medical Association. All Rights Reserved. Conclusion CHAPTER 13 MEDICINE SECTION AND LEVEL II NATIONAL CODES