1. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 1 CHAPTER 13 INTRODUCTION TO THE CPT AND LEVEL II NATIONAL CODES (HCPCS)

2. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 2 MEDICAL CODING Transforms services/procedures/ supplies/drugs into __________ codesTransforms services/procedures/ supplies/drugs into __________ codes Transforms diagnosis and procedures into ________ codesTransforms diagnosis and procedures into ________ codes CPT/HCPCS ICD-9-CM

3. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 3 Levels of Service Codes Level I CPT—(Category 1: 99201-99607, Category III: 0017T-0259T)Level I CPT—(Category 1: 99201-99607, Category III: 0017T-0259T) Level II HCPCS, National Codes— (A0021-V5364)Level II HCPCS, National Codes— (A0021-V5364) Level III Local Codes—phased out due to HIPAALevel III Local Codes—phased out due to HIPAA

4. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 4 Diagnosis Codes ICD-9-CM, Volumes 1 & 2ICD-9-CM, Volumes 1 & 2 International Classification of Diseases, 9th Ed., Clinical ModificationInternational Classification of Diseases, 9th Ed., Clinical Modification

5. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 5 ICD-9-CM Classification ______Classification ______ Explains why service was providedExplains why service was provided Changes diagnoses into _____Changes diagnoses into _____ Diabetes becomes ___.XX (highest level of specificity)Diabetes becomes ___.XX (highest level of specificity) system 250 codes

6. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 6 Why Codes? Computers understand ________Computers understand ________ Specific descriptions attached to each codeSpecific descriptions attached to each code numbers

7. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 7 CPT Developed by the AMA in ____Developed by the AMA in ____ ____-digit codes____-digit codes Updated in _________ for use January 1Updated in _________ for use January 1 Five 1966 November

8. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 8 Examples of Types of CPT Codes MedicalMedical SurgicalSurgical Diagnostic servicesDiagnostic services Anesthesia, etc.Anesthesia, etc. Category II and Category III codes—alpha numericCategory II and Category III codes—alpha numeric –Category II = ___________ measuring –Category III = emerging __________ performance technology

9. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 9 CPT Codes Allow For Communication that is both _______ and _______Communication that is both _______ and _______ A mechanism to report a service not described by a specific CPT or Level II codeA mechanism to report a service not described by a specific CPT or Level II code effective efficient

10. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 10 Consider Renal endoscopy through nephrostomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, and insertion of endopyelotomy stent)Renal endoscopy through nephrostomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, and insertion of endopyelotomy stent) OR 50575OR 50575

11. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 11 Codes Are Used to tell third-party payers about ________/procedures providedUsed to tell third-party payers about ________/procedures provided Often used as basis of _______Often used as basis of _______ services payment

12. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 12 Incorrect Coding Results in providers being paid _____________Results in providers being paid _____________ –Either over or underpayment –Decreases cash flow –Liability risk inappropriately

13. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 13 Codes Are Used By ClinicsClinics HospitalsHospitals Rehabilitation unitsRehabilitation units Ambulance servicesAmbulance services Long-term careLong-term care Wherever __________ services are providedWherever __________ services are provided health care

14. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 14 Outpatient Services for Physicians Reported on insurance formReported on insurance form _________ = universal form_________ = universal form CMS-1500

15. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 15 CMS-1500 Figure: 13.1

16. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 16 CPT Format Symbols in CPTSymbols in CPT Used to convey __________Used to convey __________ ________, moderate (conscious) sedation included (full list in Appendix G, CPT)________, moderate (conscious) sedation included (full list in Appendix G, CPT) –Example 45391, Colonoscopy with endoscopic ultrasound examination ____________, pending FDA approval (Appendix K, CPT)____________, pending FDA approval (Appendix K, CPT) –Example 90650, Human Papilloma virus (HPV) vaccine, types 16, 18, bivalent, 3 dose schedule, for intramuscular use information Bullseye Lightning bolt

17. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 17 Circle ( ○ ) = Reinstated or recycled codeCircle ( ○ ) = Reinstated or recycled code Bullet = ____ Code Bullet = ____ Code Figure: 13.2 New Figure: 13.6

18. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 18 ▲Triangle = _______ Code Figure: 13.3 Revised

19. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 19 ►◄ Right and Left ________ = Beginning and Ending of Text Change Figure: 13.4 Triangles

20. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 20 _____ = Add-On Code Figure: 13.5 + Plus

21. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 21 Add-On Code (…Cont’d) Can only be used with another specific codeCan only be used with another specific code Never used _____Never used _____ No reduction for multiple servicesNo reduction for multiple services Full list in Appendix _ of CPTFull list in Appendix _ of CPT alone D

22. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 22 =Circle With Line, =Circle With Line, -51 Cannot Be Used With these Codes -51 Cannot Be Used With these Codes CPT Appendix E contains a listing of - 51 exempt codesCPT Appendix E contains a listing of - 51 exempt codes Services typically exempt from multiple procedure reductionsServices typically exempt from multiple procedure reductions Figure: 13.7

23. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 23 Appendices of CPT Appendix A: ________Appendix A: ________ Appendix B: Additions, ________, RevisionsAppendix B: Additions, ________, Revisions Appendix C: Clinical Examples, ___ CodesAppendix C: Clinical Examples, ___ Codes Appendix D: _______ CodesAppendix D: _______ Codes Appendix E: ___ Exempt CodesAppendix E: ___ Exempt Codes Appendix F: ___ Exempt CodesAppendix F: ___ Exempt Codes Appendix G: Include Moderate (_________) SedationAppendix G: Include Moderate (_________) Sedation Modifiers Deletions E/M Add-On -51 -63 Conscious (Cont’d…)

24. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 24 Appendices of CPT (…Cont’d) Appendix H: Performance Measures, Category __ Codes, on websiteAppendix H: Performance Measures, Category __ Codes, on website Appendix I: Genetic Testing ________Appendix I: Genetic Testing ________ Appendix J: Electrodiagnostic Medicine Listing of _______, _____, and Mixed NervesAppendix J: Electrodiagnostic Medicine Listing of _______, _____, and Mixed Nerves Appendix K: Product Pending ____ ApprovalAppendix K: Product Pending ____ Approval Appendix L: ________ FamiliesAppendix L: ________ Families Appendix M: Crosswalk to _______ CPT CodesAppendix M: Crosswalk to _______ CPT Codes Appendix N:Summary of Resequenced CPT CodesAppendix N:Summary of Resequenced CPT Codes II Modifiers Sensory Motor FDA Vascular Deleted

25. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 25 ___ CPT Sections (like chapters) 1.Evaluation & Management (E/M) 2.Anesthesia 3.Surgery 4.Radiology 5.Pathology & Laboratory 6.Medicine Category II CodesCategory II Codes Category III CodesCategory III Codes Appendices A-MAppendices A-M IndexIndex Six

26. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 26 Categorized By SectionsSections SubsectionsSubsections SubheadingsSubheadings CategoriesCategories

27. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 27 Categorized By (…Cont’d) ________________ –Knee or Shoulder __________________ –Incision or Excision __________________ –Fracture or Dislocation ____________________ –Cast or Strap ________________________________ –Anterior Cranial Fossa or Middle Cranial Fossa Anatomy Procedure Condition Description Surgical Approach

28. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 28 Categorized By, Example Figure: 13.9 (…Cont’d)

29. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 29 Guidelines Section-specific information begins each sectionSection-specific information begins each section Figure: 13.10

30. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 30 Notes Must-reading located throughout the CPTMust-reading located throughout the CPT Figure: 13.12

31. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 31 Two Types of Codes Stand-alone: ___ descriptionStand-alone: ___ description Indented: Dependent on _________ __________Indented: Dependent on _________ __________ –Verbiage before the semicolon applies to all indented codes that follow Full preceding stand-alone

32. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 32 Types of Codes, Example Figure: 13.14

33. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 33 Semicolon Indicates full description in ______________Indicates full description in ______________ You must return to the stand-alone for full descriptionYou must return to the stand-alone for full description preceding code

34. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 34 Modifiers Add Information CPT ModifierCPT Modifier Two digitsTwo digits –62 Two surgeons performed a surgical procedure –Each surgeon applies his/her individual skill –Each surgeon bills the procedure with modifier -62

35. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 35 Level II HCPCS Modifiers “-AS” Physician’s Assistant“-AS” Physician’s Assistant “-F1” Left hand, second digit“-F1” Left hand, second digit __ modifiers used on CPT or HCPCS__ modifiers used on CPT or HCPCS All

36. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 36 Example of Modifier 43820 Gastrojejunostomy43820 Gastrojejunostomy -62 two surgeons -43820-62 two surgeons performed a gastrojejunostomy -62 modifier may be allowed based on payor Example: Medicare requires documentation of medical necessity

37. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 37 Modifier on the CMS-1500 Modifiers are placed in 24D on CMS-1500Modifiers are placed in 24D on CMS-1500

38. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 38 Unlisted Services Codes ending in ____ = “no specific Category I or III code”Codes ending in ____ = “no specific Category I or III code” Used if ___________________Used if ___________________ ____________ must accompany submission____________ must accompany submission “99” no more specific code Special report

39. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 39 Special or Written Report Indicates: NatureNature ExtentExtent NeedNeed TimeTime EffortEffort __________ Used__________ Used Photos and medical journal articles if relevantPhotos and medical journal articles if relevant Equipment

40. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 40 Category I Codes Category _ codes (00100–99607)Category _ codes (00100–99607) –Approved by AMA and Food and Drug Administration –Proven clinical effectiveness (efficacy) I

41. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 41 Category II Codes— Supplemental Tracking Codes Used for ___________ measurementsUsed for ___________ measurements Codes collect data concerning quality of care and test(s) requiredCodes collect data concerning quality of care and test(s) required ____________ and end in the letter “F” (1006F)____________ and end in the letter “F” (1006F) Location AMA WebsiteLocation AMA Website performance Alphanumeric

42. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 42 Category III Codes— New Technology Temporary codes—up to _ yearsTemporary codes—up to _ years Identify emerging technology, services, and proceduresIdentify emerging technology, services, and procedures Located after ________ sectionLocated after ________ section Alphanumeric (0016T)Alphanumeric (0016T) –May or may not receive future ________ I code status 5 Medicine Category

43. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 43 Category III Codes Category __ codes have not been approved and have no proven clinical effectivenessCategory __ codes have not been approved and have no proven clinical effectiveness Usage orderUsage order –Use ___________ code instead of unlisted code –Use unlisted code if no Category III code III Category III

44. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 44 The Index! Used to locate service/procedure terms and codesUsed to locate service/procedure terms and codes Speeds up code locationSpeeds up code location Like a dictionaryLike a dictionary First entries and last entriesFirst entries and last entries

45. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 45 CPT Index Figure: 13.18

46. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 46 Presentation of Codes in Index Single code: 38115Single code: 38115 Multiple codes: 26645, 26650Multiple codes: 26645, 26650 - Note ______ - Note ______ Range of codes: 22305-22325Range of codes: 22305-22325 - Note ______ comma hyphen

47. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 47 Location Methods With Examples 1.________________: repair, excision 2.____________: median nerve, elbow 3.__________________: cleft lip, clot 4.________: toe and interphalangeal joint 5._______: Jones procedure, Heller operation 6.___________: ECG, PEEP (Pressure Breathing, Positive) Service/procedure Anatomic site Condition or disease SynonymEponym Abbreviation

48. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 48 Always Reference indexReference index Locate code in ___________ of CPTLocate code in ___________ of CPT Read the entire __________ and any _____Read the entire __________ and any _____ main portion description notes

49. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 49 “See” in Index Cross-reference termsCross-reference terms –“Look here for code” Index: Stem, Brain: See BrainstemIndex: Stem, Brain: See Brainstem

50. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 50 HCPCS Healthcare Common Procedure Coding SystemHealthcare Common Procedure Coding System Developed by Centers for Medicare and Medicaid Services (____)Developed by Centers for Medicare and Medicaid Services (____) –Formerly _____ HCPCS developed, ____HCPCS developed, ____ CPT did not contain all codes necessary for Medicare services reportingCPT did not contain all codes necessary for Medicare services reporting CMS HCFA 1983

51. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 51 Levels of Codes Level I: ___Level I: ___ Level II:_______, also known as national codesLevel II:_______, also known as national codes Level III: Local codes (__________) due to HIPAALevel III: Local codes (__________) due to HIPAA CPT HCPCS phased out

52. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 52 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

53. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 53 Level II: _______ Codes Codes for wide variety of providersCodes for wide variety of providers –Physicians –Dentists –Orthodontists –Temporary codes for Medicare National (Cont’d…)

54. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 54 Level II: National Codes (…Cont’d) Codes for wide variety servicesCodes for wide variety services –Specific drugs –________________________ (DME) –Ambulance services Durable medical equipment

55. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 55 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

56. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 56 Format Begins with ____, followed by four _____Begins with ____, followed by four _____ –Example: E0618, apnea monitor Each letter represents group of codesEach letter represents group of codes –Example: “_” codes used to report drugs and dosage letterdigits J

57. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 57 Temporary Codes Certain letters (_, K, _, S, H, T) indicate temporary codesCertain letters (_, K, _, S, H, T) indicate temporary codes –Example: K0006 heavy duty wheelchair Code books published every ______Code books published every ______ –But codes added, deleted, and revised throughout the year –Notified through carrier bulletins GQ January

58. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 58 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, _______ __________ –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. binaural hearing aid

59. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 59 Where HCPCS Are Used _________ settings_________ 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 Outpatient

60. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 60 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 See Figure 13–22 in textbookSee Figure 13–22 in textbook(Cont’d…)

61. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 61 HCPCS Index Alphabetical orderAlphabetical order(Cont’d…) (…Cont’d) Figure: 13.22 Modified from Buck CJ: 2011 HCPCS Level II Professional Edition, St. Louis, 2011, Saunders.

62. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 62 HCPCS Index Main text displayMain text display (…Cont’d) Figure: 13.27 Modified from Buck CJ: 2011 HCPCS Level II Professional Edition, St. Louis, 2011, Saunders.

63. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 63 HCPCS Modifiers ___ and ______ modifiers used with both HCPCS and CPT codes___ and ______ modifiers used with both HCPCS and CPT codes Figure: 13.25 CPT HCPCS Modified from Buck CJ: 2011 HCPCS Level II Professional Edition, St. Louis, 2011, Saunders.

64. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 64 Anatomical Modifiers F1Left hand, second digitF1Left hand, second digit __Left hand, third digit__Left 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 __Right hand, thumb__Right hand, thumb F6Right hand, second digitF6Right hand, second digit F7Right hand, third digitF7Right hand, third digit __Right hand, fourth digit__Right hand, fourth digit F9Right hand, fifth digitF9Right hand, fifth digit F2 F5 F8

65. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 65 Often Used HCPCS Modifiers __ Left__ Left __ Right__ Right Example:Example: Right kidney biopsy, 50200-RTRight kidney biopsy, 50200-RT Left kidney biopsy, 50200-LTLeft kidney biopsy, 50200-LT LT RT

66. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 66 Ambulance Modifiers Origin and destination used in combination:Origin and destination used in combination: –First letter: _____ –Second letter: __________ –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 Origin Destination

67. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 67 Table of Drugs Listed by generic nameListed by generic name Modified from Buck CJ: 2011 HCPCS Level II Professional Edition, St. Louis, 2011, Saunders. Figure: 13.26

68. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 68 Durable Medical Equipment DMEDME Used with chronic disabling conditionUsed with chronic disabling condition Medicare and Medicaid pay for some DME itemsMedicare and Medicaid pay for some DME items Physician must attest to need using __________________ NecessityPhysician must attest to need using __________________ Necessity Certificate of Medical

69. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 69 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-___) attesting to medical necessityPhysician must complete form (CMS-___) attesting to medical necessity 484

70. Copyright © 2011, 2010, 2009, 2008, 2007, 2006, 2005, 2004, 2002 by Saunders, an imprint of Elsevier Inc. Slide 70 Conclusion CHAPTER 13 INTRODUCTION TO THE CPT AND LEVEL II NATIONAL CODES (HCPCS)