1. Medicine

2. CPT® CPT® copyright 2011 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

4. Medicine Immunizations Vaccines, Toxoids Psychiatry Biofeedback Dialysis Gastroenterology Ophthalmology Otorhinolaryngology Cardiovascular Pulmonary Endocrinology Neurology Genetics Nutritional Therapy Acupuncture Moderate Sedation

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

6. Medicine and ICD-9-CM Alphabetic Index to Diseases Tabular List Official Guidelines for Coding and Reporting

7. Medicine Guidelines Multiple Procedures Add-on Codes Separate Procedures Unlisted Service or Procedure Special Report Materials Supplied by Physician

8. Immune Globulins (90821-90399) Immune globulins Botulinum antitoxin Cytomegalovirus (CMV) immune globulin Diphtheria antitoxin Hepatitis B immune globulin Rabies immune globulin Tetanus immune globulin

9. Vaccines and Toxoids (90476-90749 ) Vaccines Vaccination Immunization Toxins Toxoids

10. Psychiatry (90801-90899) Outpatient, inpatient Providers psychiatrist (MD) psychologist (PhD) clinical social workers (LCSW) Modifier 22 Increased procedural services Modifier 52 Reduced services

11. Psychiatry Consultation (99241-99255) Follow-up by consultant office visits (99211-99215) rest home, domicile (99334-99337) home (99347-99350) Transfer of care – new or established pt. Diagnostic psychiatric evaluations (90801-90802)

12. Dialysis Hemodialysis Miscellaneous Dialysis Procedures End-Stage Renal Disease Services (ESRD) Other Dialysis Procedures Age-specific, reported once per month (90951-90962) outpatient; (90963-90966) home services

13. Dialysis Miscellaneous Dialysis Procedures (90945- 90947) Peritoneal dialysis Hemofiltration Patient and helper training (90989-90993)

14. Ophthalmological Services E/M codes (92002-92014) New and Established patients Special Ophthalmological Services

15. Special Otorhinolaryngologic Services (92502-92700 ) Vestibular Function Tests With and without recording Audiologic Function Tests Evaluative and Therapeutic Services Special Diagnostic Procedures Cardiovascular Services

16. Noninvasive Vascular Diagnostic Studies (93880-93990) 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

17. Allergy and Immunology (95004-95199) Allergy Testing Code 95004 allergen testing Code 95010 drug allergy Allergen Immunotherapy Codes 95115-95199 Pulmonary Studies

18. Neurology and Neuromuscular Procedures Sleep testing (95800-95811) sleep studies vs. polysomnography Routine Electroencephalography (EEG) Muscle and Range of Motion Testing Electromyography (EMG) Guidance for Chemodenervation and Ischemic Muscle Testing

19. Neurology and Neuromuscular Procedures Nerve Conduction Tests (95900-95905) Intraoperative Neurophysiology (95920) Autonomic Function Tests (95921-95923) Evoked Potentials and Reflex Tests (95925- 95937) Special EEG Tests Neurostimulators, Analysis-Programming

20. Medical Genetics and Genetic Counseling Services Chromosome Gene Genetics Genetic counseling

21. Hydration Hydration, Therapeutic,Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly complex Drug or Highly Complex Biologic Agent Administration. Time based codes (96360-96361)

22. Non-Chemotherapy Complex Drugs and Substances Infusions – therapeutic, prophylactic or diagnostic Specific to time, technique, substances added, and additional set-up Multiple drugs

23. 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 )

24. Chemotherapy Paracentesis Thoracentesis Peritoneocentesis Intrathecal Ventricular or Intraventricular

25. Physical Medicine and Rehabilitation Treatment plan Problem list Goals Physician review progress each 30 days Progress made – recorded Modify or discontinue therapy

26. Modalities (97010-97039) Supervised 97010-97028 Constant Attendance 97032-97039 Diathermy, Vasopneumatic devices Therapeutic Procedures (97110-97546)

27. Wound Care Management Orthotic Management and Prosthetic Management Active wound care (97597-97606) Not to be reported with (11042-11047) Orthotic management and Prosthetic management Orthotics Prosthetics

28. 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

29. 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

30. Education and Training for Patient Self-Management Education and training Self Management How many in the group? Telephone services – patient, parent, or guardian 24 hours 7 days

31. On-line Medical Evaluation (98969) On-line encounter or other electronic communication mode of the medical kind Includes all services provided

32. 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.

33. Qualifying Circumstances for Anesthesia (99100-99140) All are add-on codes +99100 +99116 +99135 +99140

34. Moderate (Conscious) Sedation Services included with Moderate Sedation (not reported separately) Assessment of the patient Establishment of IV access and fluids Administration of agent Maintenance of sedation Monitoring of oxygen saturation, H.R., BP Recovery

35. Other Services and Procedures 99183 Physician attendance and supervision of hyperbaric oxygen therapy, per session

36. Home Health Procedures/Services Define home setting: Patient’s residence Assisted living apartments Group homes Nontraditional private homes Custodial care facilities or schools

37. Home Health Procedures/Services Prenatal services (99500) Postnatal assessment and follow-up care (99501) Home visit for newborn care and assessment (99502)

38. Home Infusion Procedures/Services Home Infusion Code 99601 – up to 2 hours Code 99602 – each additional hour of infusion

39. Medication Therapy Management Services Performed by a pharmacist Documentation required: Patient history Current medications Recommendations

40. 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

41. 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

42. CPT® Appendices Appendix A – modifiers and description Appendix B – summary of additions and deletions Appendix C – clinical examples Appendix D, E F and G are summary lists Appendix H – go to www.ama-assn.org/go/cpt

43. CPT® Appendices Appendix I – Genetic Testing Code Modifiers Appendix J – Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves Appendix K – products pending FDA approval

44. CPT® Appendices Appendix L – Vascular families Appendix M – crosswalk to deleted CPT® codes Index – back of CPT® Book

45. The End