1. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. 11-1 Chapter 11 Medicine Coding

2. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives LO 11.1 Interpret the guidelines for coding the administration of immunizations. LO 11.2 Apply the guidelines to accurately report injections and infusions. LO 11.3 Determine the correct coding parameters for reporting psychiatric services. 11-2

3. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Learning Objectives (cont.) LO 11.4 Abstract physicians’ notes to accurately report dialysis services. LO 11.5 Identify specifics to correctly report ophthalmology services. LO 11.6 Determine how to accurately report cardiovascular services. 11-3

4. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms Ablation Catheter Duplex scan Immunization Infusion 11-4

5. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Key Terms (cont.) Injection Ophthalmologist Optometrist Otorhinolaryngology Push 11-5

6. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Introduction The Medicine section of the CPT book contains services provided by healthcare professionals that are not listed in any other sections. 11-6

7. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Medicine Section Services reported with codes from the Medicine section: –Flu shots –Vaccinations –Allergy shots –Psychotherapy –Dialysis 11-7

8. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Medicine Section (cont.) –Hearing evaluations –Vision checks –Chemotherapy –Acupuncture 11-8

9. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Immunizations Contain two parts –The administration of the medication –The medication itself Each part is coded separately 11-9

10. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Immunizations (cont.) Medication can be administered via injection: –Percutaneous –Intradermal –Subcutaneous (SC) –Intramuscular (IM) 11-10

11. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Immunizations (cont.) Other routes of administration: –Intranasal (INH) –Oral (ORAL) –Intra-arterial (IA) –Intravenous (IV) 11-11

12. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Injections and Infusions Services included in the code: –Administration of local anesthetic –Initiation of IV –Accessing an indwelling IV, subcutaneous catheter, or port –Flushing the line at completion –All necessary supplies 11-12

13. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Injections and Infusions (cont.) Guidelines –More than one infusion into one IV site: report first service only –More than one IV site used: report services for each site 11-13

14. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Injections and Infusions (cont.) Guidelines –Report different drugs/materials and that service separately –Report infusion time as actual time fluid is provided 11-14

15. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Injections and Infusions (cont.) IV or Intra-arterial push –Injection administered and observed continuously by the health care professional –An infusion that lasts 15 minutes or less 11-15

16. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Injections and Infusions (cont.) Multiple Administrations –Sequencing guidelines are different for reporting physician services than for those reporting for the facility 11-16

17. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Injections and Infusions (cont.) Multiple Administration For physicians –Primary reason must be coded as the initial service 11-17

18. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Injections and Infusions (cont.) Multiple Administrations For facilities 1.Chemotherapy service 2.Therapeutic, prophylactic, and diagnostic services 3.Hydration services 11-18

19. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Injections and Infusions (cont.) Specific service hierarchy: 1.Infusions 2.Pushes 3.Injections 11-19

20. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Psychiatry, Psychotherapy, and Biofeedback Identify the location where services were provided –Office or other outpatient facility –Inpatient hospital or residential care facility 11-20

21. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Psychiatry, Psychotherapy, and Biofeedback (cont.) Identify type of therapy provided –Insight-oriented/behavior modification/supportive –Interactive using play equipment, language interpreter, or other forms of nonverbal communication 11-21

22. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Psychiatry, Psychotherapy, and Biofeedback (cont.) Identify how much time the therapist spent face-to-face with the patient Identify whether any other E/M services were also provided at the same time 11-22

23. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Dialysis Codes for reporting dialysis are based on: Patient’s age The location of services provided The level of physician services during the encounters 11-23

24. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Dialysis (cont.) Services during a dialysis month include: –Determination of dialysis cycle –Outpatient E/M of the dialysis visits 11-24

25. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Dialysis (cont.) Services during a dialysis month include: –Telephone calls –Patient management –Face-to-face visits with the patient 11-25

26. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Dialysis (cont.) Dialysis with diagnosis of ESRD –Codes 90951–90966 represent full month of dialysis and are only reported once a month –Codes 90967–90970 if not a full month; multiply by each day of service 11-26

27. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Gastroenterology Some tests and procedures performed on the gastroenterological system are coded from this section of CPT. 11-27

28. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Ophthalmology The study of the conditions and diseases of the eye NOT for optometry services (e.g., fitting of glasses and contact lenses) 11-28

29. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Ophthalmology Relationship between patient and physician –New patient or established patient Level of service –Intermediate or comprehensive 11-29

30. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Otorhinolaryngologic Services Services pertaining to ears, nose, and throat These codes report special services provided; not normally part of an office visit 11-30

31. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Cardiovascular Services Cardiovascular therapeutic services (92950–92998) Cardiography (93000–93278), including EKG Implantable and wearable cardiac device evaluations (93279–93299) 11-31

32. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Cardiovascular Services (cont.) Echocardiography (93303– 93352) Cardiac catheterization (93451–93462 + 93530– 93533) Electrophysiological procedures (93600–93662) 11-32

33. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Cardiovascular Services (cont.) Cardiac Catheterization –Introduction of the catheter –Positioning and repositioning of the catheter –Recording intracardiac and intravascular pressure 11-33

34. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Cardiovascular Services (cont.) Cardiac Catheterization - Obtaining blood samples - Final evaluation and report of procedure 11-34

35. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Cardiovascular Services (cont.) Electrophysiological Procedures Intracardiac electrophysiologic studies (EPS) –Insertion of electrode catheter 11-35

36. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Cardiovascular Services (cont.) Intracardiac electrophysiologic studies (EPS) –Repositioning of the catheter –Recording of electrograms –Analysis of recorded electrograms –Report of the procedure and findings 11-36

37. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Cardiovascular Services (cont.) Electrophysiological Procedures –Code simultaneous diagnostic EPS and ablation separately 11-37

38. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Noninvasive Vascular Studies Codes 93875–93990 include: Preparation of patient for testing Supervision of performance of tests Recording of study Interpretation and report of findings 11-38

39. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Noninvasive Vascular Studies (cont.) Codes are chosen by the type of study –Noninvasive physiologic –Transcranial Doppler (TCD) –Duplex scan 11-39

40. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Pulmonary Codes 94002–94799 include: The exam and/or laboratory procedure Interpretation and report of findings 11-40

41. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Allergy and Clinical Immunology Codes 95004–95199 Testing to determine allergens Immunotherapy, sometimes called desensitization 11-41

42. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Neurology and Neuromuscular Procedures Codes 95803–96020 include Recording of the test Physician's interpretation and report of findings 11-42

43. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Neurology and Neuromuscular Procedures (cont.) EEG Electroencephalogram EMG Electromyogram EOG Electrooculogram MEG Magnetoencephalography 11-43

44. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Central Nervous System Assessments Testing of cognitive processes to evaluate the extent of the patient’s condition for treatment plan creation 11-44

45. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chemotherapy Administration Codes 96401–96549 include Administration of local anesthetic Initiation of IV Accessing an indwelling IV, subcutaneous catheter, or port 11-45

46. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chemotherapy Administration (cont.) Codes 96401–96549 include Flushing the line at completion Appropriate supplies Preparation of chemotherapy agents 11-46

47. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Physical Medicine and Rehabilitation Codes 97001–97799 Some codes require face-to-face service Knowledge of different modalities is required to correctly code these services 11-47

48. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Acupuncture Codes 97810–97814 Measured in 15-minute increments Many insurance policies now cover these services 11-48

49. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Acupuncture (cont.) Time for face-to-face service only Determine whether electrical stimulation was used 11-49

50. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Osteopathic Manipulative Treatments Codes 98925–98929 Codes defined by number of body regions in the encounter 10 regions 11-50

51. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chiropractic Manipulative Treatment Codes 98940–98943 Codes measured by number of regions treated during the encounter Codes use spinal or extraspinal descriptions 11-51

52. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Education and Training for Patient Self-Management Codes 98960–98962 Teaching patient and/or caregiver to administer treatment properly 11-52

53. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Non–Face-to-Face Nonphysician Services Codes 98966–98969 Qualified nonphysician member of healthcare team provides an assessment or management service 11-53

54. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Special Services, Procedures, and Reports Codes 99000–99091 Services or reports outside the normal realm of a healthcare professional’s responsibilities 11-54

55. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Qualifying Circumstances for Anesthesia Codes are added to the claim form when an anesthesiologist provides services to a patient with certain complications – (+) Add-on codes –Extreme age –Utilization of total body hypothermia –Utilization of controlled hypotension –Emergency conditions 11-55

56. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Moderate (Conscious) Sedation Codes 99143–99150 Code determined by –Age –Length of time –Professional providing sedation 11-56

57. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Home Health Procedures/Services Codes 99500–99602 Healthcare professional other than a physician providing services to a patient at his or her home 11-57

58. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Medication Therapy Management Services For pharmacist intervention for a patient taking multiple medications Documentation needed –Review of the pertinent patient history –Review of medication profile –Specific recommendations for improving patient health outcomes –Recommendations to support patient’s treatment compliance 11-58

59. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Modifiers Modifier 26 needed when services are analyzed by a separate physician than the one who performed the test 11-59

60. Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education. Chapter Summary The variety of services included in the Medicine section emphasizes the fact that finding the correct code begins in the alphabetic index and culminates in the numerical listings. 11-60