Procedural Coding: Introduction to CPT Chapter 5 Lecture 1

1. 5 Procedural Coding: Introduction to CPT Chapter 5 Lecture 1

2. 5-2 Learning Outcomes When you finish this chapter, you will be able to: 5.1 Discuss the purpose of the CPT code set. 5.2 Describe the organization of the index, the main text, and the appendixes in CPT. 5.3 Summarize the format and seven of the symbols that are used in CPT. 5.4 Describe the purpose and correct use of CPT modifiers. 5.5 List the six general steps for selecting correct CPT procedure codes. 5.6 Explain how the key components are used as the basis for selection of CPT Evaluation and Management codes.

3. 5-3 Learning Outcomes (Continued) When you finish this chapter, you will be able to: 5.7 Describe the purpose and the physical status modifiers used in the Anesthesia section of CPT Category I codes. 5.8 Recognize the concepts of the surgical package and of separate procedures in the Surgery section of CPT Category I codes. 5.9 State the purpose of the Radiology section of CPT Category I codes. 5.10 Describe the correct use of codes for laboratory panels in the Pathology and Laboratory section of CPT Category I codes.

4. 5-4 Learning Outcomes (Continued) When you finish this chapter, you will be able to: 5.11 Explain why two codes from the Medicine section of CPT Category I codes are reported for immunizations. 5.12 Compare the purpose of Category II and Category III codes.

5. 5-5 Key Terms • E/M codes (evaluation and management codes) • fragmented billing • global period • global surgery rule • key component • modifier • outpatient • panel • physical status modifier • primary procedure • add-on code • ancillary services • bundling • Category I codes • Category II codes • Category III codes • conscious sedation • consultation • Current Procedural Terminology (CPT) • descriptor

6. 5-6 Key Terms (Continued) • unlisted procedure • professional component (PC) • resequenced • secondary procedure • section guidelines • separate procedure • special report • surgical package • technical component (TC) • unbundling

7. 5-7 5.1 Current Procedural Terminology,Fourth Edition (CPT) • Procedure codes for physicians’ and other health care providers’ services are selected from the Current Procedural Terminology code set • Category I codes—five-digit procedure codes found in the main body of CPT • Each code has a descriptor—a brief explanation of the procedure • Category II codes—optional CPT codes that track performance measures • Category III codes—temporary codes for emerging technology, services, and procedures

8. 5-8 5.2 Organization • CPT contains the main text, which has six sections of Category I codes: • Evaluation and Management • Anesthesia • Surgery • Radiology • Pathology and Laboratory • Medicine • Category II and Category III codes have 14 appendixes and an index

9. 5-9 5.2 Organization (Continued) • Section guidelines—usage notes at the beginnings of CPT sections • Unlisted procedure—service not listed in CPT • Special report—note explaining the reasons for a new, variable, or unlisted procedure or service