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Chapter 18

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  1. Chapter 18 CPT Medicine

  2. CPT Medicine Section • Classifies diagnostic and therapeutic procedures and services • Noninvasive • No surgical incision or excision • Minimally invasive (e.g., percutaneous access) • Last section of CPT (continued)

  3. CPT Medicine Section Procedure-oriented (e.g., immunizations) Applies to various medical specialties (e.g., gastroenterology, ophthalmology) Applies to different types of health care providers (e.g., physical therapists [PTs], occupational therapists [OTs])

  4. Medicine Section Guidelines • Provide instruction about: • Multiple procedures • Add-on codes • Separate procedures • Subsection information • Unlisted service or procedure • Special report • Materials supplied by physician

  5. Instructional Notes Unique to subsection Provide coding clarification and direction

  6. Multiple Procedures When performed on same date, report separate code for each procedure and/or service

  7. Add-On Codes Reported for procedures and services performed in addition to primary procedure Do not add modifier -51 (multiple procedures) to add-on codes

  8. Separate Procedures Considered integral component of complete procedure Identified by description “separate procedure” Only report “separate procedure” code in addition to code for comprehensive procedure if “separate procedure” is performed independently (continued)

  9. Separate Procedures Modifier -59 (distinct procedural service) When “separate procedure” is performed independently from other services, add modifier -59 to “separate procedure” code

  10. Bundled Medicine Codes • Use OCE or NCCI software to identify bundled codes • Unbundling • Reporting component codes in addition to major procedure code • Fraud

  11. Unlisted Service Assigned when no specific code describes procedure performed Submit written report that describes procedure

  12. Special Report • Submitted when unlisted procedure is reported • Includes: • Adequate description of nature, extent, and need for procedure or service • Time, effort, and equipment necessary to provide service (continued)

  13. Special Report • Additional items that may be documented: • Complexity of symptoms • Concurrent problems • Diagnostic and therapeutic procedures • Final diagnosis • Follow-up care • Pertinent physical findings

  14. Material Supplied by Physician Supplies other than those typically included with a procedure or service are reported separately.

  15. Medicine Subsections • Immunization administration • Report these codes in addition tovaccine/toxoid codes

  16. Reporting E/M Codes with Immunizations E/M service must exceed services included with immunization administration codes Add modifier -25 to E/M code to identify “significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service”

  17. Hydration, Therapeutic, Prophylactic, and Diagnostic Injections • The following services are not separately coded and reported: • Administration of local anesthesia • Intravenous (IV) insertion • Access to catheter, IV, or port • Routine syringe, tubing, and other supplies • Flushing performed upon completion of infusion

  18. Coding Tips • When multiple injections or infusions or combination services are provided, report initial code just once • Exceptwhen two, separate IV sites are required • When length of infusion time is included in code description, report code based on actual infusion time

  19. Hydration • Review for documentation that physician supervised the following: • Patient assessment • Patient consent • Patient safety • Staff who provided infusion services

  20. Coding Tips Placement of peripheral vascular access devices is integral to vascular infusions. Codes for placement of these devices are not separately reported. Administration of IV fluids to maintain line patency is not separately coded and reported.

  21. Psychiatric Procedures • A complete mental status examination includes: • Orientation to time, place, and person • Recent and remote memory • Attention span and concentration • Language • Fund of knowledge • Mood and affect

  22. Biofeedback Reviewing patient history Preparing biofeedback equipment Placing electrodes Reading and interpreting responses Monitoring the patient Controlling muscle responses

  23. Coding Tip When individual psychotherapy and group psychotherapy services are provided on the same date to the same patient, report a code for each service provided.

  24. Dialysis • Subsection includes the following headings: • End-stage renal disease (ESRD) services • Hemodialysis • Miscellaneous dialysis procedures

  25. Hemodialysis Filters waste from patient's blood; blood leaves body via an artery, is filtered, and then returned into a vein

  26. Coding Tips All E/M services related to ESRD and rendered during dialysis are included in the dialysis procedure code. An E/M service related to ESRD performed on the day of dialysis is not separately coded and reported.

  27. Cardiovascular • Subsection includes the following headings: • Therapeutic services and procedures • Cardiography • Echocardiography • Cardiac catheterization • Intracardiac electrophysiological studies • Peripheral arterial disease rehabilitation (continued)

  28. Cardiovascular • Subsection includes the following headings: • Noninvasive physiologic studies and procedures • Other procedures

  29. Electrocardiogram Shows disruptions of heart rhythms A - Paroxysmal atrial tachycardia (PAT) B - Atrial fibrillation C - Ventricular fibrillation

  30. Echocardiography Large area of red shows flow of blood through abnormal opening between aorta and right atrium

  31. Therapeutic Services • The following therapeutic procedures should be reported in addition to cardiac catheterization codes: • Cardiopulmonary resuscitation (CPR) • Transcutaneous pacing • Cardioversion • Circulatory assist procedures • Thrombolysis (continued)

  32. Therapeutic Services • The following therapeutic procedures should be reported in addition to cardiac catheterization codes: • Transcatheter placement of stents • Percutaneous transluminal coronary angioplasty (PTCA) • Atherectomy

  33. Cardiac Catheterization • Fluoroscopic guidance procedures are integral to invasive intravascular procedures and are not separately coded and reported. • Percutaneous coronary artery interventions include: • Stent placement • Atherectomy • Balloon angioplasty (continued)

  34. Cardiac Catheterization • For a given coronary artery and its branches, report only the most complex intervention • Regardless of the number of stent placements, atherectomies, or balloon angioplasties performed in that coronary artery and its branches

  35. Cardiac Catheterization • Do not add modifier -59 to codes reported for percutaneous coronary artery stent placement, atherectomy, or balloon angioplasty • Review documentation to determine: • Catheter placement • Injection procedure • Supervision and interpretation (continued)

  36. Cardiac Catheterization Once catheter is inserted into heart, contrast medium is injected, and an angiogram is performed to detect coronary vessel patency (openness)

  37. Allergy Testing When percutaneous or intracutaneous single tests are performed on the same date as other “sequential and incremental” tests, report codes for both tests if the tests were performed for different allergens. Allergy testing is not usually performed on the same day as allergy immunotherapy.

  38. Allergy Testing When a single test for an antigen is positive, and sequential tests with three additional, different dilutions of the same antigen are performed, report one code for the single test and separate codes for the sequential tests.

  39. Allergy Testing When allergy testing is an integral part of rapid desensitization kits, do not separately code and report the allergy testing.

  40. Scratch Test Allergens placed on skin; skin scratched; allergen labeled Reactions usually occur within 20 minutes; for example, reaction to ragweed

  41. Neurology and Neuromuscular Procedures Sleep studies Routine electroencephalography (EEG) Muscle and range of motion testing Electromyography and nerve conduction test Intraoperative neurophysiology Autonomic function tests (continued)

  42. Neurology and Neuromuscular Procedures • Evoked potentials and reflex tests • Special EEG test • Neurostimulator • Analysis-programming • Motion analysis • Functional brain mapping

  43. Chemotherapy Administration Oral Implantation of catheter port into central vein or body cavity Infusion or injection of IV chemotherapy into vein (continued)

  44. Chemotherapy Administration Injection of intramuscular (IM) chemotherapy into muscle Injection of subcutaneous (SQ) chemotherapy under skin

  45. Special Dermatological Procedure • Performed in addition to E/M service • Photodynamic therapy • Ultraviolet (UV) light • Goeckerman treatment (UV-B light) • Psoralen ultraviolet A (PUVA) • Goeckerman and/or PUVA treatment for at least four to eight hours • Laser treatment

  46. Physical Medicine and Rehabilitation (PT, OT ) Physical Therapy (PT) and Occupational Therapy (OT) evaluations Modalities under supervision Therapeutic procedures Active wound care management Tests and measurements Orthotic and prosthetic management

  47. Medical Nutrition Therapy Type of assessment Individual or group therapy Length of time

  48. Osteopathic Manipulative Treatment Provider who performs osteopathic manipulative treatment (OMT) cannot separately report anesthesia services for OMT Codes include pre-manipulation patient assessment

  49. Chiropractic Manipulative Treatment • Additional E/M services may be reported separately by adding modifier -25 • If patient’s condition requires separate E/M service beyond usual preservice and postservice work

  50. Education and Training for Patient Self-Management • Qualified, non-physician health care professional who uses standardized curriculum • 97802 • Initial assessment and intervention, individual patient, face-to-face for 15 minutes • 97803 • Reassessment and intervention, individual patient, face-to-face for 15 minutes (continued)