2010

Basic Current Procedural

Terminology
HCPCS Coding
2014 edition

Chapter 2:
Application of the CPT System
2010
Conditions for Inclusion of a Procedure
within CPT
Commonly performed by physicians across the
country
Consistent with contemporary medical practice
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CPT Category IMajor Sections
Evaluation and Management (E/M)
Anesthesiology
Surgery
Radiology
Pathology and Laboratory
Medicine


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Evaluation and Management (9920199499): An overview
Physician visit codes
Consultation codes
Emergency Department Services
Critical Care
Nursing Facility Care
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Anesthesiology
(0010001999)
Anatomic format
Include general, regional, supplementation of local
anesthesia
Includes preop and postop visits, monitoring,
administration of fluids and/or blood
Some insurance carriers use time for
reimbursement
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Surgery (1004069990)
Largest section and most difficult
Note section divided into:
Section (Surgery)
Subsection/category (Urinary system)
Subcategory (Kidney)
Heading (Incision)
Procedure codes (50010)
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Radiology (7001079999)
Four subsections
Diagnostic radiology
Diagnostic ultrasound
Radiation oncology
Nuclear medicine
Most hospitals maintain these codes in
computerized file (chargemaster)
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Pathology and Laboratory
(8004889399)
Most hospitals maintain codes in computerized
file (chargemaster)
Physicians maintain list of common procedures
performed (superbill or computer file)

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Medicine (9028199199)
Specialized section
Types of codes
Psychiatric services
Physical therapy
Ophthalmological services
Cardiac catheterization
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Category II Codes
Added in 2004
Performance measurements
For data collection
End with letter F
Use is optional
Example:
4002F Statin therapy, prescribed
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Category III Codes
Emerging technology
Alphanumeric codes
Used for data collection
Temporary
Updates available on AMAs Web site
Payment depends on the payer

Example:
0085T Breath test for heart transplant rejection
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Format: Conventions and Characteristics of
CPT
Stand alone and
semicolon ( ; )
Bullet
Triangle
Facing triangles
Plus sign +


Circled bullet
Null Symbol
Pending FDA Approval
Symbol
# Resequenced Code

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Symbols: Stand Alone and Semicolon
Example

37600 Ligation; external carotid artery
37605 internal or common carotid artery

Code 37600 stands alone, meaning it needs no
interpretation.
Because code 37605 is indented, it relies on the
description before the semicolon in the preceding entry
to complete the code description.
Therefore, Code 37605 reads as:
Ligation; internal or common carotid artery


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Symbols: Bullet

Indicates a new code for the current year
Listed in Appendix B

Example:

46707 Repair of anorectal fistula with plug (eg,
porcine small intestine submucosa
[SIS])
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Symbols: Triangle

Indicates a revised code for the current year
Listed in Appendix B

Example:
21555 Excision, tumor, soft tissue of neck or
anterior thorax, subcutaneous; less
than 3 cm
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Symbols: Facing triangles

Indicates new or revised text
Used throughout CPT

Example: appears after code 39502
(For laparoscopic paraesophageal hernia repair,
see 43281, 43282)
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Symbols: Plus sign +

Designed as an add-on code
Must be used in addition to the primary procedure code
Summary of codes in Appendix D

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Symbols: Plus SignExample
11200 Removal of skin tags, multiple
fibrocutaneous tags, any area; up to and
including 15 lesions
+ 11201 each additional ten lesions, or part
thereof (List separately in addition to
code for primary procedure)

Note: 11201 is used in conjunction with 11200.
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Symbols: Null Symbol
Exemption to modifier 51
Alerts coders to the fact that the code cannot be
appended with modifier 51
Applies to physician coding only
All exempt codes listed in Appendix E

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Symbols: Null Symbol


Example
17004 Destruction (eg. laser surgery,
electrosurgery, cryosurgery, surgical
curettement), premalignant lesions (eg.
Actinic keratoses), 15 or more lesions
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Symbols: Circled bullet

Indicates that CPT code includes conscious sedation as
an inherent part of providing the procedure

Example: 33010 Pericardiocentesis; initial

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Symbols: Pending FDA Approval Symbol


Identifies codes for vaccines that are pending FDA
approval

Example:
90650 Human Papilloma virus (HPV) vaccine,
types 16, 18, bivalent, 3 dose schedule, for
intramuscular use
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Symbols: # Resequenced Code
CPT codes do not appear in numeric sequence
For example:

46221 Hemorrhodectomy; internal, by rubber band ligation(s)
#46945 Hemorrhoidectomy, internal, by ligation other than rubber
band; single hemorrhoid column/group
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Unlisted Procedure
Allows the coder to assign a code to a procedure not
listed in CPT
Assigned as a last resort
Payers want documentation (operative report)

Note: The Alphabetic Index lists all unlisted procedures.
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Appendices
Appendix A: List of modifiers
Appendix B: Summary of additions, deletions, and
revisions
Appendix C: Clinical examples for E/M coding
Appendix D: Summary of add-on codes
Appendix E: Summary of CPT codes exempt from
modifier 51
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Appendices - continued
Appendix F: Summary of CPT Codes exempt from
modifier 63
Appendix G: Summary of CPT Codes which include
conscious sedation
Appendix H: Alphabetic index of performance
measures by clinical condition or topic
Appendix I: Genetic testing code modifiers

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Appendices - continued
Appendix J: Electrodiagnostic medicine listing of
sensory, motor and mixed nerves
Appendix K: Product pending FDA approval
Appendix L: Vascular families
Appendix M: Crosswalk for deleted CPT codes
Appendix N: Summary of Resequenced CPT codes

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Index
First step for locating a code
Alphabetic list
Main terms in bold print
Subterms indented
Never code directly from the index
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Health Record Documentation
CPT-4 and ICD-9-CM codes reported on the health
insurance claim form or billing statement must be
supported by the documentation in the health
record
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Abstracting
Look for key action terms
Excision
Biopsy
Removal
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Coding References
CPT Assistantauthoritative reference
CMS Medicare/Medicaid Transmittals
Contains payer advice
Can be confusing if it contradicts CPT guidelines
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Coding Skills
Abstracting
documentation
Use of CPT
Accurate
code assignment
Knowledge of payer
guidelines and NCCI
Use of software
and resources