Chapter 28 Cpt Coding

Medical coding after 1976 became the standard for health care providers to set cost and bill for procedures based on the ICD codes. The ICD codes are taken from the different sources within patients’ health care record, physician notes, lab results, x-rays. Procedures performed on body parts are all taken into consideration when assessing a value for services rendered. The fees associated with each procedure are regulated by the U.S. Department of Health and Human Services and by state governments. Before this system of billing, physicians charged whatever they thought was appropriate and in many instances bartered for their services. (Department Health and Human Services, 1998)

Under the references comes the 3M Coding Reference Plus, and it contains AHA Coding Clinic for HCPCS, Coders’ Desk Reference for Procedures by Optum, Anesthesia Crosswalk, Faye Brown’s ICD-9-CM Coding Handbook, and ICD-10-CM and ICD-10-PCS Coding Handbook. The References include introductions, changes in the ICD coding, and guidelines for coders to find and better understand the coding process. For example, the Anesthesia section provides the section of the surgery and next to it the section where the right code can be assigned. Then, the Coding Clinic for HCPCS provide some articles and questions with their answers related to coding and the changes to some codes. These references are crucial in the coding sector, especially with the changes that occur on some codes and modifiers. Coders should be aware of the references and use them to avoid intention and non-intention mistakes, frauds or abuse.

The five-character cpt codes are used by insurers to help determine the amount of reimbursement that a practitioner .

Part 1: Discuss the necessity of understanding the interaction of the CPT procedural codes and the ICD diagnostic codes.

These procedures would only be reported as additional procedure numbers that would QUALIFY an anesthesia service.

In society today patient encounters take place in a variety of different settings. Evaluation and Management codes (E/M) describe a patient encounter with a physician and are the most frequently used codes that adhere to unique criteria. The criteria are to identify the settings, patient type and level of service. In the CPT Manual E/M codes are located in the front of the book and are broken down by divisions which are known as categories and subcategories. The categories are the first level of division because they identify the location of where the service took place such as a hospital visit, office visit and consultation. The subcategories identify the type of service rendered depending on the patient type if they are new or established, age and frequency. Also the subcategories are classified into levels of services that are identified by specific codes. It is by utilizing this classification that one is able to determine the nature of the work by the service type as well as place and patient status.

Healthcare providers use Current Procedural Terminology (CPT) codes for communicating what services was rendered to the patient, to insurance companies for billing purposes. CPT category 1 codes are codes that relate to the services and procedures rendered to patient's primarily in an outpatient facility. Category 1 codes are updated yearly and are for procedures that are consistent with medical practices and procedures widely performed. Category 1 CPT codes are sectioned into six categories which include evaluation and management (EM), anesthesiology, surgery, radiation, pathology/laboratory, and medicine. CPT category 2 codes are codes that are used to communicate services rendered performance measurements and is also updated yearly.

According to www.aapc.com “Medical coding is the transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical alphanumeric codes” (What is medical coding, n.d.) Since careers in the field of medical coding is rapidly growing most people would assume that it is a newer practice. However, medical coding’s foundation dates to around the 17th century. Today, the world of medical coding is still changing and evolving just as much as it was years ago. Some of the most commonly used code sets used today are ICD-10CM, CPT, and HCPCS.

CPT stands for Current Procedural Terminology. A modifier gives complete detail to a procedure/service that was performed but does not change the code or definition. They are also used so that healthcare professionals can answer the payment policy requirements that are established by other "entities". In the book CPT 2017 Standard book under Appendix A on page 515, you will find the modifiers and the full detail of each one. There are Modifiers, Anesthesia Physical Status Modifiers, Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use. The ASC Hospital Outpatient Use has CPT codes for CPT Level I Modifiers , Category II Modifiers, Level II (HCPCS/National) Modifiers. Category II Modifiers can only be reported with

- The visit was reported by assigning a CPT code for a new patient’s office visit that involves a significant amount of work by the physician. By definition, this code states that a physician provided a comprehensive history, a comprehensive examination, and medical decisions of moderate complexity.

With the implementation of the ICD-10 coding system, many problems and challenges have arisen. Teaching the physicians and other medical staff how to correctly code with the new system has been first and foremost a problem. Also, if medical coders don’t have the correct codes marked, they can just revert to the “non-specific” code, and this will eventually throw off their collected data and could possibly hamper their efforts for full reimbursement.

Good job Jerica I agree we will code them as a bundle. Surgical endoscopy includes diagnostic endoscopy when coding. A modifier is use when

When describing the seven different characters of the ICD-10-PCS codes will define for each one, for open approach is defines as cutting through the skin or the mucous membrane or any other body layers that is necessary of the site of the procedure. The procedure that are performed by an opening will have an approach that have a fifth character that value 0. The access location for the approach is either the skin or a mucus membrane or any type of instrumentation that are used is not applicable.

That is great Madelyn, I completely agree with you about it being bundled with but charged as a surgical code only. But one question for you what's the difference between diagnostic endoscopy and

Under unusual circumstances, general anesthesia may be performed for procedures that typically require local or regional anesthesia or no anesthesia at all. The modifier “23” should be submitted with the appropriate procedure code to report unusual anesthesia. This modifier should not be reported with procedure codes that include the term “without anesthesia” in the description or for procedures that are normally performed under general anesthesia. The payer will review unusual anesthesia