Chapter 8: Introduction to CPT

Use Appendix A of the CPT manual to list the correct two-digit modifier in the following example: Bilateral inguinal herniorrhaphy

-50

Use Appendix A of the CPT manual to list the correct two-digit modifier in the following example: Multiple procedures performed during the same surgical session.

-51

Use Appendix A of the CPT manual to list the correct two-digit modifier in the following example: A decision to perform surgery is made during an evaluation and management service on the day before or the day of surgery.

-57

Using Appendix A of the CPT manual answer the following: 1. What is the two-digit modifier that indicates two primary surgeons? 2. If the CPT code is 43820 (gastrojejunostomy without vagotomy) and two primary surgeons performed the service, the service could be stated this way: __________, by each surgeon

-62 43820-62

Use Appendix A of the CPT manual to list the correct two-digit modifier in the following example: A surgical team is required.

-66

Use Appendix A of the CPT manual to list the correct two-digit modifier in the following example: A post-operative ureterotomy patient has to be returned to the operating room (unplanned) for a complication related to the initial procedure during the post-operative period.

-78

Use Appendix A of the CPT manual to list the correct two-digit modifier in the following example: Physician A actively assists physician B during a surgical procedure.

-80

The first CPT was published in this year:

1966

The first edition of the CPT was published in what year?

1966

In which year were CPT codes incorporated as Level codes into the Healthcare Procedure Coding System (HCPCS)?

1983

Name the box location on the CMS-1500 form for CPT/HCPCS codes?

24D

Locate the following main terms in the CPT manual index, and then locate the subterms and secondary subterms and fill in the code(s) you find there: Main term: Femur Subterm: Abscess Secondary subterm: Incision

27303

Locate the following main terms in the CPT manual index, and then locate the subterms and secondary subterms and fill in the code(s) you find there: Main term: Fracture Subterm: Ankle Secondary subterm: Lateral

27786, 27814

Locate the following main terms in the CPT manual index, and then locate the subterms and secondary subterms and fill in the code(s) you find there: Main term: Repair Subterm: Abdomen Secondary subterm: Suture

49900

Surgery Unlisted procedure; middle ear: code? Arthroscopy: code? Esophagus: code?

69799 29999 43499

Therapeutic radiology clinical treatment planning, code?

77299

Therapeutic radiology treatment management, code?

77499

Clinical brachytherapy, code?

77799

Radiology Unlisted procedure; clinical brachytherapy: code? Unlisted miscellaneous procedure; diagnostice nuclear medicine: code?

77799 78999

Urinalysis, code?

81099

Pathology and Laboratory Unlisted procedure; cytogenetic study: code? urinalysis procedure: code? chemistry procedure: code?

88299 81099 84999

Surgical pathology procedure, code?

88399

Dialysis procedures, inpatient or outpatient, code?

90999

Allergy/clinical immunological service, code?

95199

Special dermatological service, code?

96999

What is the code listed in the Medicine Guidelines that is to be used to identify materials supplied by the physician that are beyond those ordinarily included in the service provided?

99070

Medicine Unlisted special service, procedure, or report: code?

99199

Write the definition of a chief complaint using the E/M Guidelines.

A concise statement describing the symptom, problem, condition, diagnosis, or other factor that is the reason for the encounter, usually stated in the patient's words.

The CPT manual was developed by the ______

AMA

What organization first published the CPT coding system?

AMA

✚ means?

Add-on

Appendix D

Add-on codes

There are six index location methods presented in Chapter 8. List any four of the methods.

Anatomic site Condition or disease Synonym Abbreviation

What appendix are modifiers located in?

Appendix A

Where is the complete list of additions, deletions, and revisions located in the CPT manual?

Appendix B

What appendix are clinical examples located in?

Appendix C

Which CPT manual appendix contains a complete list of add-on codes?

Appendix D

Which CPT manual appendix contains a complete list of all modifier -51 exempt codes?

Appendix E

▶◀ (horizontal triangles) mean?

Beginning and end of text changes

What would providers enter on the insurance form to show payers which services or procedures were performed?

CPT codes and/or HCPCS codes

Providers are reimbursed for the procedures and services rendered based on what codes?

CPT, HCPCS

What type of CPT codes have four numbers followed by a letter?

Category III Codes

CPT

Coding system developed by the American Medical Association.

CPT stands for ____________

Current Procedural Terminology

Guidelines that are applicable to all codes are found at the beginning of what?

Each section

Description: Emergency Department Services, Physician Direction of Advanced Life Support. Main Term: ? Code: ?

Emergency 99288

What does the symbol of a circle with a line through it (Ø) placed before a CPT code indicate about the code?

Exemption to modifier -51

Condition/Disease: Intertrochanteric femoral fracture (closed treatment). Main Term: ? Code: ?

Fracture 27238

A common, concise coding system is required by what law?

HIPAA

A standard for communicating health care data, as represented in CPT, was necessary to address requirements of this 1996 act:

Health Insurance Portability and Accountability Act

What type of code has only a portion of the code description?

Indented code

O (circle) means?

Indicates a reinstated or recycled code in Category III of CPT

# (number sign) means?

Indicates an out-of-numerical sequence code

◉ (bull's eye) means?

Moderate (conscious) sedation included

Appendix E

Modifier -51 exempt

Ø means?

Modifier -51 exempt

Appendix F

Modifier -63 Information on Infants <4 kg

Appendix K

Modifier -63 Information on Infants <4 kg

● (bullet sign) means?

New

The updated CPT manual is available for purchase in what month?

November

ϟ (lightning bolt) means?

Pending FDA approval status

Guidelines

Provides specific instruction about coding for each section of the CPT manual.

You would expect to find the CPT code 71045 in what section of the CPT manual?

Radiology

Procedure: Removal of gallbladder calculi by means of an open procedure. Main Term: ? Code: ?

Removal, Calculi 47480

Anatomic site: Lung, bullae excision. Main Term: ? Code: ?

Resection 32141

▲(triangle) means?

Revised procedure description

; (semicolon) is used to?

Save space

Locate the abbreviation "ANA" in the CPT index. The entry you find is......

See Antinuclear Antibodies (ANA)

Locate the term "Renal Disease Serivces" in the CPT index. You are directed to.....

See Dialysis

Locate the term "Arm" in the CPT index. You are directed to.....

See Radius; Ulna; Wrist

How many sections are in the CPT manual?

Six

Symbols

Special guides that help the coder compare codes and descriptors with the previous edition of CPT.

What is the report called that a physician dictates to show that an unusual or rare procedure is performed?

Special reports

What type of code has the full code description?

Stand-alone code

Category II

Supplemental codes used for performance measurements.

With a CPT manual open to the page that contains 30100, locate the following information for the 30100 code: Section: Subsection: Subheading: Category:

Surgery Respiratory System Nose Excision

Single codes displayed in the CPT index should be verified in the ___________ portion of the CPT manual to ensure accuracy.

Tabular

Category III

Temporary CPT codes.

What association publishes the CPT?

The American Medical Association

When you see the symbol ▲ in front of a code, you know what about the code?

The code has been changed or modified

What symbol indicates that the description for a code has changed?

Triangle

Symbols with definitions are located at the bottom of the page in the CPT manual; True or False?

True

A procedure or service not found in the CPT manual may be coded as what?

Unlisted procedure

Under whose supervision are the Pathology and Laboratory services provided?

a physician

Words following the semicolon in stand-alone codes can indicate the following three things:

alternative anatomic site, alternative procedure, or description of the extent of service.

According to the Surgery Guidelines, surgical destruction is a part of a surgical procedure and _________ methods of destruction are not ordinarily listed separately.

different

The use of a coding system allows you to communicate not only quickly, but also __________

exactly

According to the Radiology Guidelines, who must sign a written report to have the report considered part of the radiologic procedure?

interpreting physician

Providers of health care are paid based on the codes submitted for _____________ or procedures provided to the patient.

services

Reporting a Category III code requires a(n) ____________________________ to accompany the claim.

special report

Before assigning an indented code, refer to the preceding......

stand-alone

Describe a stand-alone code

those codes that have full description

Describe an indented code

those codes that include their own description as well as that portion of the stand-alone code description found before the semicolon in a preceding code.

A category III code would be reported rather than a Category I______ code.

unlisted

Special reports must be submitted with claims for procedures that are unusual, new, seldom used, or use Category I______ codes or Category ________ codes.

unlisted, III