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Medical

Billing & Insurance


Coding
Unlocking the Mystery of
CPT Coding
Loretta Pinkowski, Instructor

Insurance Coding Systems Overview

The three main coding systems that are


used within the United States and
throughout most of the world are:
1. Current Procedural Terminology (CPT)
2. International Classification of Diseases,
9th Revision, Clinical Modification (ICD-9CM)
3. Healthcare Common Procedural Coding
System (HCPCS)

What is CPT?
The Current Procedural Terminology
coding system or CPT is a registered
trademark of the American Medical
Association (AMA) and is copyrighted by
the physicians organization.
The code sets are HIPAA compliant for
procedures and services provided by
physicians, ambulatory surgical centers
(ASCs), and hospital outpatient (OP)
services.

The Six Sections of the CPT


Evaluation & Management (E/M)
Anesthesia
Surgery
Radiology/ Nuclear Medicine
Pathology & Laboratory Tests
Medicine

Using the CPT


Read each sections specific

instructions in order to properly code


the procedures contained in a history &
physical report or in a medical chart.
It may be necessary to consult a

medical dictionary for alternate


terminology for a specified procedure.

Using the CPT Index


The Index lists all main procedures by

the procedure done, then (indented


below) by the site of the procedure.
For example- when a surgical report states
that an angioplasty was performed on the
right coronary artery you first look for the
procedure angioplasty in the CPT Index.

Using the CPT Index (cont)


When you find Angioplasty. Look in the

indented section for right coronary artery.


You will find coronary artery, then indented
further is Percutaneuos Transluminal with
codes
92982, 92984.
You should look up any words that do not
match the procedure report OR words for
which you do not know the meaning.

CPT Numeric Section


We now go to the numeric section to

look up the numeric CPT codes given92982- 92984


We see by the heading that we are in
the Medicine section: 92982- 92984
Percutaneuos Transluminal Angioplasty
and Stent Placement.

Double Check
Go back to your report or medical chart

and double check the procedure you


are to code.
Look at the numeric headings and write
the appropriate code on the CMS-1500
claim form or select the appropriate
code from your computers practice
management software program.

Semicolons in the CPT


Some descriptions are subprocedures

of other descriptions. They will be


indented under the main procedure.
To properly understand an indented
procedure, read the description of the
main procedure up to the semicolon (;)
Next, add the remaining description
found in the indented section.

Signs & Symbols used in CPT


***Hint: Look at the bottom of each page
in the numerical section for these signs
& symbols and their definition****
() This code is new to this edition of
CPT
() This code has been revised
(+) Add-on code must be used with
another code; Cannot be used alone

Modifiers
Modifiers more fully describe the

procedure that was performed and alter


the monetary value of the procedure.
Two-digit codes which are added to the
end of CPT codes to denote unusual
circumstances. I.e.: -25 means
significant, separately identifiable E/M
service by the same physician on the
same day as another service.

Most Common Modifiers


-21 Prolonged E/M
-22 Unusual procedure
-24 Unrelated E/M by same physician during

postop period
-25 Additional E/M service on same day as
office procedure by the same physician
-26 Professional Component
-32 Mandated Service
-47 Anesthesia by surgeon

Most Common Modifiers cont


-50 Bilateral procedure
-51 Multiple procedures
-52 Reduced services
-57 Decision for surgery
-59 Additional separately billable

procedure
-62 Two surgeons
-80 Assistant surgeon

Unlisted Codes
Unlisted codes are at the end of each CPT

section and subsection. They are unusual or


new types of services not common enough to
have a code yet. They require a report
attached to the claim to identify exactly what
services or procedures were performed in
order to determine payment.
These codes are selected by body system or
type of service and typically end in a 9.

CPT vs HCPCS
Level I= CPT developed by the AMA
Level II = HCPCS National Codes (A-V)
Additional codes & modifiers to report nonphysician medical services and supplies to
Medicare & Medicaid
Level III = Local HCPCS codes (W-Z)
Codes assigned & maintained by your local
Medicare carriers
HCPCS codes are alphanumeric

Professional Coding Organizations


American Academy of Professional

Coders (AAPC; www.aapc.com)


AAPC is the nation's largest training and
credentialing organization for the business
side of medicine. AAPC certified members
in medical coding and medical auditing
represent the highest level of expertise in
the industry.

Professional Coding Organizations


American Health Information

Management Association
(AHIMA; www.ahima.org)
AHIMA is committed to lifelong learning
in HIM; certification distinguishes an
individual as competent,
knowledgeable, and committed to
quality healthcare through quality
information.

Questions & Answers ?

Classroom Assignment
Count off 1, 2, and 3 and move into

three groups.
Using the CPT coding books provided,
each group will look up the following
procedure or service that corresponds
with the number of your group in the
index and write the proper code from
the numeric section on a piece of paper.

Coding Assignment
1. Manual therapy techniques, 1 or more

regions , each 15 minutes (hintMedicine section)


2. Hips and thighs, liposuction
3. Swine flu shot with administration
(hint- with indicates two codes used)

Answer Key
1. 97140 manual therapy techniques, 1

or more regions , each 15 minutes


2. 15877 - Hips and thighs, liposuction
3. 90663 - H1N1=Swine flu, and 90470Administration