CPT

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CPT

• Current Procedural Terminology
• Fourth Edition

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Background

• A systematic listing and coding of procedures and
  services performed by the M.D.
• Each CPT is five-digits.
• By using this system, the procedure or service
  rendered is accurately identified.

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LayoutSix Sections

• Evaluation and Management
• Anesthesiology
• Surgery

• Radiation
• Pathology and Laboratory
• Medicine (except Anesthesiology).

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Evaluation and Management

• A.k.a. EM codes
• 99201 to 99499
• Think TIME and COMPLEXITY.

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Anesthesiology

• 00100 to 01999 plus any required modifiers (we
  will talk about those later).
• Time begins when anesthesiologist preps patient
  until he/she leave patient in postop.

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Surgery

• 10040 to 69990
• Code the procedure
• Does not include complications or follow-ups
• Supplies outside of normal can be coded
  separately.

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Radiology

• 70010 to 79999
• Does not include Nuclear Medicine or Diagnostic
  Ultrasound.

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Pathology

• 80049 to 89399
• Provided by MD or technologist under the
  supervision of MD.
• Includes drug testing, chemistries, UA,
  mircobiology, surgical pathology, etc.

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MedicineExcept Anesthesiology

• 90281 to 99199

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So how does it work?

• We will start with EM codes or Evaluation and
  Management.
• Most widely used in MD office.
• Always found in the front of the CPT book.
• Always need to consider several things

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Things to consider with EM

• Place of service
• Content of service (what is being done, for
  instance is it an office consultation)?
• Nature of problem
• Time required to deliver the care needed

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Terms to Remember

• New Patient
• Established Patient

• Chief Complaint
• Concurrent Care

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Levels of EM ServicesDescriptors

• History
• Examination
• Medical Decision Making
• Counseling
• Coordination of Care
• Nature of Problem
• Time

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The first three are the Key

• History
• Examination
• Medical Decision Making

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Although the others are important to deciding
which CPT code to use, they are considered
contributory and are not required to be
provided to all patients.
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Lets start with History Four types

• Problem focused CC, and brief HPI.
• Expanded problem focused CC, brief HPI and
  problem pertinent system review.
• Detailed CC, extended HPI, problem pertinent
  system review (limited number of systems) and
  pertinent past, family/social hx.

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Lastly.

• Comprehensive CC, extended HPI, ROS directly
  related to the problem(s), review of all
  additional body systems, complete past, family
  and social hx.

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Second of the KeyExamination

• Problem focused limited to affected area or
  organ
• Expanded problem focused Affected organ or area
  plus other symptomatic/related organ systems.
• Detailed Extended exam of affected body area and
  other related systems
• Comprehensive General multi-system exam

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Third aspect of the KeyMedical Decision Making

• The number of possible diagnoses and/or the
  number of mgmt options to be considered.
• The amount of and/or complexity of medical
  records, dx. Tests and other information that has
  to be reviewed/analyzed
• and..

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Lastly...

• The risk of significant complications,
  morbidity/mortality.

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Decision Making 4 levels

• Straight forward
• Low complexity
• Moderate complexity
• High complexity

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A few examples

• New Patient seen in the Office

• You have five choices
• 99201
• 99202
• 99203
• 99204
• 99205

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So what decides?

• The three keys we discussed earlier history,
  exam and decision making required.
• Look at 99201. You are told that in order to use
  this code you must have problem focused hx.,
  problem focused exam and straightforward decision
  making. Time 10 minutes usually.

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An Uprising!

• As the detail and complexity of the visit
  increase, so does the timeso your code will
  change.
• For instance if we had a comprehensive hx.,
  comprehensive exam, and medical decision making
  of moderate complexity (time on average 45
  minutes) our code would be 99204.

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Remember!

• These are codes for a NEW patient that is being
  seen in the MD office.
• Different EM codes are used based on the place
  of service and if the patient is new or
  established.

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How about the hospital?

• Observation patients usually stay less than 24
  hours and if available, are on an observation
  unit.
• Also consider if they are inpatient or
  outpatient.
• Initial visit by MD or subsequent visit?
• Discharge or admission?

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Had enough for today?

• Six sections
• Identified by a range of numbers
• Five digit code plus any applicable modifiers
• EM at front.
• History, exam, decision making