CPT CODING

1
CPT CODING

• Current Procedural Terminology

2
Charge Master

• After charge master review, several codes not
  being used
• Code not on green charge sheet?
• May charge and E and M and Procedure
• Increases reimbursement
• Fee for Service vs Capitation

3
How to Bill EM With Procedure

• If you are seeing a patient to follow up on their
  hypertension and during the visit the patient
  asks if you could take a look at a skin tag. If
  during this visit you remove the skin tag you can
  charge for an EM visit as well as for the
  removal of a skin tag. The EM would be for the
  hypertension and the skin tag removal for the
  skin tags.

4

• In the previous case there were 2 CPT codes being
  billed and 2 diagnosis.
• 99213 Level 3 office visit attached to the
  diagnosis of Hypertension
• 11200 Skin tag removal, up to 15, attached to
  diagnosis skin tag.

5
25 Modifier

• In this case when billing you would attach a
  modifier of 25 to the EM service.
• Modifier 25- Significant, Separately Identifiable
  Evaluation and Management Service by the Same
  Physician on the Same Day of the Procedure or
  Other Service

6
Modifier 25 Cont.

• You do NOT need to have different diagnosis in
  order to bill an EM and procedure
• If the EM service was prompted by the symptom or
  condition for which the procedure was provided
  you do not need to have different diagnosis for
  billing.

7
PROCEDURES

• Shaving Lesion
• Excision of Benign Lesion
• Excision of Nail
• Trigger Point Injection
• Tendon Injection
• Finger Splint Application
• Anoscopy

8
CONT.

• Unna Boot Application
• Strapping Toes
• Vaginal PH
• Consult
• Preventative Medical Exam

9
OFFICE CONSULT

• Not listed on green sheet
• 99241-99245
• New or Established Patient
• Most done in our office would be pre-op
  physicals.
• Note level of consult you would like charged on
  bottom of green sheet.

10
PREVENTIVE MED

• Most insurance pay for a yearly preventive
  medical exam.
• Yearly Physical
• Primary Diagnosis must be
• Routine Exam
• Annual Exam
• Well Child Exam

11
CONT

• Charge must be Preventive Medical Exam
• Located at bottom of green sheet, 1st column

12
REIMBURSEMENT

• OFFICE CONSULT
• 99241 63.75
• 99242 85.00
• 99243 114.75
• 99244 167.45
• 99245 208.25
• OFFICE VISITS
• 99211 21.25
• 99212 34.00
• 99213 52.70
• 99214 80.75
• 99215 113.90

13
PREVENTIVE MED

• 99391 (UNDER 1 YEAR) 80.75
• 99392 (1-4 YEARS) 80.75
• 99393 (5-11 YEARS) 80.75
• 99394 (12-17 YEARS) 89.25
• 99395 (18-39 YEARS) 89.25
• 99396 (40-64 YEARS) 97.75
• 99397 ( 65 AND OLDER) 106.25

14
JUST A FEW REMINDERS

• A DIAGNOSIS MUST BE ON ALL ORDERS
• CAN NOT USE RULE OUT
• CODE THE SYMPTOMS

15
CONCLUSION

• DOCUMENT, DOCUMENT, DOCUMENT
• EVERYTHING YOU DO

16

• CHARGE, CHARGE, CHARGE
• FOR ALL PROCEDURES AND SERVICES

17

• MONEY, MONEY, MONEY, MONEY