Principles of CPT Coding

Author: AMA
Affiliation:
Publisher: American Medical Association
Publication Date: 2017
ISBN 10: 1622025512
ISBN 13: 9781622025510
eISBN: 9781622025527
Edition: 9th

Description:

Principles of CPTr Coding, ninth edition, is a best-selling resource that provides education on CPTr billing and guidelines. It offers valuable training on how to code correctly with CPT.

Table of Contents

Front Matter

  • ABOUT
  • Preface
  • At-a-Glance Review of the Features of Principles of CPT® Coding, 9th Edition
  • Acknowledgments

PART 1 CPT Coding and HCPCS

    1: Introduction to the CPT Code Set and HCPCS Level II Coding System

    • CPT Code Set Nomenclature
    • Parent and Child Codes Relationship
    • CPT Code Symbols
    • The CPT Code Set
    • Use of the CPT Code Set
    • Development of the CPT Code Set
    • Maintenance of the CPT Code Set
    • Requests for CPT Code Set Changes
    • The CPT Code Set Change Process
    • Categories of CPT Codes
    • Performance Measurement Exclusion Modifiers
    • Category III Codes
    • Implementation Dates for CPT Codes
    • The Healthcare Common Procedure Coding System
    • Code Modifiers
    • Evaluate Your Understanding

    2: Evaluation and Management Services

    • Classification of E/M Services
    • Definitions of Commonly Used Terms
    • Instructions for Selecting a Level of E/M Service
    • A Review of the Categories and Subcategories of E/M Services
    • Procedures Included With E/M Codes
    • Who Can Report E/M Codes
    • Documentation Guidelines
    • References
    • Evaluate Your Understanding

    3: Anesthesia

    • Reporting Basic Anesthesia Administration Services
    • Types of Anesthesia
    • Evaluate Your Understanding

    4: Surgery

    • Overview
    • Surgery Guidelines
    • Evaluate Your Understanding

    4.1: General and Integumentary System

    • General
    • Fine Needle Aspiration
    • Skin, Subcutaneous, and Accessory Structures
    • Nails
    • Breast Procedures
    • Evaluate Your Understanding

    4.2: Musculoskeletal System

    • General
    • Head: Prosthesis
    • Neck (Soft Tissues) and Thorax: Fractures and/or Dislocations
    • Spine (Vertebral Column): Surgery
    • Re-exploration Procedures
    • Approach for Spine Surgery
    • Forearm and Wrist: Distal Radius and Ulnar Styloid Fracture Treatment
    • Foot and Toes: Bunion Procedures
    • Types of Bunion Deformities
    • NonBunionectomy–Related Procedures
    • Endoscopy and Arthroscopy
    • Evaluate Your Understanding

    4.3: Respiratory System

    • Sinus Surgery
    • Nasal Endoscopy
    • Larynx Endoscopy
    • Trachea and Bronchi
    • Lungs and Pleura
    • Video-Assisted Thoracic Surgery
    • Stereotactic Radiation Therapy
    • Lung Allotransplantation
    • Evaluate Your Understanding

    4.4: Cardiovascular System

    • Transmyocardial Revascularization
    • Pacemaker or Implantable Defibrillator Guidelines
    • Transcatheter Pulmonary Valve Implantation
    • Coronary Artery Bypass Procedures
    • Endoscopic (Minimally Invasive) Venous Conduit Harvest
    • Cardiac Hybrid Procedures
    • Cardiac Assist
    • Extracorporeal Membrane Oxygenation/Extracorporeal Life Support Services
    • Component Coding for Endovascular Repair of Aortic Aneurysm
    • Repair of Ascending (Thoracic) Aortic Aneurysm
    • Endovascular Repair of Abdominal Aortic, Descending Aortic, or Iliac Aneurysm
    • Fenestrated Endovascular Repair of Visceral and Infrarenal Aortic Aneurysm
    • Vascular Injection Procedures
    • Thrombectomy
    • Transcatheter Procedures
    • CPT Category III Peripheral Atherectomy Codes
    • Intravascular Ultrasound Services
    • Evaluate Your Understanding

    4.5: Digestive System

    • Lips, Tongue, and Floor of Mouth
    • Stomach
    • General Guidelines for Endoscopy
    • CPT Category III Code ERCP With Optical Endomicroscopy
    • Bariatric Surgery
    • Biliary Tract
    • Abdomen, Peritoneum, and Omentum: Incision, Excision, and Destruction
    • Percutaneous Gastrostomy, Jejunostomy, Gastrojejunostomy, and Cecostomy
    • Hernia Repair
    • Reference
    • Evaluate Your Understanding

    4.6: Urinary System

    • Renal Transplantation
    • Renal Pelvis Catheter Stent Procedures
    • Renal Tumor Ablation
    • Ureter: Incision and Biopsy
    • Insertion of Bladder Catheter
    • Endoscopic Procedures
    • Prostate Procedures
    • Radiation Treatment
    • Evaluate Your Understanding

    4.7: Male Genital System

    • Penis: Incision
    • Testes: Excision
    • Epididymis: Excision and Repair
    • Scrotum: Incision, Excision, and Repair
    • Vas Deferens: Incision and Excision
    • Spermatic Cord: Excision
    • Prostate: Incision and Excision
    • Evaluate Your Understanding

    4.8: Female Genital System

    • Maternity Care and Delivery
    • The Obstetric Package
    • Evaluate Your Understanding

    4.9: Nervous System

    • Skull, Meninges, and Brain
    • Neuroendoscopy
    • Spine and Spinal Cord
    • Stereotactic Radiosurgery (Spinal)
    • Neurostimulators (Spinal)
    • Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System
    • CPT Category III Code for Destruction of Extensive Cutaneous Neurofibroma
    • Evaluate Your Understanding

    4.10: Eye and Ocular Adnexa

    • Organization of Codes
    • Eyeball
    • Anterior Segment
    • Keratoplasty
    • Other Corneal Procedures
    • Ocular Surface Reconstruction
    • Anterior Chamber
    • Posterior Segment
    • Ocular Adnexa
    • Strabismus Surgery
    • Recession and Resection Procedures
    • Conjunctiva
    • Lacrimal System
    • One or More Sessions
    • Evaluate Your Understanding

    4.11: Auditory System

    • External Ear
    • Middle Ear
    • Inner Ear
    • Operating Microscope
    • Evaluate Your Understanding

    5: Radiology

    • Introduction to Radiology
    • Administration of  Contrast Materials
    • Supply of Contrast Materials and Radiopharmaceuticals
    • Written Reports
    • Interpretation of Outside Films
    • Diagnostic Radiology (Diagnostic Imaging)
    • Radiologic Examination of Lower Extremities
    • Computed  Tomography Imaging
    • Magnetic Resonance Imaging
    • Gynecological and Obstetrical
    • Magnetic Resonance Angiography
    • Fluoroscopy
    • Interventional Radiology
    • Bundling of Procedure and S&I Codes
    • Vascular Interventional Radiology
    • Coding Conventions for Vascular Interventional Procedures
    • Diagnostic Studies of Cervicocerebral Arteries
    • Diagnostic or Therapeutic Services
    • Diagnostic Ultrasound
    • Radiological Guidance
    • Breast, Mammography
    • Bone and Joint Studies
    • Radiation Oncology
    • Consultation: Clinical Management
    • Clinical Treatment Planning—External and Internal Sources
    • Simulation
    • Medical Radiation Physics, Dosimetry, Treatment Devices, and Special Services
    • Radiation Treatment Delivery
    • Radiation Treatment Management
    • Proton Beam Treatment Delivery
    • Hyperthermia
    • Clinical Brachytherapy
    • Intracavitary Brachytherapy
    • HDR Radionuclide Brachytherapy Services
    • Interstitial Brachytherapy
    • Brachytherapy Therapeutic Radiology Simulation-Aided Field Setting
    • Brachytherapy Isodose Calculation
    • Surgeon Services
    • Nuclear Medicine
    • Gastrointestinal System
    • Musculoskeletal System
    • Evaluate Your Understanding

    6: Pathology and Laboratory

    • Collection of  Specimen
    • Organ or Disease-Oriented Panels
    • Drug  Assay
    • Therapeutic Drug Assays
    • Evocative or  Suppression Testing
    • Consultations (Clinical Pathology)
    • Urinalysis
    • Molecular Pathology
    • Genomic Sequencing Procedures and Other Molecular Multianalyte Assays
    • Chemistry
    • Hematology and Coagulation
    • Transfusion Medicine
    • Microbiology
    • Cytopathology
    • Cytogenetic Studies
    • Surgical Pathology
    • In Vivo (eg, Transcutaneous) Laboratory Procedures
    • Other Procedures
    • Reproductive Medicine Procedures
    • Evaluate Your Understanding

    7: Medicine

    • Immunizations
    • Immune Globulins, Serum or Recombinant Products
    • Immunization Administration for Vaccines/Toxoids
    • Psychiatry
    • Dialysis
    • Gastroenterology
    • Ophthalmology
    • Special Otorhinolaryngologic Services
    • Cardiovascular
    • Cardiac Catheterizations
    • Noninvasive Vascular Diagnostic Studies
    • Pulmonary
    • Allergy and Clinical Immunology
    • Endocrinology
    • Neurology and Neuromuscular Procedures
    • Medical Genetics and Genetic Counseling Services
    • Central Nervous System Assessments/Tests (eg, Neuro-Cognitive, Mental Status, Speech Testing)
    • Health and Behavior Assessment and Intervention
    • Hydration, Therapeutic, Prophylactic, and Diagnostic Injections and Infusions; and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration
    • Photodynamic Therapy
    • Special Dermatologic Procedures
    • Physical Medicine and Rehabilitation
    • Medical Nutrition Therapy
    • Acupuncture
    • Osteopathic Manipulative Treatment
    • Chiropractic Manipulative Treatment
    • Education and Training for Patient Self-Management
    • Non–Face-to-Face Nonphysician Services
    • Special Services, Procedures, and Reports
    • Moderate (Conscious) Sedation
    • Home Health Procedures/Services
    • Medication Therapy Management Services
    • Evaluate Your Understanding

    8: Modifiers

    • Introduction to CPT Modifiers
    • Why Use Modifiers?
    • Modifier 22
    • Modifier 23
    • Modifier 24
    • Modifier 25
    • Modifier 26
    • Modifier 32
    • Modifier 33
    • Modifier 47
    • Surgical Modifiers 50 to 56
    • Modifier 50
    • Modifier 51
    • Modifier 52
    • Modifier 53
    • Modifiers 54, 55, and 56
    • Modifier 57
    • Modifier 58
    • Modifier 59
    • Modifier 62
    • Modifier 63
    • Modifier 66
    • Modifiers 76, 77, 78, and 79
    • Modifiers 80, 81, and 82
    • Modifier 90
    • Modifier 91
    • Modifier 92
    • Modifier 95
    • Modifier 99
    • Modifiers Approved for Ambulatory Surgery Center (ASC) Hospital Outpatient Use
    • Evaluate Your Understanding

PART 2 Documentation, Insurance, and Reimbursement Overview

    9: Medical Coding, Payment, and Documentation

    • What Is Medical Coding?
    • Payment for Health Care Providers
    • HIPAA Coding Classifications
    • Importance of Coding
    • Reference
    • Evaluate Your Understanding

    10: Insurance Payment Overview

    • Health Insurance Overview
    • How the Revenue Cycle Is Key to Accurate Claims Submission
    • Insurance Processing of Claims and Accounts Receivable Management
    • References
    • Evaluate Your Understanding

    11: Medicare Payment Overview

    • Medicare Overview
    • Medicare Payment Systems Overview
    • Medicare as Secondary Payer
    • Medicare Coverage Criteria
    • Medicare Payment Systems Resources
    • Evaluate Your Understanding

    12: Medicare Physician Payment: Medicare Physician Fee Schedule

    • Physician Services Overview
    • Medicare Physician Payment
    • Medicare Physician Fee Schedule Database
    • Medicare MPFS Payment Calculation
    • Medicare Physician Payment for Nonphysician Practitioners (NPPs)
    • Reference
    • Evaluate Your Understanding

    13: Overview of Medicare’s National Correct Coding Initiative Edits

    • History and Rationale Behind the NCCI Edits
    • The NCCI Policy Manual Format
    • Evaluate Your Understanding

    14: Medical Record Documentation

    • Documentation Overview
    • Health Insurance Portability and Accountability Act of 1996
    • Key Uses for Medical Record Documentation
    • General Principles to Document Clinical Services
    • Bottom Line
    • References
    • Evaluate Your Understanding

    15: Fraud and Abuse Issues in Health Care Coding, Payment, and Documentation

    • Fraud and Abuse Overview
    • Office of Inspector General
    • Medicare Claims Review Programs
    • National Correct Coding Initiative Edits
    • Medically Unlikely Edits
    • Comprehensive Error Rate Testing Program
    • Recovery Audit Contractor Program
    • Medicare Administrative Contractor Medical Review Program
    • Fraud and Abuse Laws
    • Coding and Billing Issues
    • Compliance Plans
    • References
    • Evaluate Your Understanding

    16: Pulling It All Together: Coding, Payment, and Documentation

    • Five Tips to Success with Coding, Payment, and Documentation
    • Moving From What to How

APPENDIX A Evaluate Your Understanding Answers

Photo and Illustration Credits