Coding 101 - Introduction to CPT

1. Coding 101 - Introduction to CPT Steven A. Adams, CPC, CPC-H, COA

2. Doctor & Coder

3. Table of Contents Introduction to CPT E&M Codes Other Common Codes Modifiers Coding Resources

4. Doing It Right The First Time!Five Steps to Proper Reimbursement 1. Understand the Guidelines 2. Perform the Service 3. Document What You Did (according to the guidelines) 4. Bill what you documented 5. Collect what you billed

6. We Don�t Want You To Feel Like This Anymore.

8. Job Description For Coders

9. 2004 Changes

10. Avoiding trouble is largely a matter of knowing the rules & remembering your audience.

12. Here�s Your Audience Criminal Justice Field Accountants Biologists

16. History Examination Decision-making Counseling Coordination of care Nature of presenting problem(s) Time First Established 1992

17. Outpatient Visit

18. New - Consults Level 1 Level 2 Level 3 Level 4 Level 5 Self limited problem Self limited problem OTC, minor surgery Undiagnosed problem Rx management Endoscopy surgery without risk factors Major surgery risk factors Major surgery with risk factors Complex problem with data review

20. Outpatient Visit

21. Established - Subsequent 99211 99212 99213 99214 99215 Nurse Code (1) stable / resolved problem (1) Unstable; or Multiple stable problems Multiple conditions, something is wrong Counseling - 25 minutes Highly acute problem w / data Counseling - 40 minutes

23. Initial Hospital Care

24. Initial Hospital Care 99221 99222 99223 Low complexity problems Moderate Severity High Severity

26. Subsequent Hospital Service

27. Subsequent Hospital Care 99231 99232 99233 Recovering or improving Responding inadequately to therapy Unstable or developed significant new problem

29. Comprehensive Nursing Facility Assessments

30. Assessments 99301 99302 99303 Annual assessment - affirm plan of care Nursing assessment - new plan of care Admission or readmission - new plan of care required

32. Subsequent Nursing Facility Care

33. Subsequent Nursing Care 99311 99312 99313 Recovering or improving Responding inadequately to therapy Unstable or developed significant new problem

37. Injections 90471 / 90472 90782-90784 Vaccines, Toxoids Bundled with E&M

38. Medicare Injections G0008 Influenza Injection � V04.8 90659 Influenza Vaccine (Whole Virus) G0009 Pneumococcal Injection - V03.82 90732 Pneumovax Vaccine G0010 Hepatitis Injection 90746 Hepatitis � V05.3 90782 Therapeutic Injection (IM) J3420 B-12 � Waiver Signed

39. Destruction

40. Destruction Flat Warts

41. Preventive Services Hide not your talents. They for use were made. What's a sundial in the shade. Ben Franklin

42. Medicare Information G0101 - Breast and pelvic Q0091 - Pap smear G0107 - Occult Blood

43. Medicare Information G0180 � Initial services. Use when patient has not received Medicare-covered home health services for at least 60 days. $80 G0179 � Recertification services. Use this after a patient has received services for at least 60 days when the physician signs the certification after the initial certification period. $70

45. Global Fee Policy �Concept is that certain services are included in the allowance for a surgical procedure.�

46. Not In Global Package Initial Consult Unrelated Visits Diagnostic Test Return Trips to OR Staged Procedures

47. Minor Surgery / Service 22 - Surgery Only 24 - E&M Only 25 - E&M Only (Minor surgery / service) 57 - E&M Only (Major surgery) 58 - Surgery Only (Related, staged) 78 - Surgery Only (Related, complication) 79 - Surgery Only (Not Related)

51. Library Coders Desk Reference Principles of CPT/ICD-9 CPT Changes Coding Alert Magazines Coder�s Edge - AAPC

52. Resources gamedicare.com lmrp.net hcfa.gov aapc.com cms.hhs.gov/providerupdate/whatsnew.asp ahima.org medville.com cms.hhs.gov

53. Doing It Right!Five Steps to Reimbursement 1. Understand the Guidelines 2. Perform the Service 3. Document What You Did (according to the guidelines) 4. Bill what you documented 5. Collect what you billed

55. Questions?