INTRODUCTION: CPT CODES & ICD-9 CODES
Current Procedural Terminology (CPT) is a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians. The CPT codes are useful for administrative management purposes including claims processing.
The International Classification of Diseases, 9th Revision (ICD-9) is designed for the classification of morbidity and mortality information for statistical purposes, and for the indexing of hospital records by disease and operations, for data storage and retrieval.
FAMILY PLANNING CPT CODES: Applicable to Male Services Office or other outpatient services
• New Patient
o 99201:
A problem focused history / examination Straightforward medical decision making
o 99202:
An expanded problem focused history / examination Straightforward medical decision making
o 99203:
A detailed history / examination
Medical decision making of low complexity
o 99204:
A comprehensive history / examination
Medical decision making of moderate complexity
o 99205:
A comprehensive history / examination Medical decision making of high complexity • Established Patient
o 99211:
May not require physician presence
Minimal problems; service time ~5 minutes
o 99212:
A problem focused history / examination Straightforward medical decision making
o 99213:
An expanded problem focused history / examination Medical decision making of low complexity
o 99214:
A detailed history / examination
FAMILY PLANNING CPT CODES (Cont’d)
Preventive Medicine Services (New / Established Patient) • 99384 / 99394: 12 – 17 yrs
• 99385 / 99395: 18 – 39 yrs • 99386 / 99396: 40 – 64 yrs • 99387 / 99397: 65+ yrs
Destruction of Lesions - Male Genital System
• 54050: destruction of lesion(s) on penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical
• 54055: electrodesiccation • 54056: cryosurgery
• 54057: laser surgery • 54060: surgical excision
• 54065: destruction of lesion(s), penis, extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery)
Destruction of Lesions - Rectum
• 46900: destruction of lesion(s) on anus, simple; chemical • 46910: electrodesiccation
• 46916: cryosurgery • 46917: laser surgery • 46922: surgical excision
• 46924: destruction of lesion(s), anus, extensive Destruction of Benign or Premalignant Lesions
• 17110: destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions • 17111: 15 or more lesions
FAMILY PLANNING ICD CODES: Applicable to Male Services
• Encounter for Contraceptive Management (V25)
– Family Planning advice: V25.09
– Other FPM surveillance: V25.49 • Chlamydia-male; 99.41
• Chlamydia screening: V73.98 • Gonorrhea: 098.0
• Herpes, genital: 054.10
• Herpetic infection, penis: 054.13 • Pain-scrotum: 608.9
• Penile lesion: 078.11
• Penis-unspecified disorder: 607.9 • Routine General Med Exam: V70.0 • Urethral discharge: 788.7
• Urethritis: 597.80
• Male genital disorder: 608.89 • Rash-dermatitis, eczema: 692.9
• Rash. non-specific skin eruption: 782.1 • Worried well: V65.5 • Counseling STI's: V65.45 • STI screening: V74.5 • STI exposure: V01.6 • Viral warts-condyloma: 078.19 • HIV counseling: V65.44 • Folliculitis: 704.8 • Hemorrhoids: 455.6 • Syphilis: 92.9
Sample Male Family Planning Coding Scenarios Worksheet 1. STI Screening Example
Evaluation and Management Code Selection
Based on New (99201-99205) vs. Established (99211-99215)
S- CC: New Partner Clearance; HPI: 4 partner past 6 months; ROS: No discharge/dysuria
O- NAD, A&O X3; Temp: 98.6
A&P- Screening STI (V74.5); Safe sex and STI prevention discussed (V25.09)
HCPCS (CPT) Code: 99202 or 99213; ICD-9 Code as above 2. STI Infection Example
Evaluation and Management Code Selection Based on New (99201-99205) vs. (99211-99215)
S- CC: Discharge; HPI: White, penile d/c for one week; Worse in AM;ROS: + Dysuria, - lymph.; Social History: New partner within last month with unprotected intercourse
O- Somewhat distressed, A&O X3; Temp: 99.9; White, milky discharge from penis, no lesions or rash
A&P- Discharge (788.7), Dysuria, (788.1), Exposure to STI, (V01.6); Safe sex and STI prevention discussed (V25.09)
HCPCS (CPT) Code: 99203 or 99214 with 788.1 and V25.09; 36415 (Blood draw for RPR) with 788.7 and V01.6
3. Annual
Evaluation and Management Code Selection Based on New (99384-99387) vs. (99394-99397)
S- CC: Annual/CPE/Preventive; HPI: None necessary; 10+ ROS; PFSH: All 3
O- 8 or more Organ Systems (No Body Areas)
A&P- Normal Adult Preventive (V70.0); Safe sex and STI prevention discussed (V25.09)
4. Wart Evaluation with Aldara Treatment Example Evaluation and Management Code Selection
Based on New (99201-99205) vs. (99211-99215)
S- CC: Bumps; HPI: Clusters of white, raised bumps on penis and groin area starting 4 weeks ago; ROS: Neg dysuria/fever; Social History: Two partners, last 60 days
O- Somewhat distressed, A&O X3; Temp: 98.6; Raised veruca cell lesions, .25 cm in diameter with 3-4 in cluster on penile shaft and above base on groin area
A&P- Condyloma (078.11) with Aldara prescription; RTC two weeks; Safe sex and STI prevention discussed (V25.09)
HCPCS (CPT) Code: 99203 or 99214 with ICD-9 as above 5. Wart Evaluation and Destruction Example
Evaluation and Management Code Selection Based on New (99201-99205) vs. (99211-99215)
S- CC: Bumps; HPI: Clusters of white, raised bumps on penis and groin area starting 4 weeks ago; ROS: Neg dysuria/fever; Social History: Two partners, last 60 days
O- Somewhat distressed, A&O X3; Temp: 98.6; Raised veruca cell lesions, .25 cm in diameter with 3-4 in cluster on penile shaft and above base on groin area
A&P- Condyloma (078.11) treated with TCA; RTC 7 days for retreatment; Safe sex and STI prevention discussed (V25.09)
HCPCS (CPT) Code: 99203 or 99214 (-25 modifier) with both ICD-9 as above and 17110 and 54050, both with ICD-9 of 078.11
6. Wart Destruction Only (Destruction Coding Options) Code surgical service only UNLESS a “significantly, separately identifiable” problem raised at time of wart destruction which would result in also coding E&M
Wart Destruction (Cryo, Chemo, Laser, Electro.)
– Penile: 54050-54060 (Simple, method specific) & 54065 (Extensive)
