Coding with the CPT
Before You Begin
It is advised that you purchase the
most up-to-date CPT code book
Outline
History of the CPT
Who uses CPT Coding?
CPT Sections
How to Code in the CPT Sections
Use of Modifiers
History of the CPT
CPT first published in 1966 by the AMA
1970 = 5 digit codes replaces 4 digit codes
HCPCS adopts CPT codes in 1983
1987 = CPT codes reported for outpatient procedures
2000 = DHS designates CPT National Coding System
•Ambulatory Surgical Centers
•Community Mental Health Centers •Dialysis Centers
•Emergency Department •Home Health Agencies •Hospice Centers
•Hospitals (Acute Care) •Hospital Outpatient •Physicians
•Skilled Nursing Facilities
Who Uses
CPT Codes?
Category I Codes – codes within the
traditional 6 sections of the CPT code book
Category II Codes – Contain performance measures – located after the medicine section
Category III Codes – Emerging Technology codes that are also located after the
medicine section
3 Categories
of Codes
Front cover =
1) Symbols - 9 main
2) Modifiers
3) POS
6 Main Sections
Appendices
Index
Back Cover =
Common Abbreviations
Getting
Familiar with
the CPT
Code Book
There are over 9000 codes for medical services.
There are six main sections of CPT codes and
descriptors
1) Evaluation & Management (E/M) Service
2) Anesthesia
3) Surgery
4) Radiology
5) Pathology & Laboratory
6) Medicine
Evaluation & Management Codes
These codes form the basis of physician and patient interaction.
The codes are based on the:
Place of Service
New vs. Established Patient
Nature of the Presenting Problem Content of Service
Time Requirement for Services Needed
Counseling & Coordination of care
Each component contributes to the code you will use to bill a patient for services rendered.
Organization of Evaluation & Management Codes
The section is organized by
Categories
Subcategories
New Patient
3 – 5 levels of E & M codes Established Patient
Evaluation & Management Codes
Place of Service – located in green font in the E & M section – find first
New vs. Established Patient – the AMA provides a decision tree in the E & M guidelines to help you determine if the patient is new or established
Content of Service (Examination, & History, & Medical Decision Making)
Nature of the Presenting Problem
Time Requirement for Services Needed
Steps to Code with the
Evaluation & Management Codes
1. Select the POS – review special instructions
2. Determine if the Patient is New or Established – refer to
the decision tree in the E/M guidelines
3. Review the Nature of Presenting Problem
4. Evaluate the Level of History Obtained
5. Review the Extent of the Physical Examination
6. Determine the Level of Complexity of the Medical
Decision Made
7. Check the amount of time accounted for
Evaluation & Management Codes
Assignment:
Please read through Appendix C in the CPT
code book for clinical examples that relate to
Anesthesia Codes Organization
Categories = Anatomical place
where anesthesia is delivered
Anesthesia Codes
Major considerations:
• Time reporting
• Materials provided by the physician
• Number & complexity of procedure(s)
• Anesthesia modifiers
General Surgery Codes
Subsections = Body System
Categories = Anatomical Site
Subcategories = Procedures
General Surgery Codes
The procedure subsection is organized in the following order:
• Incision
• Excision
• Introduction or Removal
• Repair, Endoscopy
• Revision or Reconstruction
• Destruction
• Grafts
• Suture
• Other Procedures
General Surgery Coding Guidelines
Surgical Package
Follow-Up Care
Materials Supplied by the Physician
Multiple Procedures
Separate Procedures
Unlisted Procedures
Radiology
The CPT Radiology Section is further divided
into the following types of procedures:
Diagnostic Radiology/Diagnostic Imaging
Diagnostic Ultrasound
Radiation Oncology
Nuclear Medicine
Radiology Organization
Subsection
Anatomical Site
Code
This section differs from other sections because
the coder will need to first identify the type of
procedure and then identify the body system targeted by the
Pathology & Laboratory Codes
Physicians will order certain tests to be performed to verify or identify why the patient has come to see the physician.
Careful attention should be noted to determine if the physician
performed the pathology or laboratory analysis or sent the samples out to another physician or lab. There are different codes for procedures completed in house versus results obtained from an outside service.
Pathology & Laboratory Codes
Type of Pathology or Laboratory
Procedure Performed
Medicine Codes
These codes are more related to specialists and Primary Care Doctors
Codes range from special services, immunizations, and chemotherapy
Depending on the office services offered will determine how often you will use codes in this section
The codes in the Medicine section are classified as noninvasive or minimally invasive diagnostic and therapeutic services and
Medicine Codes are
Divided By:
Procedure-related codes
Medical specialties
CPT Modifiers
Modifiers are included in Appendix A of the CPT code book.
Modifiers are 2 digit codes that are added to the main CPT code to indicate that a procedure has been changed.
If you are not sure if the modifier should be used, please refer to appendix A.
