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CPT CODING Power Point

This document provides information about CPT and ICD-9 medical coding. It defines both coding systems, provides examples of common codes, and explains how to determine the appropriate level of service and code for office visits based on elements like history, exam, medical decision making, and time. It also includes a case study example.

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2K views24 pages

CPT CODING Power Point

This document provides information about CPT and ICD-9 medical coding. It defines both coding systems, provides examples of common codes, and explains how to determine the appropriate level of service and code for office visits based on elements like history, exam, medical decision making, and time. It also includes a case study example.

Uploaded by

Jack
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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CPT & ICD-9 CODING

Debra Dockter NP-BC

Objective of Coding
Provider
- To prepare a standardized bill for services
given to a patient.
Payer
- To determine the amount to be paid to the
provider.

Definition
CPT (current procedural terminology) Codes are numbers assigned to every task & service a
medical practitioner may provide to a patient.
includes: medical
surgical
diagnostic services
*Used by insurers to determine the amount of
reimbursement a practitioner will receive
from the insurance company.

CPT Codes
Developed, maintained, and copyrighted by
AMA (American Medical Association)
New codes are developed for new services,
current codes may be revised, & old unused
codes are discarded annually.

*The exception: Medicare patient

CPT Codes
Examples
99201 a physical exam
90658 flu vaccination
90716 chicken pox vaccine (varicella)
12002 laceration repair
*Service reimbursement will vary according to
medical provider and insurance company.

3 Key Components for CPT


Coding

Necessary components needed for billing a


patient visit :
* History of problem(s)
* Exam related to problem(s)
* Medical Decision
These components are determined by:
Evaluation & Medical Decision Making
*Great resource: www.fpnotebook.com

Evaluation & Medical Decision Making

The levels of E & M services are based on 4


types of examinations:

Problem Focused
Expanded Problem Focused
Detailed
Comprehensive

Patient Criteria for E/M


I. Patient Type: New
No professional services in the last 3 years.
II.

Patient Type: Established


Maintained professional services in the last 3
years.

Billing for Problem Focus Visit

Problem Focus Visit presenting problem self


limited or minor, the provider will spend 10
minutes face to face with the patient and/or
family.
New patient visit
Established visit

CPT 99201
CPT 99211

Billing for Expanded Problem Focus

Expanded Problem Focus presenting


problem low to moderate severity, provider
spends 15 minutes face to face with patient.
New patient
Established patient

CPT 99202
CPT 99213

Billing for Detailed

Detailed usually the presenting problem(s)


are moderate to high severity & physical
assessment typically 25 minutes face to face
with the patient.
New patient
Established patient

CPT 99203
CPT 99214

Billing for Comprehensive

Comprehensive high complexity, multisystem exam or complete exam of a single


organ system, lasting 40 minutes.

New patient visit


CPT 99204
Established patient visit CPT 99215

E/M Coding: Level of Visit


CPT Code

History

Exam

Management

99211

Minimal

Minimal

99212

Problem
focused

Problem
focused

Straightforward 10 minutes

99213

Expanded
problem
focused

Expanded
problem
focused

Low
complexity

15 minutes

99214

Detailed

Detailed

Moderate
complexity

25 minutes

99215

Comprehensive Complex

High
complexity

40 minutes

Minimal

Time
5 minutes

E & M Visit: Elements/Bullets

Female exam consists of 11 elements


- Inspection & palpation of breasts
- Digital rectal exam
- Pelvic exam
- External genitalia
- Cervix
- Urethral meatus
- Uterus
- Bladder
- Adnexa
- Vagina
- Anus & perineum

E/M Visit: Physical Examination


LEVEL

SINGLE ORGAN SYSTEM EXAM

Problem Focused

1-5 bullet elements

Expanded Problem Focused

6 or more bullet elements

Detailed

12 or more bullet elements

Comprehensive

Female GU exam, abdomen,


constitutional, & other organs

ICD Codes

Defintion

ICD (International Statistical Classification of Disease) are alphanumeric


designations given to every diagnosis and description of symptoms!

Describes why that service was provided.


*Remember the CPT code describes the service that was
rendered for billing purposes.

IDC-9 codes most commonly used codes, ICD-10 transition is very expensive, & most
providers have not yet upgraded to the ICD-10 system.
IDC-11, the next major update ( in the development).

ICD Codes

Diagnostic Codes identifies diseases,


disorders, human response, & medical signs.
Example
Dx of GERD (acid reflux) code 530.81

ICD-CM Coding Rules

List the principal diagnosis first


If diagnosis is not established, code for
symptom
-Dont code for rule-out diagnosis
Dont code a diagnosis that doesnt apply to
the present visit.
Preventive E/M codes linked to V codes.

What are V-Codes?


Specific ICD-9 codes used to identify encounters
for reasons other than illness or injury.
Examples
CPT
ICD-9 description
Start OCs
V 25.01
prescription
IUC insertion V 25.11
Insertion of IUC
Missing string V 45.51
Presence of string
STI evaluation V 01.6
Contact/exposure
Pregnancy test V72.41
Test/exam-negative

Case Study Screen Me For


Everything

28 y/o established fe request for STI


screening.asymptomatic
Monogamous relationship 4 months ago;
unprotected sex with new partner 6 wks ago
Pelvic exam negative; CT, GC, wet prep
Wet prep negative, vaginal pH: 4.0
Blood drawn for HIV, VDRL, Hepatitis B,
Hepatitis C

Case Study: Answer


CPT code

ICD-CM code

Procedure
Supplies
Drug
Lab

None
None
None
87210 (microscopy)
83986 (vaginal pH)

V01.6 (STI exposure)


or V69.2 (HRSB*)

E/M

99203

Modifier

None

*HRSB: high risk sexual


behavior
*Unnecessay tests Hep B,C

V01.6 (STI exposure)


or V69.2 (HRSB*)

IN Summary
Coding is:
Complex
Hard to remember
Boring
But:
- It is how you are credited for the work you do
- It is often a determinant of how you are paid
- It is how fee-for-service is paid
Therefore, DO IT WELL

Improve Your Coding

Buy new CPT & ICD-9 books ANNUALLY

Review coding issues & new developments at


staff meetings.

Coding Resource
ACOG web site: www.acog.org
- Quick Link - Coding

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