CPT and HCPCS Coding Made Easy! : A Comprehensive Guide to CPT and HCPCS Coding for Healthcare Professionals

by Davis, James B.

• ISBN13: 9781570660849
• ISBN10: 1570660840
• Edition: 4th
• Format: Paperback
• Copyright: 1999-01-01
• Publisher: Practice Mgmt Information Corp

Table of Contents

PREFACE	i
CODING BASICS	1	(20)
CPT	1	(1)
HCPCS	2	(2)
KEY POINTS REGARDING CPT & HCPCS	3	(1)
PREPARING FOR CPT & HCPCS CODING	4	(7)
EVALUATE YOUR RESOURCES	4	(1)
REVIEW PROCEDURE STATEMENTS AND CODES	5	(1)
TRAINING AND DEVELOPMENT	6	(1)
STRUCTURE OF CPT	7	(1)
STRUCTURE OF HCPCS	8	(3)
HOW TO USE CPT	11	(6)
FORMAT AND CONVENTIONS OF CPT	12	(1)
GUIDELINES	12	(1)
STARRED PROCEDURES	13	(1)
MODIFIERS	13	(1)
APPENDICES	13	(2)
ALPHABETICAL INDEX	15	(2)
HOW TO USE HCPCS	17	(3)
FORMAT AND CONVENTIONS OF HCPCS	17	(1)
GUIDELINES	18	(1)
HCPCS MODIFIERS	18	(1)
CODING RULES FOR HCPCS	18	(1)
MEDICAL AND SURGICAL SUPPLIES	19	(1)
HCPCS CODE OVERLAP	19	(1)
FORMAT OF HCPCS CODES	19	(1)
EXERCISE 1: CODING BASICS	20	(1)
CODING & BILLING ISSUES	21	(34)
SUPPORTING DOCUMENTATION	21	(1)
SPECIAL MEDICARE CONSIDERATIONS	22	(1)
BILATERAL MODIFIER USAGE	22	(1)
UNLISTED PROCEDURES OR SERVICES	23	(1)
CPT CHANGES, ADDITIONS AND DELETIONS	23	(2)
HCPCS CHANGES, ADDITIONS AND DELETIONS	25	(1)
STARRED PROCEDURES	25	(1)
NEW PATIENT VERSUS ESTABLISHED PATIENT	26	(1)
NEW PATIENT OR INITIAL VISIT	26	(1)
ESTABLISHED PATIENT/FOLLOW-UP VISITS	26	(1)
PLACE (LOCATION) OF SERVICE	26	(1)
HOSPITAL CARE	27	(2)
HOSPITAL DISCHARGE	28	(1)
EXERCISE 2: CODING & BILLING ISSUES, PART 1	29	(1)
REFERRAL	30	(1)
SEPARATE OR MULTIPLE PROCEDURES	30	(1)
MULTIPLE SURGICAL PROCEDURES	30	(1)
CONSULTATIONS	30	(1)
CONSULTATION FOLLOW-UP	31	(1)
CONFIRMATORY CONSULTATIONS	31	(1)
EMERGENCY SERVICES	31	(1)
SUPPLIES AND MATERIALS SUPPLIED BY PHYSICIAN	31	(2)
PROCEDURE DOWN-CODING	33	(2)
DUE TO DIAGNOSIS CODES	34	(1)
DUE TO LACK OF DOCUMENTATION	34	(1)
PURCHASED DIAGNOSTIC SERVICES	35	(1)
CPT MODIFIERS	36	(7)
HCPCS MODIFIERS	43	(10)
HCPCS NATIONAL MODIFIERS	43	(8)
HCPCS AMBULANCE SERVICE MODIFIERS	51	(1)
HCPCS LOCAL MODIFIERS	52	(1)
EXERCISE 3: CODING & BILLING ISSUES, PART 2	53	(2)
EVALUATION & MANAGEMENT SERVICES	55	(92)
GUIDELINES/CLASSIFICATION OF EVALUATION AND MANAGEMENT SERVICES	55	(1)
SUBSECTION INFORMATION	56	(1)
MATERIALS SUPPLIED BY PHYSICIAN	56	(1)
DEFINITIONS OF COMMONLY USED TERMS	57	(4)
NEW AND ESTABLISHED PATIENTS	57	(1)
CHIEF COMPLAINT	57	(1)
CONCURRENT CARE	57	(1)
COUNSELING	58	(1)
FAMILY HISTORY	58	(1)
HISTORY OF PRESENT ILLNESS	59	(1)
PAST HISTORY	59	(1)
SOCIAL HISTORY	59	(1)
SYSTEM REVIEW (REVIEW OF SYSTEMS)	60	(1)
LEVELS OF EVALUATION AND MANAGEMENT SERVICES	61	(1)
KEY COMPONENTS	61	(4)
HISTORY	61	(1)
EXAMINATION	62	(2)
MEDICAL DECISION MAKING	64	(1)
CONTRIBUTORY COMPONENTS	65	(2)
COORDINATION OF CARE	65	(1)
NATURE OF THE PRESENTING PROBLEM	65	(2)
TIME	67	(2)
FACE-TO-FACE TIME	68	(1)
UNIT/FLOOR TIME	68	(1)
DIAGNOSTIC TESTING OR STUDIES	69	(1)
UNLISTED SERVICES	69	(1)
SPECIAL REPORT	69	(1)
CLINICAL EXAMPLES	69	(1)
MODIFIERS	70	(1)
CHOOSING EVALUATION AND MANAGEMENT CODES	70	(3)
DOCUMENTATION GUIDELINES	73	(1)
WHAT IS DOCUMENTATION AND WHY IS IT IMPORTANT?	74	(1)
WHAT DO PAYERS WANT AND WHY?	74	(1)
GENERAL PRINCIPLES OF MEDICAL RECORD DOCUMENTATION	75	(1)
DOCUMENTATION OF E/M SERVICES	76	(1)
DOCUMENTATION OF HISTORY	77	(2)
CHIEF COMPLAINT	79	(1)
HISTORY OF PRESENT ILLNESS	79	(1)
REVIEW OF SYSTEMS	80	(1)
PAST. FAMILY AND/OR SOCIAL HISTORY	81	(1)
DOCUMENTATION OF EXAMINATION	82	(4)
GENERAL MULTI-SYSTEM EXAMINATIONS	84	(1)
SINGLE ORGAN SYSTEM EXAMINATIONS	85	(1)
GENERAL MULTI-SYSTEM EXAMINATIONS	86	(5)
CONTENT AND DOCUMENTATION REQUIREMENTS	90	(1)
CARDIOVASCULAR EXAMINATION	91	(3)
CONTENT AND DOCUMENTATION REQUIREMENTS	93	(1)
EAR. NOSE AND THROAT EXAMINATION	94	(4)
CONTENT AND DOCUMENTATION REQUIREMENTS	97	(1)
EYE EXAMINATION	98	(3)
CONTENT AND DOCUMENTATION REQUIREMENTS	100	(1)
GENITOURINARY EXAMINATION	101	(4)
CONTENT AND DOCUMENTATION REQUIREMENTS	103	(2)
HEMATOLOGIC/LYMPHATIC/IMMUNOLOGIC EXAMINATION	105	(3)
CONTENT AND DOCUMENTATION REQUIREMENTS	107	(1)
MUSCULOSKELETAL EXAMINATION	108	(3)
CONTENT AND DOCUMENTATION REQUIREMENTS	110	(1)
NEUROLOGICAL EXAMINATION	111	(3)
CONTENT AND DOCUMENTATION REQUIREMENTS	113	(1)
PSYCHIATRIC EXAMINATION	114	(3)
CONTENT AND DOCUMENTATION REQUIREMENTS	116	(1)
RESPIRATORY EXAMINATION	117	(3)
CONTENT AND DOCUMENTATION REQUIREMENTS	119	(1)
SKIN EXAMINATION	120	(3)
CONTENT AND DOCUMENTATION REQUIREMENTS	122	(1)
DOCUMENTATION OF THE COMPLEXITY OF MEDICAL DECISION MAKING	123	(5)
NUMBER OF DIAGNOSIS OR MANAGEMENT OPTIONS	123	(1)
AMOUNT AND/OR COMPLEXITY OF DATA TO BE REVIEWED	124	(1)
RISK OF SIGNIFICANT COMPLICATIONS. MORBIDITY AND/OR MORTALITY	125	(2)
TABLE OF RISK	127	(1)
DOCUMENTATION OF AN ENCOUNTER DOMINATED BY COUNSELING OR COORDINATION OF CARE	128	(1)
OFFICE AND OTHER OUTPATIENT SERVICES	129	(1)
CLINICAL EXAMPLES FOR OFFICE EVALUATION AND MANAGEMENT SERVICES	129	(4)
HOSPITAL OBSERVATION SERVICES	133	(1)
HOSPITAL INPATIENT SERVICES	134	(1)
CONSULTATIONS	135	(1)
EMERGENCY SERVICES	136	(1)
CRITICAL CARE SERVICES	137	(1)
NEONATAL INTENSIVE CARE	138	(1)
NURSING FACILITY SERVICES	139	(1)
DOMICILIARY, REST HOME OR CUSTODIAL SERVICES	140	(1)
HOME MEDICAL SERVICES	140	(1)
PROLONGED SERVICES	140	(1)
CASE MANAGEMENT SERVICES	141	(1)
CARE PLAN OVERSIGHT SERVICES	141	(1)
PREVENTIVE MEDICINE SERVICES	142	(1)
NEWBORN CARE	142	(1)
SPECIAL SERVICES AND REPORTS	143	(1)
MISCELLANEOUS SERVICES	143	(1)
SERVICES RENDERED AFTER REGULAR HOURS	143	(1)
SERVICES RENDERED AT SPECIAL LOCATION	143	(1)
OFFICE EMERGENCY SERVICES	143	(1)
EXERCISE 4: EVALUATION & MANAGEMENT SERVICES	144	(3)
ANESTHESIA SERVICES	147	(6)
GUIDELINES	147	(1)
SUBSECTION INFORMATION	148	(1)
TIME REPORTING	149	(1)
PHYSICIANS' SERVICES	149	(1)
MATERIALS SUPPLIED BY PHYSICIAN	149	(1)
SEPARATE OR MULTIPLE PROCEDURES	149	(1)
SPECIAL REPORT	149	(1)
ANESTHESIA MODIFIERS	149	(1)
PHYSICAL STATUS MODIFIERS	150	(1)
OTHER MODIFIERS	150	(1)
QUALIFYING CIRCUMSTANCES ANESTHESIA	151	(2)
SURGERY SERVICES	153	(22)
GUIDELINES	153	(1)
PHYSICIAN'S SERVICES	153	(1)
LISTED SURGICAL PROCEDURES	153	(1)
FOLLOW-UP CARE	153	(1)
FOR DIAGNOSTIC PROCEDURES	153	(1)
FOR THERAPEUTIC PROCEDURES	153	(1)
MATERIALS SUPPLIED BY PHYSICIAN	154	(1)
MULTIPLE SURGICAL PROCEDURES	154	(1)
ORDER OF LISTING	154	(1)
BILLING FULL VERSUS REDUCED FEES	155	(1)
SEPARATE PROCEDURE	155	(1)
SUBSECTION INFORMATION	156	(1)
UNLISTED SERVICE OR PROCEDURE	156	(1)
SPECIAL REPORT	157	(1)
MODIFIERS	157	(2)
STARRED PROCEDURES	159	(2)
SURGICAL DESTRUCTION	161	(1)
WOUND REPAIR	161	(1)
SIMPLE REPAIR	161	(1)
INTERMEDIATE REPAIR	161	(1)
COMPLEX REPAIR	161	(1)
STEPS FOR CODING WOUND REPAIRS	161	(1)
FREE SKIN GRAFTS	162	(1)
MUSCULOSKELETAL SYSTEM	163	(1)
GRAFTS OR IMPLANTS	163	(1)
RECONSTRUCTION OF ORAL AND FACIAL DEFORMITIES	164	(1)
APPLICATION OF CASTS	164	(1)
ARTHROSCOPY	164	(1)
RESPIRATORY SYSTEM	164	(1)
CARDIOVASCULAR SYSTEM	165	(1)
VASCULAR INJECTION PROCEDURES	165	(1)
HEMIC AND LYMPHATIC SYSTEMS	166	(1)
MEDIASTINUM AND DIAPHRAGM	166	(1)
DIGESTIVE SYSTEM	166	(1)
URINARY SYSTEM	166	(1)
URODYNAMICS	166	(1)
CYSTOSCOPY, URETHROSCOPY AND CYSTOURETHROSCOPY	167	(1)
MALE GENITAL SYSTEM	167	(1)
FEMALE GENITAL SYSTEM	168	(1)
MATERNITY CARE AND DELIVERY	168	(2)
ANTEPARTUM CARE	168	(1)
DELIVERY	169	(1)
POSTPARTUM CARE	169	(1)
COMPLICATIONS OF PREGNANCY	169	(1)
PARTIAL MATERNITY SERVICES	169	(1)
ENDOCRINE SYSTEM	170	(1)
NERVOUS SYSTEM	170	(1)
SURGERY OF THE SKULL BASE	170	(1)
EYE AND OCULAR ADNEXA	170	(1)
AUDITORY SYSTEM	171	(1)
EXERCISE 5: ANESTHESIA AND SURGERY	172	(3)
RADIOLOGY SERVICES	175	(6)
GUIDELINES	175	(1)
SUBJECT LISTINGS	175	(1)
SEPARATE OR MULTIPLE PROCEDURES	175	(1)
SUBSECTION INFORMATION	175	(1)
COMPLETE PROCEDURES	176	(1)
SUPERVISION AND INTERPRETATION ONLY	176	(1)
MODIFIERS	176	(1)
BILATERAL PROCEDURE CODES	177	(1)
SPECIAL MEDICARE CONSIDERATIONS	177	(1)
DIAGNOSTIC ULTRASOUND	177	(1)
THERAPEUTIC RADIOLOGY	178	(1)
CONSULTATION OR CLINICAL MANAGEMENT	178	(1)
CLINICAL TREATMENT PLANNING	179	(1)
CLINICAL TREATMENT MANAGEMENT	179	(1)
NUCLEAR MEDICINE	179	(2)
HCPCS RADIOLOGY EQUIPMENT TRANSPORTATION CODES	180	(1)
LABORATORY SERVICES	181	(4)
GUIDELINES	181	(1)
SERVICES IN PATHOLOGY AND LABORATORY	181	(1)
SUBSECTION INFORMATION	181	(1)
MODIFIERS	182	(1)
ORGAN OR DISEASE PANELS	182	(1)
PATHOLOGY CONSULTATIONS	183	(1)
SURGICAL PATHOLOGY	183	(1)
EXERCISE 6: RADIOLOGY AND LABORATORY	184	(1)
MEDICINE SERVICES	185	(24)
GUIDELINES	185	(1)
MULTIPLE PROCEDURES	185	(1)
ADD-ON CODES	185	(1)
SEPARATE PROCEDURES	185	(1)
SUBSECTION INFORMATION	186	(1)
UNLISTED SERVICE OR PROCEDURE	187	(1)
MODIFIERS	187	(1)
SPECIAL REPORT	188	(1)
MATERIALS SUPPLIED BY PHYSICIAN	188	(1)
IMMUNIZATION INJECTIONS	188	(1)
THERAPEUTIC OR DIAGNOSTIC INFUSIONS	189	(1)
THERAPEUTIC OR DIAGNOSTIC INJECTIONS	189	(1)
DRUGS ADMINISTERED OTHER THAN ORAL METHOD	190	(1)
PSYCHIATRY	190	(1)
PSYCHIATRIC CONSULTATIONS	191	(1)
DIALYSIS	191	(1)
GASTROENTEROLOGY	192	(1)
OPTHALMOLOGY	192	(4)
INTERMEDIATE OPHTHALMOLOGICAL SERVICES	192	(1)
COMPREHENSIVE OPHTHALMOLOGICAL SERVICES	193	(1)
SPECIAL OPHTHALMOLOGICAL SERVICES	194	(1)
DETERMINATION OF THE REFRACTIVE STATE	194	(1)
CONTACT LENS SERVICES	195	(1)
SPECTACLE SERVICES	195	(1)
HCPCS CODES FOR VISION SERVICES	196	(1)
OTORHINOLARYNGOLOGIC SERVICES	196	(1)
AUDIOLOGIC FUNCTION TESTS WITH MEDICAL DIAGNOSTIC EVALUATION	196	(1)
HCPCS CODES FOR HEARING SERVICES	197	(1)
CARDIOVASCULAR SERVICES	197	(1)
SPECIAL MEDICARE CONSIDERATIONS	197	(1)
NON-INVASIVE VASCULAR STUDIES	197	(1)
SPECIAL MEDICARE CONSIDERATIONS	198	(1)
PULMONARY SERVICES	198	(1)
SPECIAL MEDICARE CONSIDERATIONS	198	(1)
ALLERGY AND IMMUNOLOGY	198	(1)
OTHER ALLERGY MEDICAL SERVICES	199	(1)
ALLERGEN IMMUNOTHERAPY	199	(1)
NEUROLOGY AND NEUROMUSCULAR PROCEDURES	199	(1)
SPECIAL MEDICARE CONSIDERATIONS	199	(1)
CHEMOTHERAPY ADMINISTRATION	200	(1)
CHEMOTHERAPY DRUGS	201	(1)
PHYSICAL MEDICINE AND REHABILITATION	201	(1)
SPECIAL PHYSICAL MEDICINE CODING ISSUES	201	(1)
OSTEOPATHIC SERVICES	201	(1)
CHIROPRACTIC SERVICES	202	(1)
DOCUMENTATION OF TREATMENT PHASE	202	(1)
SPECIAL SITUATIONS	203	(1)
SPECIAL SERVICES AND REPORTS	203	(3)
MISCELLANEOUS SERVICES	204	(1)
SERVICES RENDERED AFTER REGULAR OFFICE HOURS	204	(1)
SERVICES RENDERED AT SPECIAL LOCATION	205	(1)
OFFICE EMERGENCY SERVICES	205	(1)
SUPPLIES AND MATERIALS	205	(1)
SPECIAL REPORTS	206	(1)
TRANSPORTATION SERVICES	206	(1)
MISCELLANEOUS/EXPERIMENTAL	206	(1)
DENTAL PROCEDURES	206	(1)
REHABILITATIVE SERVICES	207	(1)
TEMPORARY CODES	207	(1)
EXERCISE 7: MEDICINE SERVICES	208	(1)
APPENDIX A: ANSWERS TO CODING EXERCISES	209	(8)
INDEX	217