I want us to go over a few things
regarding the CPT code book in this
podcast. I've tried different ways to do
this and there isn't a good way
that I can show you both pages at the
same time and show you the entire page.
so we're just going to see what I can do
here and I'll do the best I can. On the inside
cover, this is the outside cover, the
inside cover you see here all these
modifiers and we will be talking about
these a lot especially these and these a
lot this semester and here's the symbols
for interpreting what they mean and
these are also reproduced at the bottom
of the pages of the CPT, in case you forget.
The Anesthesia Physical Status (codes) are here.
That's only applying to Anesthesia codes.
These modifiers, depending on which
one you choose, some are applicable for
physician (coding and billing) and some are applicable for
hospitals (coding and billing), what will be assigned and how
it would be assigned. The place of
service codes here this is just for when
you are filing a claim for payment you
have to say where the treatment or the
procedure took place. So this is the
code book that people that are entering
that information are getting it from this page.
Table of Contents is just what it is in
any book. It's a good overview of
everything that's covered but I do have
to suggest that perhaps you're looking
for something specifically and you can't
find it. I do recommend that you would
just go to that part of the Table of
Contents maybe and see if you can find
it, depending on what you're looking for.
The majority of the codes that we will
talk about are in the Surgery section.
There are all the different body systems.
If you look over here, right here, this is
the Surgery Section and all the
different body systems that are included.
Then all the different appendices
are here. The main one you are going to
use is Appendix A, which is right up here.
It talks about the modifiers. That's the
main one that you'll be using and then
when we get to E&M codes, evaluation and
management codes ,you might be looking at
Appendix C because there's a lot of
clinical examples there. Then if we come
into the Introduction section here and
read through that. The main thing I
want you to notice about this under
"Format of the Terminology" is how to read
these code descriptions. Let me see if I
can blow this up so it's a little bit,
let's see if I can blow it up, make it a
little bit bigger
and what I want to show you is you have
the code and then you have a description
and then there'll be a semicolon and
then in the codes that follow (the semicolon) you pick up
on all the words that were present
before the semicolon and then you jump
down to this one. So in other words in 25105, it would read arthrotomy, wrist
joint with synovectomy 25100 reads
Arthrotomy, wrist joint with biopsy and
that semicolon is what you're looking
for. Whenever you're seeing these codes,
many times you will have several codes
going down the page but they all share
that common beginning point so you're
looking for that semicolon. So let's find
a couple in the codebook and see if I
can show you some examples of that.
It's very common so it shouldn't be hard
to find. So if we look here, let me see if
I can blow it up a little bit more,
okay, under 49491, we read this as
"Repair, initial inguinal hernia, preterm
infant, younger than 37 weeks gestation
at birth, performed from birth up to 50
weeks postconception age with or
without hydrocelectomy" and then you
see a semicolon right there. The next
modifying term is "reducible" so then when
you were looking,
and if we look at
49492, you're going to go back up here
and you're going to read exactly the
same until you get to the semicolon and
then instead of saying "reducible" you
would say "incarcerated or strangulated".
While we're looking, a couple of things I
want to bring to your attention. There
are publications that AMA puts out "CPT Changes"
is one. CPT Assistant is one.
We look at these for guidelines or guidance.
If you remember from your HIT220/221 class,
we talked about "Coding Clinic".
Coding Clinic is specific to ICD codes.
CPT Assistant is specific to CPT codes
so we would be looking at those two
things as a reference to see where this
came from. I also want to show you
there's instructional notes in CPT just
as there is in the ICD (codebook). In this
particular one, it says "Do not report
modifier -63 in conjunction with these
two codes" 49491 and 49492
and let's say you think "what's modifier
63?" If we go to the front of the
CPT codebook, let's look under here, (Modifier) 63 -procedures
performed on infants less than four
kilograms. So that's how you might read a
little bit in here and make those
decisions. If we kept going down (the page),
there's an explanation here for what
"postconception age" means. It defines it.
The hard thing, I think about CPT, to me
at least, is that it's a lot of reading and
it's so easy to not read it in its
entirety in a given passage and kind of
brush over it. You can bet if you rush it
you're going to miss something so at
least in the very beginning stages when
you're learning to use the code book,
take your time, really take your time and
read it carefully. Okay, let me see if I
can show you another one. I've got it
blown up 3X so it looks like it's
fairly well. It's just hard to do that.
Okay here's one under 65130
insertion of an ocular implant secondary
after evisceration in scleral shell. It
looks like the semicolon is right here
instruction of ocular implant secondary
semicolon after evisceration in scleral
shell and this code would be read
insertion of ocular implant secondary
after enucleation muscles not attached
to implant and 65140 would say
insertion of ocular implant secondary
after enucleation muscles attached to
implant so you see the
very minor differences but they're so
important. A lot of times you see the word
"not", that little word "not" in 65135 is the
only distinction between 65135 and 65140
so it's so important that you do
that. The other thing I want to say
about the code book is the index. I want
to talk about that for a bit. I think
sometimes students get frustrated
because they want me or someone to tell
them exactly how to find something and
not to be chasing their tail. Well,
unfortunately, that's not how it works.
The main terms, when you're looking those
up, a main term can be either the
procedure you're looking up, like an
endoscopy; the organ that's affected, the
examples given there is tibia, not just
organs or anatomic sites that are affected
(tibia, colon, salivary gland); the
condition, like an abscess; or a synonym,
an eponym which is someone's name
given to a procedure or an abbreviation.
So you really, if you don't find it under
one type of main term, you're going to
look under another and that's that. Trial
and error is how you'll find it. Now as
you have more years coding and get some
experience, you will more rapidly know
where to look that up but when you first
start coding, it's just very time
consuming and that's why I think
students are always surprised at how
long it takes to do homework. But that's
why. It isn't black and white. You
really have to try different things
until you find what you're looking for.
>any times in the index you'll find a
code range. It will give you (a range). When
more than one code applies to a given
index entry, you get a code range. So
really all you can do is go back to the
code book itself and start with that
first number in the (code) range and just start
reading them until you find the
description that matches exactly what
you're looking for. The only
other word of warning i would say i
guess about the Index is to really watch
your indentation levels. It
follows like the bypass, the resection
then you get to device and these words
come under device so placement of the
device, removal of the device, replacement
of the device, revision of the device so
those all go together and then you
see port component along the same lines
of the device. Just really watching
your indentations. Also similar to when I
taught diagnosis coding. if you don't
know procedure or body part that's named,
use your Google search engine to look
those up. It is very helpful. Let's see this
word right here "Bardenheurer"
Let's see if I can figure out how to
spell that .I type in
Bardenheurer operation, put a colon
and look at this. It tells us it is an
operation for the ligation of the innominate
artery, so if you go to that website, you
can read and get more information about
that. Another thing you could do
in addition to
looking there with your Google search
engine is to go to YouTube. If you're
going to be a serious coder, you are going
to get very acquainted with YouTube.
There are so many things you can watch
and learn or hear a lecture about here.
So when I look up this here in YouTube, I
see an anatomy review course, innominate
artery bleed controlled arterial
ligation. Then there's some videos there
for artery and surgery so you see all
the different things. I mean there is
literally anything you want to look at.
That's all. If you have any questions, let
me know. If you're serious about coding,
you're going to be doing this kind of
extra work to learn as much as you can
about procedures because even if you're
working in the field, new things are
being developed all the time. It's
important that you stay on top of it. If
you have any questions or you find any
interesting articles when you're on the
internet. please put a link in the
discussion board so we can all go look
at it. Thank you so much and please make
a point of watching the podcast that I'm
creating for each chapter. I'll be going
over some of the problems that are in
the book as well as talking about the
types of questions that might be on
exams so it really does behoove you to
take the time to spend watching this
podcast with me. I try to make them no
longer than 15 minutes so that you can
really get a concise idea of what's in
the chapter and what's important but
nothing replaces the time it's going to
take you to use your code book finding
codes. That's just how you learn to
code. I did some research on the internet
to see if i could find out how other
people were teaching students the use of
the code book and I found some
interesting things that I thought made
sense. I didn't learn to code this way
but I don't think it's a bad idea so
what I'm going to try to do while I'm
recording this podcast is talk to you
about the different things I've read and
if you find something rings true when
you hear it, then definitely incorporate
that as your way of learning to use the
code book. The thing I learned about most
recently was using annotation in
specific ways to identify the format of
the CPT code book as you go through it
so that you can more easily read the
codes. I thought it made sense so we're
going to look at a few of those and see.
Let's go to the document camera and
I've chosen to show you what I learned
under the Shaving of Epidermal or Dermal
Lesions.
Now what I was told was that
you should circle a family and a family
is when you have a common core
description, all the language up to
your semicolon so you circle
that family. In this case, this
family., If there had been any
parenthetical notes down here, you would
include that in your circle and then you
take a highlighter. I'm using pink but
you can use whatever and you highlight
the words after the semicolon. In this
case, it would be lesion diameter and
then here's the other words after the
semicolon.
Then the next thing it advises you to do
is to underline unique words that you
should notice and I think in this case
it would be "single" so I'm going to
underline that and I'm going to
underline epidermal or dermal. Now
hopefully, when I go to select a code, it's
going to really stand out to me which
one I should use. Let's do it again with
this one. Shaving of epidermal or dermal
lesion, single lesion, scalp, neck, hands,
feet, genitalia, lesion diameter
there's the lesion diameter again after
your semicolon. Here what is unique about
these. This one is trunk, arms or legs.
This one is scalp, neck, hands, feet,
genitalia and the next family
talks about something different. So let's
circle this one. They all go together. Now
this one is talking about the shaving
face, ears, eyelids, nose, lips, mucous
membrane and then after the semicolon
lesion diameter. So that's one way that
I've seen and I think it makes sense.
I especially liked it because it groups
the codes together. I forgot to
circle this one. This is a separate
family. So i'm going to try to do that as
i move through my codebook this time but
i'm going to show you some things today.
You're going to see where I had made
some notes before I decided to try and
use this annotation technique. You get
the idea I think.