Today we'll look at Chapter 2- the
Application of the CPT System and just
go through a few exercises. As you become
more familiar with your code book. it
will come a little bit easier. I want to
review the main terms. This
information is taken from the Index. I'll
show you that on the document camera in
just a minute. There's four primary ways
you're going to look up your main terms.
One is by the name of the procedure or
the service; another is the organ or the
body system or the anatomic site that
you're having the procedure on; the
condition that precipitates the
procedure or something related to it; a
synonym, eponym, or abbreviation so there's
four primary ways you're going to
look for something. So if we take a
minute and look in the code book, you'll
see where I took this from. This is
something that will just be second nature
very soon. Here you see, we are in the
index. This is the very first page of the
index that says Main Terms . Here's
those four ways that you can look up
some terms. Sometimes they stand alone;
sometimes they're followed by modifying
terms but you're going to start looking
for your code in one of these four ways
the majority of the time. Okay let's look
at this one. A patient presents with a 1
centimeter carbuncle on the posterior
section of the neck. The surgeon performs
an incision and drainage. A carbuncle is
like an abscess. The ICD-10 code is here
and that is our medical necessity
that would justify this procedure. So
then you look at those four questions,
What's the procedure that we're coding?
Incision and drainage. What part of the
body" The skin of the neck. What's the
condition? A carbuncle on the neck.
Any synonym, eponym or abbreviation? Not in this
case, not applicable.
So if we look in the Index, under
Incision and Drainage, we find the term
"carbuncle". It gives us the code 10060, 10061
then you go to the CPT code
book, you look up that code in the
Integumentary System. You read it and
determine which of these two codes from
the index would be the right answer to
describe this diagnostic statement.
It would be the 10060. If the physician
had documented a lot more information
that would qualify for a "complicated" or
if he had drained
multiple abscesses, then you would use
the 10061. Okay the first one was
looking at a procedure and finding the
main term under Incision and Drainage.
Now let's look at one that we have to
look at our main term a little bit
differently. The diagnostic statement is
the biliary catheter exchange . What's the
procedure? It is a catheter exchange.
What body part? A bile duct. The condition?
They don't tell us. Synonym, eponym, abbreviation? Not applicable.
So the only thing we have
to work with is the biliary tract or
bile duct and it's a catheter exchange.
So we just start looking for main terms
that would help us identify that. I tried
"exchange" (as the main term) first and the index wasn't
helpful. There's so few modifying terms
there but not the "exchange" of a biliary
catheter. Then I tried "bile duct" next.
Nothing there. Then I tried "bile duct, catheter".
Nothing there and then
"bile duct exchange". Nothing there. Okay it has
to be here somewhere so then I just
start reading all the sub terms under
"bile duct" and I get to "drainage" and then
you can just quickly scan and after
"drainage", you see the "catheter" and then
under the "catheter: you see "exchange" so
you found it. That is exactly what
it's like to find a code, but
not all the time. Sometimes it's very
straightforward' sometimes it isn't.
This example isn't that straightforward
but you see how you can work around to
get to, to keep narrowing down your
choices until you can just read the text.
Let's try another one. Ablation of a
polyp in the esophagus. What's our main
term" Ablation. If you don't know the
meaning of a term, go to your Google
search engine, type in "ablation" followed
by a colon (ablation:) and that will take you to
some definitions. You can read what
that means or if you have a medical
dictionary, you can look it up there.
Ablation is "destruction". The anatomic
site we're talking about? The esophagus.
Tthe condition? Patient has a polyp in the
esophagus. The last bullet point
doesn't apply. Now we've got ablation,
or esophagus or polyp (to choose as our main term). So under "ablation",
there were no sub terms for polyp or
esophagus but when I went to "polyp" (as the main term) I did
find esophagus and under esophagus, I found ablation.
So I was able to find it using
the "condition" in this case. So when you
go to look up that code that's given
that 43229, that code description
begins with the word "with" meaning that
it is tied back to some code description
in previous codes before the semicolon (in the description).
Remember in one of our lectures, we
talked about the information up
to the semicolon and all the codes under
the code you're looking at uses that
same "core", if you will, that same
description up to the semicolon. Then
after the semicolon, you see the
differentiation between those codes so
you would have to get to 43229
and read previous codes until
you got to the "core", to the main
descriptor and there's many before this
one. Let's do another one- closed
reduction of the fractured neck of the
radius with manipulation.
So the main term? Your procedure is
closed reduction with manipulation and
the reason why that's important, when you
get to choose your codes, one of the codes
will say "with manipulation" and one will
say "without manipulation". Organ or
anatomic site? It is the neck of the radius.
The condition? It is a fracture. So those are
the three things we know from this
diagnostic statement that we can begin
to look for a term.So we go the index.
There's no sub term for "radius" under
"reduction" so we're going to go to a
different main term. Let's say we start
with "fracture, radius, closed treatment" and
that takes us to this set of codes. But
when we look up that range of codes in
the code book, they are for the "closed
treatment of the radial and ulnar
fracture" so you've got two broken bones
in your forearm. So then we're going to go
back to the index and we're going to
look for codes that describe just the
radius, the neck of the radius and don't
include the ulna. So when I go back to
the index and start reading down a
little bit further. you get to "fracture,
radius head / neck, closed treatment and
there's your code range. Now we go to
that section of the CPT book we see the
codes are just for the radial head "or"
the neck fracture. We have to choose
between "without manipulation" and "with
manipulation" . Now I want to look at some
examples of test questions so that you
know the types of questions you're going
to see on exams and the types of
questions that you might see on a
national exam. If you're taking the RHIT
exam or one of the coding exams in
your future. This particular question
talks about codes 11200 through 11201
which are removal of skin tags. The question is
asking, "What's the correct code for the
removal of 16 skin tags?" So let's go to
the code book and look at that.
Okay, so I went to the codes in the
codebook. This is in the Integumentary
System. The removal of skin tags has its
own section and the code description for
11200 says "up to and including 15
lesions". In our question it was "16" and as
you see in the code description for 11201 is
each additional 10 lesions or part thereof so what that
means for the removal of 16 skin tags
you're going to have to use (two) codes 11200
and code 11201. That is written
with a comma between those. (11200, 11201). I also want
you to notice the little add-on code
there. That tells you that that code 11201 would not be used alone. It has to be
used along with 11200 in order for to
makes sense because it is each
additional 10 lesions or part thereof.
There's your answer: 11200, 11201.
Okay let's look at an
example of another test question. I'm
showing you these to show the types of
questions that I can ask on the exam
that you won't be surprised. What i'm
asking you to do is to go to these codes
and read the code descriptions and by
reading them, you should be able to
assign codes. So it's not so much this
time about looking up a code as it is
about being able to read carefully the
code descriptions and choose the codes
that best describe the procedure that
we're doing. Let's look at another one
Reference codes 31360 through 31368
for a laryngectomy. What is the correct
code assignment for a laryngectomy with
subtotal supraglottic and radical neck
dissection? So you're going to actually
read those code descriptions. So let's
start with 31360 and here we are in the
code book and you see 31360
laryngectomy total without radical
radical dissection. Then we have a
total, with radical neck dissection then
we have 31367, subtotal superglottic, without
radical dissection. 31368 subtotal
supraglottic with radical neck
dissection so our answer would be 31368.
That code description describes exactly
what our diagnostic statement there says
it does. So, 31368 is the correct code
assignment for a laryngectomy with
subtotal supraglottic and radical neck
dissection. Okay let's do another one.
Reference codes 49491 through 49525
for inguinal hernia repair. What you
want to notice for these, this particular
case, it's an "initial" inguinal hernia
repair, it's incarcerated and the
patient's 47 years old. Those are all
things we need to know when we choose
this code. So let's go to 49491 and the
code book 49491 Repair
initial inguinal hernia, preterm infant,
Well, we know that's not right so when we
go to the next one 49492, this
incarcerated or strangulated goes with
this code for the preterm infant (49491). So we
know it's not either of those. So let's
move down to this one, 49495
Repair, initial, inguinal
hernia, full-term infant younger than 6
months or preterm. Ok, we know we're in
the wrong neighborhood again. So let's
try another one. This code 49496
goes with the bottom of the other (previous) one so
now we're up to 49500. This is for
someone age six months to younger than 5.
Okay that's not right either. Now let's
go here 49505 repair, initial inguinal,
hernia, five years or older., reducible.
Okay well most of that's right. We
do have a repair and the person is older
than five years old but the "reducible" is
the problem.This is an incarcerated or a
strangulated hernia so then we go the
code under that, 49507 and this is what is
described. So this is very close- repair,
initial, five years or older, incarcerated,
strangulated 49507. You notice that
these (include the word) "initial", all the codes up
to this point. Our initial inguinal
hernias and this one is a "recurrent" (hernia) so
the exercise we are coding was
initial. So I'm going to say it's 49507
and here we go. That is the correct
answer so you see that even though we
haven't studied these body systems yet, I
can still ask you these questions on an
exam because I'm not asking you to find
a code. I'm asking you to read the codes
that I've given you and be able to
determine differences in them and select
the one that describes whatever
procedure or service that I am giving
you to define.
Okay the last thing I want to say is
that you can use either the CPT Index
which is what I've gone over here or you
can use the code book, if you know the
different body sections, to find a code.
If you cannot find a code, you can
certainly ask questions of me on
discussion board or by phone or by email
but whenever you contact me, I expect you
to tell me what path you tried to find a
code. We don't learn to code by having
someone else tell us how they found the
code. We learn to code by looking for it,
by knowing how to use the code book. So
whenever you post a question, that (pathway) has to
accompany your question. Okay if you have
any questions, please post them in Discussion Board and
have a good week.