Hello, today we're going to start Chapter
8 which is the Medicine chapter in
the CPT code book. There are four
separate parts, which is four separate
podcasts. There is a large amount of
material in this chapter. It covers just
about everything that isn't covered
elsewhere in CPT code book. I did not go
in and type all of the sections and
subsections onto a PowerPoint slide but
my suggestion is that you would go to
the front of Chapter 8 in your code
book and just look at all of those
topics. Those in green (main heading level) are your sections
and then below that are your subsections
and below that are specific procedures
within that subsection. There are
literally three pages of topics that are
part of the outline to the Table of
Contents. So be sure and go there. The
PowerPoint slides will cover some of the
guidelines and some of the sections, not
all of them, but you are expected to read
all of your code,book sections,
descriptions as well as your chapter in
this (CPT) textbook. Don't forget that there
are guidelines throughout the CPT
chapters, either in front of sections,
within them or after them, depending upon
how it's written. Most of the ones I
think in this chapter are found before
the section begins. Alright, let's jump in
and we'll start with Immunizations and
Injections. there's two slides that talk
about this. One of the biggest things
you're going to have to remember is that
not only are you coding for the vaccine
itself but you're also coding for the
administration of the vaccine. There
are separate codes that exist for that.
You have to really read your
descriptions because some of the
descriptions tell you one single
substance; one says multiple substances. You
must read your code description.
The guidelines remind us that the coder
has both the administration code and the
code for the product that has to be
selected. The code range 90460
through 90474 is reporting the
administration of a substance and then
90476 through 90749 identify the
type of immunization or the type of
vaccine and that would include, I just
have a few examples, but there's many
examples in a CPT code book. The codes
are based on how the immunization was
administered because you can have an IM
(an intramuscular injection), you would
have an intranasal method, however,
there's different ways. It's
differentiated (by) the number of vaccines
(single versus multiple), the age of the
patient and whether or not counseling
was provided by the physician or other
qualified health care professional. I
don't think physicians very often give
these shots. It usually is the nurses
or a PA or a nurse practitioner but
remember that the CPT codes can be
used by any qualified health care
professional, not just the physician.
On the second slide, it reminds us that when
a significant, separately identifiable
E/M service is performed at the same time
that the patient's getting that vaccine,
the appropriate E&M service code can be
appended with modifier -25 when you're
reporting your codes for that visit. The
CPT guidelines do not instruct the
code to add the -25 modifier but the author
of the CPT textbook and I, given my
experience, recommend that you use the
modifier -25. I talked to a veteran coder
and she reminded me that in some
settings and she thought it was the
Ambulatory Surgery section, Ambulatory
Surgery setting, you could not use a
-25 modifier so that's why the code book
doesn't necessarily advise us to use it.
We are expected to use our judgment
when you're coding for a facility and
the veteran coder and I agreed that if
you were coding for a physician's office,
the patient is receiving this
immunization as
well as something comes up and he
decides to have an E/M service code, you
would append modifier -25 to the E/M
service code. If you don't do that, you're
going to probably get one of those two
things denied, either the physician visit
denied or the administration and the
immunization denied. Here's an example of
this type of thing in Exercise 8.1 #2
A five year old
patient receives an immunization
injection for measles, mumps, rubella
and varicella. Varicella is chicken pox.
The pediatrician counsels the mother
about potential side effects. So we have
the patient's age, we have the vaccine that's
being given and we have the fact that
counseling was offered. Three things that
are part of our code description. the MMRV
is four components so when you have a
four-component vaccine, you need four
administration codes. I followed the same
format we've been using where I give you
the scenario on one slide, invite you to
try to find the answer before you
proceed to the slide with the answers.
There are four components, so we need four
administration codes. When we read code
90460, it tells you it's one single
substance so then you have to go to 90461
which is described as "each
additional vaccine or toxoid, with
counseling". We have four total. The 90460
accounts for one of those so we need
to list 90461 times 3. I have
seen this as "x 3" and I've also seen the same code
listed three times so it depends on
where you work how they want you to
enter your codes. They will tell you
that as part of their orientation or if (the software) it
won't accept the "x 3" then you know
you've got to type it or enter 90461
3 times. So now you've got your four
administration codes. Now you need your
code for the substance and that is 90710,
the vaccine for MMRV. There's another
(exercise) that has to do with immunization. It's
Exercise 8.1 #4: A 19 year old
female receives IM injection for an HPV
virus,
described as nonavalent,
9xHPV, 3-dose schedule. Here's
your answers. There is just one component,
the HPV virus. You only need one
administration code and I have the word "or"
there to show you that you could even
use the main term "Immunization" or the
main term "Administration" and then your
vaccine is a human papillomavirus. You
would need to know what HPV stands for.
You will learn quickly all these
acronyms in the medical field but if you
have difficulty with that, you can always
google the word or term on your internet or you can
have a little separate notebook or
something that you keep as you learn
these acronyms.Eventually they will
be second nature. Here's an example that
is not in the CPT textbook. I have it
listed as an exam example because you
will see you this item or something very
similar to it on future exams in this
course. I'm doing this for two reasons. I
want to see who's looking at these podcasts
because if you were watching these
podcasts, you should do well on the exams.
I don't have anything on these exams
that isn't covered by content within
these podcasts. So if you're reviewing the
podcast, attempting to work the exercises,
you will do well on these exams.This
particular example, 34 year old patient
receives an administration of Tdap
(Tetanus diphtheria toxoids and acellular
pertussis) by IM injection. IM is "intramuscular".
True or False? The correct codes are 90460, 90714.
The answer is false and there's your
codes. So what I'm trying to get you to
see is that I may write exam items in different
ways. Sometimes you'll have to find a CPT
code, sometimes it'll be true/false,
sometimes it'll be multiple choice.
Either way, you're going to have to find
codes to be able to answer the questions.
Here's the rationale and the codes
for that how I got that answer. Tdap is
three substances (tetanus, diphtheria
toxoids and the pertussis) so you will
need three administration codes and your
code for the Tdap. We're going to start a
new section now with Psychiatry.
Psychiatry can be provided in an
outpatient or inpatient setting or a
partial hospital setting depending on
how your institution is defined. When E/M
services are provided along with
services from the Psychiatry section, a code
from E/M and a code from Psychiatry are
reported at the same time. Time is an
important factor in the selection of
these codes. Let's look at one of the
examples. Exercise 8.2 Psychiatry #2
This is for an individual session
with behavior modification and insight
oriented psychotherapy in the office for
45 minutes.Time is an important factor.
Our code is Psychotherapy as main term, individual
patient; there's the code range. 90832-90834
fits the code description for what we
need.
New section- we'll talk about Dialysis.
There is a Table 8.1 in the 2016 CPT
textbook. It should be very similar in
future editions of the textbook. It shows
you that there are four subcategories of
codes under this section. There's
Hemodialysis, Dialysis, End-stage renal
disease services and Other dialysis
procedures. Hemodialysis is when you are
hooked up to a machine and your blood
(hemo=blood) is actually filtered. When
you look at this set of codes, it
differentiates between inpatient ESRD (end
stage renal disease) and non-ESRD
procedures or outpatient
non-ESRD dialysis
services. So you read your code descriptions
very carefully after you've read your
scenario. Dialysis procedures is for
those types of dialysis other than hemodialysis
Peritoneal comes to mind. In
this type of dialysis, it actually
flushes in the peritoneal cavity. Next
end stage renal disease services
differentiates between outpatient
versus home and age of patient and
number of visits. Most of the coding
that you will do in this class will be
for the end stage renal disease services
but I still want to know what the other
sections cover. Then the other
dialysis procedures, I've never used them
but they are typically used for training,
hemoperfusion and unlisted codes.
Here's an exercise that has to do with
dialysis. (Exercise 8.3 Dialysis #2) A 19 year old patient was
diagnosed with end-stage renal disease.
During the first week of service for the
month, the patient was treated twice
before being transferred to Cleveland
Clinic for further treatment. Hint: You
are coding for the visits that are
directed at end-stage renal disease (ESRD)
services and you notice it says "during
the first week of service for the month"
because we are looking at a time factor.
"Treated twice" so two visits
a month and here's your answer. There is
an index entry for End-stage renal
disease services, less than a full month
because you see the patient's only been
there the first week. It gives you a
range of codes and then 90969 per day.
Here's an example not in a CPT textbook
and one for which you will see an exam
question or something very similar. A 52
year old patient is seen in the
outpatient dialysis clinic for three
face-to-face visits in the month of July
for treatment of end-stage renal disease.
Hint: You are coding the visit for
treatment of ESRD; you are not coding the
hemodialysis. Your main term would again
be the "End stage renal disease services".
You would capture the outpatient setting.
There's your range of codes and when you
look up 90961, it is for patients 20
years old or older. Our patient is 62
with 2-3 face-to-face visits. Our patient
had three per month and our patient
had three in the month of July. So you
really consider several things within
your scenario when you're finding those
codes. Totally different section, we will
look at Ophthalmology. Similar to
the E/M definitions, ophthalmology
differentiates codes based on whether
it is a new or established patient. The
code book also defines what "intermediate"
and "comprehensive" services include. This
is in the guidelines and just as a note,
prescription of glasses is part of a
general ophthalmologic service and is not
reported separately but the fitting of
the glasses can be coded separately.
Prescription of contact lens is not part
of a general service and should be
reported separately with a code from the
series 92310 through 92326. Here's
your example.The new patient has a
comprehensive ophthalmology exam and
evaluation. We look at the index under
"Ophthalmology, diagnostic, eye exam, new
patient" gives us this range and when we
look up those codes 92004 is a
comprehensive exam with a new patient.
One thing I'll say about this section
or these sections in the CPT code book-
there's no way you're going to remember
all these codes. The best you can do is
remember to look at your Table of
Contents, find the section that you're
looking for and start there. If you have
any difficulties finding the main term
or finding a code, it may be easier just
to go to the Table of Contents and read
through your topics or your sections
because there aren't that many codes
within each section. Sometimes that's the
easiest way to find a code within this
chapter. If you have any questions about
this first part of Chapter 8, please post
in the discussion board. If it's a
specific question, please tell me the
path you used to try and find your code
and I will try to help you. Thanks so
much and have a good day.