In this podcast, we will finish up
Chapter 8 with Part 4 and primarily
we're going to be looking at the review
exercises that are found at the end of
Chapter 8. I suggest as we go through
these slides that you would attempt to
answer your CPT codes before advancing
through the slides just to be sure that
you have the practice of finding these
answers. (Ex. 8 Review #2) A 30 year old male is given a
subcutaneous injection of a live
varicella virus vaccine by the nurse
practitioner. You've got a vaccine so
you know you're going to have to code
for the vaccine substance itself as well
as for the administration of the
injection. There are your two codes.
(Ex. 8 Review #4) MDI or metered dose inhaler treatment
for patient with asthma. You would have
inhalation treatment as your main term,
airway obstruction, pressurized or
non-pressurized to give you 94640.
(Ex. 8 Review #6) Physician treats plaque psoriasis of
arms and legs with the use of laser.
There is a section in this chapter
called "Special Dermatological Procedures"
and it talks about treatment for various
dermatology conditions and one is
psoriasis. It does look at the bpdy surface
area. Our example gives us 250 square
centimeters. Psoriasis treatment gives
you this range of codes but when you
look at the codes they are
differentiated by the method of
treatment which in our case is laser and
a surface area. Code 96921 is for
surface area 250 square centimeters to
500 square centimeters so that's the one
that we select. (Ex. 8 Review #8) An IV chemotherapy
infusion lasting three hours. The
infusion is here. We start reading our
code descriptions. Code 96413 states "up
to one hour, single or initial substance"
and then 96415 is "each additional hour"
so we would list 96415 x 2 to
account for the remaining two hours.
(Ex. 8 Review #10 ) Speech
audiometry with threshold and
recognition, both ears. Your index path
way it falls under an "Audiologic function
test". Audiometry, when you see that -metry (suffix),
that means "measurement" so you know it's
some type of test. You know you're doing
something with the ears so I think
"audiologic" would come to mind pretty
quickly so then you just follow your sub
terms until you get to audiometry and
speech. We look up our code descriptions
and 92555 is speech audiometry, threshold
92556
includes the speech recognition so we want
the 92556 as our answer. The guidelines ay
the beginning of this section tell us
that all services include the testing of
both ears. You must read your guidelines
to find that. To me that should be bolded (bold font)
but it's not, so it's highlighted in my
book. So because all services include
testing of both ears, you do not need a
-50 modifier. The next exercise (Ex. 8 Review #12) A
pharmacist spends 30 minutes providing
medication therapy management services
to an established patient. "Medication
therapy management" would be our main
term and "pharmacist provided" sub term.
We read those code descriptions and 99606 is
the initial 15 minutes with an
established patient and 99607 is each
additional 15 minutes. Remember that when
you're providing medication therapy
management services, the fact that it's a
new or established patient is
significant as well as the amount of
time being spent with the patient.
(Ex. 8 Review #14) Leg Prosthetic training for 30 minutes by a
physical therapist. Prosthesis training
is actually the main term in the index
97761 is for each 15 minutes, so the
code would be listed twice to account
for those 30 minutes (97761 x 2).
(Ex. 8 Review #16) Comprehensive opthalmologic services
provided to an established patient with
extended color vision examination. The
guidelines at the beginning of this
section tell us that extended color
vision examination goes beyond the
services included under General Services
therefore it would be coded separately.
We add the modifier -25 to 92014 to
explain that additional services were
added. So there's your rationale for why
you would add that -25 modifier to your
exam and then how you would code the
color vision exam. (Ex. 8 Review #18) Complete duplex scan
of the lower extremity arteries,
bilateral. Duplex scan is the main term
found in the index. There are your sub
terms and you know that when you read the
code description for 93925 the term
bilateral is included in that code
description therefore modifier -50 is not
needed. (Ex. 8 Review #20) Individual interactive
psychotherapy for 37 minutes provided in an
outpatient setting. Psychotherapy is your
main term, individual patient (subterm) giving you
90832. The CPT guidelines tell us to
choose the code closest to the actual
time so we don't have a code for 37
minutes but we do have a code for 30
minutes. That's the code we selected. 90832
These guidelines are found under the
section "Psychotherapy".
Here is an example not in the CPT textbook
for one that you will see on an exam or
something similar to it. We didn't talk
about EMGs which are
electromyographies of various nerves. This
particular scenario is what is the
correct code assignment for bilateral
EMG of cranial nerves?Electromyography
is the main term; Needle, Cranial nerve
supplied muscle. We have two terms there.
We have two codes there. The
code description for 95868 includes
bilateral so we don't need the modifier
-50. 95867 includes unilateral but since
there's a CPT codes for bilateral, we're
going to use 95867. So again, pointing
out the importance of reading those code
descriptions. Here's an example not in
your CPT textbook. It is an exam question
or one similar to it. Patient receives a
30-minute IV infusion of two grams of
Rocephin. Rocephin is a very strong
antibiotic. A J code would be added for
the Rocephin and there is your
"Intravenous infusion, therapeutic" because
it is an antibiotic. Intravenous
infusion is your main term, therapeutic (subterm).
When you look at those code ranges, the
description for 96365 states "up to one
hour" so it would be appropriate for a
30-minute infusion of a single substance
so we select 96365. If you have any questions
about the Chapter 8 Review Exercises
please post them in the discussion board
and I will answer them. Please include the
path you used to try and find the code.
This has been a long chapter and it
covers a lot of things but I tried to
help you along by letting you know the
types of questions that are going to be
on the exam so you could do better. This
particular exam will be for the Medicine
chapter and Anesthesia chapter which is a slightly
smaller chapter so it should be. It's
just as much content but it's only two
chapters on this exam.
Thank you so much for your attention. I
know this is a lot of detail and I hope
you have a good day.
you