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INTRODUCTION TO CPT PART THREE Chapter 9 CPT: Radiology, Pathology and Laboratory, and Medicine Codes McGraw-Hill/Irwin Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
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Page 1: INTRODUCTION TO CPT PART THREE

INTRODUCTION TO CPT

PART THREE

Chapter 9

CPT: Radiology, Pathology and

Laboratory, and Medicine Codes

McGraw-Hill/Irwin Copyright © 2009 by The McGraw-Hill Companies, Inc. All rights reserved.

Page 2: INTRODUCTION TO CPT PART THREE

LEARNING OUTCOMESAfter studying this chapter, you should be able to:

1. Discuss the organization, key guidelines, and common modifiers for the Radiology section of CPT.

2. Discuss the importance of the number of views taken in radiology coding.

3. Explain the difference between the professional and technical components of a procedure.

4. Describe the use of contrast material in assigning radiology codes.5. Distinguish between screening and diagnostic services.6. Describe the organization, key guidelines, and common modifiers

for the Pathology and Laboratory section of CPT.7. Recognize common laboratory panels and their associated codes.8. Describe the organization, key guidelines, and common modifiers

for the Medicine section of CPT.9. Describe the correct coding of immunizations.10. Assign CPT radiology, pathology and laboratory, and medicine

codes with appropriate modifiers based on procedural statements.

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Page 3: INTRODUCTION TO CPT PART THREE

KEY TERMS• Administration• Analyte• Ancillary services• Assay• Automated• Biofeedback• Cardiac catheterization• Charge capture• Charge description master (CDM)• CLIA-waived test• Clinical Laboratory Improvement Amendment (CLIA)• Complete blood count (CBC)• Complete lab test• Computerized axial tomography scan (CT or CAT scan)• Continuous positive airway pressure (CPAP)• Contrast material (media)• Diagnostic procedure• Echocardiography• Electrocardiogram (ECG/EKG)• Encounter form• Fluoroscopy

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KEY TERMS• Hemodialysis• Immunotherapy• Magnetic resonance imaging (MIR)• Mammography• Manual• Modality• Nuclear medicine• Panel• Peritoneal dialysis• Positron emission tomography (PET)• Professional component (PC)• Radiation oncology• Radiologic examination• Radiology• Radiology report• Red blood cell count (RBC)• Screening procedure• Single proton emission computerized tomography (SPECT)• Spirometry• Technical component (TC)• Ultrasound• White blood cell (WBC) count

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ANCILLARY SERVICES

• Support the diagnosis and treatment of a disease or injury.

• Include work such as: laboratory tests, radiological studies, pathology studies, physical therapy and speech therapy.

• These services are provided to the patient at the request of a physician.

• Some are performed in the hospital and others are done in physician offices, clinics or another facility.

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Page 6: INTRODUCTION TO CPT PART THREE

RADIOLOGY

• CPT codes in this section concentrate on medical imaging to prevent, diagnose, and treat diseases or injuries.

• Radiologists diagnose disease by obtaining and interpreting medical images.

• Radiologist also treat a number of diseases by radiation.

• Codes in this section can be used by any physician of any medical specialty to report radiological services performed by the physician or under the physician’s supervision.

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RADIOLOGY SECTION

• Has 7 subsections– Diagnostic Radiology 70000 – 76499– Diagnostic Ultrasound 76500 – 76999– Radiologic Guidance 77001 – 77032– Breast, Mammography 77051 – 77059– Bone/Joint Studies 77071 – 77084– Radiation Oncology 77261 – 77999– Nuclear Medicine 78000 – 79999

• Organized by the method or type of radiology and the purpose of the service– Subdivided by anatomical site & type of service

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Page 8: INTRODUCTION TO CPT PART THREE

RADIOLOGY GUIDELINES• The physician ordering the radiology service needs to

submit an order giving the reason for the examination.• If contrast materials are used, be sure to check for a

bundled code or need for two codes.• A complete radiological service includes the use of

equipment/supplies and the physician’s work. Modifiers are typically used to show which component was done, unless the physician did both.– Technical component (TC) – the staff, technologists work,

equipment, supplies or preinjection/postinjection services; typically the facility charge

– Professional component (PC) – reading and interpreting the radiological test and providing a written report with findings; typically reported by the physician

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Page 9: INTRODUCTION TO CPT PART THREE

RADIOLOGY MODIFIERS• -22 – unusual (increased) procedural service• -26 – professional component• -32 – mandated services • -51 – multiple procedures• -52 – reduced services• -58 – staged or related procedure or service by the same physician during

the postop period• -59 – distinct procedural service• -62 – two surgeons-63 – procedure performed on infants less than 4 kg• -66 – surgical team• -76 – repeat procedure by same physician• -77 – repeat procedure by another physician• -78 – return to the operating room for a related procedure during the

postoperative period• -79 – unrelated procedure or service by the same physician during the

postoperative period• -80 – assistant surgeon• -99 – multiple modifiers• -LT, -RT, -TA to -T9, -FA to –F9, -LC, -LD, -RC – Anatomical modifiers

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DIAGNOSTIC RADIOLOGY • Arranged by anatomical site and then modality• Common procedures:

– Radiologic Examination– Computerized Axial Tomography (CT or CAT scan)– Magnetic Resonance Imaging (MRI)– Fluoroscopy– Diagnostic Ultrasound– Radiologic Guidance– Mammography– Bone/Joint Studies– Radiation Oncology– Nuclear Medicine

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Page 11: INTRODUCTION TO CPT PART THREE

STEPS IN ASSIGNING RADIOLOGY CODES

1. Review the complete medical documentation and identify the type of service performed.

2. Locate the body site being viewed.

3. Locate the terms in the CPT index.

4. Read the code descriptors to select codes based on radiology terminology.

5. Consider assignment of modifiers.

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Page 12: INTRODUCTION TO CPT PART THREE

PATHOLOGY AND LABORATORY

• Contains a broad range of codes from routine tests performed in a physician office to highly sophisticated labs

• Laboratory services are done to assess patient specimens

• Pathology services are done to identify diseases by studying cells and tissues under a microscope

• Most codes are for the technical component only

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PATHOLOGY AND LABORATORY GUIDELINES

• Guidelines and notes are located before the codes.

• Assign as many codes as necessary to capture all services performed.

• Unlisted codes are available and should be assigned only after checking Category III or HCPCS level II codes.

• Every laboratory test must be ordered by a physician, physician’s assistant or registered nurse practitioner.

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Page 14: INTRODUCTION TO CPT PART THREE

PATHOLOGY AND LABORATORY SUBSECTIONS

• Organ or disease panels 80048-80076• Drug testing 80100-80103• Therapeutic drug assays 80150-80299• Evocative/suppression testing 80400-80440• Consultations (clinical Pathology) 80500-80502• Urinalysis 81000-81099• Chemistry 82000-84999• Hematology and coagulation 85002-85999• Immunology 86000-86849• Transfusion Medicine 86850-86999• Microbiology 87001-87999• Anatomic Pathology 88000-88099• Cytopathology 88104-88199• Cytogenetic Studies 88230-88299• Surgical Pathology 88300-88399• Transcutaneous Procedures 88400• Other Procedures 89049-89240• Reproductive Medicine Procedures 89250-89356

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COMPLETE LABORATORY CODES

• Includes ordering the procedure or test, obtaining the sample or specimen, handling the specimen, performing the actual procedure or test, and analyzing and interpreting the results

• Blood can be collected via a vein, capillary stick or other device.

• All lab work is regulated by Clinical Laboratory Improvement Amendments (CLIA) rules.

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PATHOLOGY AND LABORATORY MODIFIERS

• -22 – unusual (increased) procedural services• -26 – professional component• -32 – mandated services • -52 – reduced services• -53 – discounted procedure• -59 – distinct procedural service• -90 – reference (outside) laboratory• -91 – Repeat clinical diagnostic lab test

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ORGAN AND DISEASE-ORIENTED PANELS

• A panel is a group of lab tests commonly performed together to diagnose organ dysfunction or to monitor a disease

• Common Panels:– Basic metabolic 80048– General Health 80050– Electrolyte 80051– Comprehensive metabolic 80053– Obstetric 80055– Lipid 80061– Renal function 80069– Acute Hepatitis 80074– Hepatic function 80076

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LABORATORY CODES

• Common procedures:– Drug testing– Therapeutic drug assays– Evocative/suppression testing– Urinalysis– Chemistry– Hematology and coagulation– Immunology– Transfusion medicine– Microbiology– Cytopathology– Pathology consultations– Surgical pathology

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Page 19: INTRODUCTION TO CPT PART THREE

STEPS IN ASSIGNING LABORATORY CODES

1. Based on the documentation locate the services in the CPT index.

2. Read all code descriptions from the code ranges provided.

3. Select code based on whether the procedure was quantitative or qualitative.

4. Consider modifier assignment.

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MEDICINE SECTION

• Includes codes for procedures that are primarily evaluative, diagnostic and/or therapeutic.

• Codes for non-invasive or minimally invasive procedures• Most procedures are typically performed in the physician

office.• Many codes are driven by time, quantity, age and

professional component service.• Located directly before the Category II and Category III

codes• Subsections are arranged by specialty areas or type of

service

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Page 21: INTRODUCTION TO CPT PART THREE

MEDICINE GUIDELINES

• When coding multiple procedures, watch for unbundling, add-on codes, and separate procedures.

• Many times more than one code is required.• E/M codes can only be assigned in addition if

this was a significant, separate E/M service.

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Page 22: INTRODUCTION TO CPT PART THREE

MEDICINE SUBSECTIONS• Immune Globulins 90281-90399• Immunization Administration 90465-90474

for Vaccines/ Toxoids• Vaccines, Toxoids 90476-90749• Hydration, Therapeutic, 90760-90799 Prophylactic,

& Diagnostic Injections & Infusions• Psychiatry 90801-90899• Biofeedback 90901-90911• Dialysis 90918-90999• Gastroenterology 91000-91299• Ophthalmology 92002-92499• Special Otorhinolarngologic services 92502-92700• Cardiovascular 92950-93799• Noninvasive Vascular Diagnostic Studies 93875-93990• Pulmonary 94002-94799• Allergy and Clinical Immunology 95004-95199• Endocrinology 95250-95251• Neurology and Neuromuscular Procedures 95805-96020

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MEDICINE SUBSECTIONS• Medical Genetics and Genetic Counseling Services 96040 • Central Nervous System Tests 96101-96120• Health and Behavior Assessment 96150-96155• Chemotherapy Administration 96401-96549• Photodynamic Therapy 96567-96571• Special Dermatological Procedures 96900-96999• Physical Medicine and Rehabilitation 97001-97799• Medical Nutrition Therapy 97802-97804• Acupuncture 97810-97814• Osteopathic Manipulative Treatment 98925-98929• Chiropractic Manipulative Treatment 98940-98943• Education and Training for Patient Self Management 98960-98962• Special Services, Procedures and reports 99000-99091• Qualifying Circumstances for Anesthesia 99100-99140• Moderate (Conscious) Sedation 99143-99199• Home Health Procedures/Services 99500-99602

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MEDICINE MODIFIERS

• -22 – unusual (increased) procedural service• -26 – professional component• -51 – multiple procedures• -52 – reduced services• -53 – discontinued procedure• -55 – postoperative management• -56 – preoperative management• -57 – decision for surgery• -58 – staged or related procedure or service by the same physician during

the postop period• -59 – distinct procedural service• -76 – repeat procedure by same physician• -77 – repeat procedure by another physician• -78 – return to the operating room for a related procedure during the

postoperative period• -79 – unrelated procedure or service by the same physician during the

postoperative period• -LC, -LD, -RC – Coronary artery modifiers• -LT, -RT, -TA to -T9, -FA to –F9, - Anatomical modifiers

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Page 25: INTRODUCTION TO CPT PART THREE

ASSIGNING MEDICINE CODES

1. Review the documentation and determine the type of service provided.

2. Locate main terms in the CPT index.3. Determine if drugs were given.4. Check subterms and read descriptors

thoroughly.5. Verify that the code description matches the

services documented.6. Assign codes for all significant services and

consider modifiers, if appropriate.

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