CPC Certification Review Training with Legacy

Introduction

• The training is designed to help pass the CPC certification exam.
• It’s not for beginners; a prior understanding of the coding process is necessary.

CPT Categories

Category 1 Codes

• Represent medical procedures like evaluation, management, radiology, labs, etc.
• Five-digit numerical codes used for reporting medical services.
• Reviewed and updated annually by the AMA.

Category 2 Codes

• Located at the back of the CPT book, identified by the letter F.
• Optional codes for performance measurement and quality of care data collection.

Category 3 Codes

• Located behind Category 2, identified by the letter T.
• Temporary codes for new technology, services, and procedures.

Guidelines and Usage

• CPT Instructions: Do not select a code that just approximates the service; use unlisted procedure codes if necessary.
• Parenthetical Instructions: Important for preventing errors but not all-inclusive; emphasis on accuracy and quality of coding.
• Guidelines: Found throughout CPT; provide information on code application, service reporting, and modifier usage.
• CPT Conventions: Offer rules on proper code selection, modifiers, and bundling.
• CPT Symbols: Indicate code revisions, add-on codes, exemptions, etc.

CPT Code Book Structure

• Category 1 codes are mandatory for reporting and reimbursement.
• Subsections and Guidelines: Provide detailed coding instructions, including when to use services together or separately and applicable modifiers.
• Index Review: Essential for finding applicable codes by condition, procedure, or site.

Appendices and Modifiers

CPT Appendices

• Appendix A: Descriptions of modifiers for CPT anesthesia and surgery.
• Removed Sections: Examples for evaluation and management services, moderate sedation codes, and clinical topics listing.
• Appendix N: Table of out-of-sequence codes.

Modifiers

• Modifier 22: For extra work in surgical CPT codes.
• Modifier 24: Unrelated evaluation and management during the post-op period.
• Modifier 25 & 57: For separate services or decision for surgery on the same day as other procedures.
• Modifier 58 & 78: For staged or unplanned return procedures during the post-op period.
• Modifier 79: Unrelated procedure during the post-op period.
• Modifiers 50, 51, 52, 53: For bilateral services, multiple procedures, reduced services, and discontinued procedures respectively.
• Modifier 59 & Subsets (XE, XS, XP, XU): Distinct procedural service.
• Modifier 62 & 66: For co-surgery and team surgery.
• Modifier 80: Assistant surgeon involvement.

Hick Picks Level 2

• Codes for services like ambulance, drugs, and durable medical equipment.
• Sections Overview:
  • A Section: Transportation and medical supplies.
  • G Codes: Medicare services and quality reporting.
  • J Codes: Drugs with specific dosage.
  • L Codes: Orthotic and prosthetic procedures.
  • Q/S Codes: Temporary codes for various procedures or products.

Global Surgery Package

• Describes pre-op, intra-op, and post-op services included in the surgical service.
• Global Periods: Zero-day for minor, 10-day for intermediate, 90-day for major surgeries.

Resources

• CPT Assistant: Official reference for coding questions and guidelines.
• CMS and NCCI: Guidelines for correct coding and reimbursement.

Conclusion

• For more detailed training, visit Medicalbillco.com.