Overview
This lecture introduced the basics of CPT coding, including how to look up CPT codes, understand CPT guidelines, use the CPT manual structure, and apply coding to real-life scenarios.
Goals of the Presentation
- Learn how to look up a CPT code using the index, chapters, and guidelines.
- Review CPT basic coding guidelines.
- Apply knowledge to real-life coding scenarios.
What is CPT Coding?
- CPT stands for Current Procedural Terminology, maintained by the American Medical Association (AMA).
- CPT codes describe medical, surgical, and diagnostic services for uniform communication among healthcare providers and payers.
- Used for anything a doctor does to or for a patient.
Steps to Look Up a CPT Code
- Step 1: Look up the main term (procedure) in the index at the back of the CPT manual (alphabetical order).
- Step 2: Verify the code in the appropriate chapter (color pages, organized by body system).
- Step 3: Confirm if any guidelines or directives apply, especially parenthetical notes.
Example Scenarios
- Example 1: Cervical esophagotomy → Main term: Esophagotomy → Index → Verify code in chapter → Confirm guidelines for proper selection.
- Example 2: Appendectomy → Main term: Appendectomy → Index → Verify multiple codes in chapter → Eliminate codes based on documentation.
- Example 3: Radical perineal prostatectomy, total abdominal hysterectomy, and coding multiple procedures: Use sequencing and guideline rules.
Types and Structure of CPT Codes
- Category 1: Five-digit codes for common procedures and services (mandatory).
- Category 2: Five-character, ending in 'F', for performance measurement (optional).
- Category 3: Five-character, ending in 'T', for temporary/emerging procedures (precede unlisted codes).
- Unlisted codes: Usually end in 99 or 999, used if no specific code exists.
CPT Symbols and Appendices
- Red dot: New code that year.
- Blue triangle: Revised code.
- Hashtag (#): Resequenced/out-of-order code.
- Plus sign (+): Add-on code (never sequenced first, not used with modifiers 51 or 50).
- Circle with slash: Modifier 51-exempt code.
- Lightning bolt: Pending FDA approval.
- Appendices A–O: Each covers different aspects like modifiers (A), new/deleted codes (B), add-on codes (D), vascular families (L), and more.
CPT Book Organization
- Six sections: Evaluation & Management, Anesthesia, Surgery, Radiology, Pathology/Lab, Medicine.
- Surgery section is largest, organized by body system and in numerical order.
Code Hierarchy & Annotation
- Parent (non-indented) and child (indented) code families exist; children share common language from parent.
- Standalone codes have no children.
- Annotation technique: Circle families, highlight indented codes, parenthetical guidelines, and key words for clarity (CHUN method).
Sequencing & Guidelines
- Sequence codes based on relative value units (RVUs) or according to CPT guidelines.
- Guidelines rank: 1) Parenthetical (parenthesis), 2) Specific, 3) General (green pages).
- CPT surgical package: Bundles related physician services (e.g., visit, anesthesia, post-op care) into one code.
Practice & Summary
- Always use three steps to code: index lookup, chapter verification, confirm guidelines.
- Apply knowledge to actual patient scenarios for practice.
Key Terms & Definitions
- CPT — Current Procedural Terminology, a standardized code set for medical procedures.
- Parent Code — The main, non-indented code in a family.
- Child Code — Indented code that relies on the parent code’s description.
- Add-on Code — Can only be used with a primary code; not sequenced first.
- Modifier — Two-character code appended to a CPT code to provide additional info.
- RVU — Relative Value Unit, determines code sequencing based on complexity/cost.
- Parenthetical Guideline — Instruction within parentheses that overrides other guidelines.
Action Items / Next Steps
- Practice looking up CPT codes using the three-step process.
- Review CPT symbols and appendix functions in your CPT manual.
- Prepare for advanced CPT coding (Part Two) and study modifiers in detail.