welcome to introduction to cpt coding by amci i'm mrs j and i along with my instructional team mrs tracy and ms rochelle are very happy to be your presenters today and without further ado let's begin with the goals of the presentation goal number one provide instruction on how to look up a cpt code go to review cpt basic coding guidelines and goal 3 review scenarios to test your knowledge now let's move on with our copyright 2021 copyright mcg ttt keyword concept ftr chun amci fab 7 flip tap master 7 mmm are all trademarks of amci cpc is a registered trademark of american academy of professional coders aapc content found within this presentation is copyright of aapc and ccs is a registered trademark of american health information management association or ahima and content found within this presentation is copyright of ahima and finally cpt is a registered trademark of american medical association ama and content found within this presentation is copyright of ama let's begin by defining what cpt coding is cpt coding well cpt is the acronym for current procedural terminology or cpt it is a code set a medical code set established by american medical association or ama and maintained annually by the cpt editorial panel the cpt code set is copyright protected by the ama and describes medical surgical and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians coders patients accreditation organizations and payers for administrative financial and analytical purposes all right coders that is the formal definition of what cpt coding is so i don't know if you're aware but at amci we like to break it down what i mean by break it down well we just like to make things as simple as possible so what is cpt coding well according to amci it is the code set used for procedures and services rendered by physicians and qualified health care practitioners professionals and cpt is maintained by the amas cpt editorial panel all right let's go even further let's break it down even further cpt codes are used for anything the doctor does to or on behalf of the patient so anytime the doctor does anything or provides any kind of service or visit coders you're going to need to reference your cpt manual all right so now that we've gotten that out of the way let's go ahead and learn how to look up a cpt code yes we're going to get right to it i think you're ready i hope you're ready i know you're ready so let's do it we have three steps in looking up cpt codes step one you are going to look up the main term or the procedure in the index step two you're going to verify that code in the chapter in the chapter that's the color pages we'll review that step three we're going to confirm if guidelines or other directives apply step one look for the main term or the procedure in the index and in cpt the index is located at the back of the book unlike icd-10 cpt index is at the back of the book and it is in alpha numerical order well alpha order more so all right step two after you get your code you will verify your code in the chapter yes i said the color pages the chapters look like this and they are in numerical order according to body systems all right confirm confirm your code selection all right and you'll do it by reviewing or looking at your coding guidelines modifiers and other directives that apply to the code so we've got three steps step one look up your main term or your procedure in the index step two you're going to verify the code that you get from the index in the chapters step 3 confirm your code that's it all right coders let's do it we're going to begin looking up our first cpt code i hope you're ready i know you're ready so let's do it patient had a cervical esophage cervical esophage our first step is look up the main term or the procedure in the index and i'll put our steps below you'll see steps one two and three we're on step one we're going to look up our main term which is the procedure in the index so of the the words in our exercise which is the main term or procedure if you said esophagotomy outstanding yes so we'll look up esophagotomy in the index remember the index is at the back of your coding manual your your cpt manual and i am um looking it up this is just the clipping all right so it is in alphabetical order and as you can see at the top this says esophagus p that's not our procedure so we're scrolling down until we see esophagotomy yes we see our procedure and across from it you'll see codes four three zero two zero and four three zero four five all right so we've got our codes now we have to move on to step two step two is verify your code in the chapter and remember step two represents well the chapter are your color pages remember that all right so we've got four three zero two zero and four three zero four five it's going to be one of those codes and just so you know the chapter it has the color pages like you see on the screen all right so it's in numerical order the chapters are in numerical order according to the body system all right so if we go to four three zero two zero you'll see it's in the esophagus chapter so we know we're in the right place because we had a esophagotomy all right next we have two codes four three zero two zero and four five and if i'm looking at both of them they look the same and the only difference is these key words you see cervical for four three zero two zero in thoracic for four three zero four five and i am going to deduce that four 43020 is the correct code because our patient had a cervical i hope you can see this esophagotomy look at that cervical all right so we don't stop there you know why because we have step three we have to confirm if this code is indeed correct because there will be guidelines or other directives that apply right so for now we are going to check out anything that is in a parenthesis at amci we call it parenthetical guidelines because these guidelines rule they take precedence over almost always all guidelines so in this parenthesis it says for esophageal intubation with laparotomy use 43510 this is not our situation our patient only had a cervical esophagotomy no esophageal intubation with laparotomy not applicable so when it doesn't apply it flies and our correct answer is four three zero two zero okay coders how do you feel all right let's move on and let's try another one and if you've got that correct out outstanding all right we have another exercise i know you're up for it so let's do it patient had an appendectomy and remember we have three steps we'll begin with step one let's see if this highlighter works is it working yes it is all right so we'll begin with step one and step one is look up the main term in the index all right that's our step one okay coders i can hear you what is the main term in our scenario all right i know you said appendectomy there you go yes so we're going to look up appendectomy in the index and remember the index is in the back of your cpt manual and right at the top we see appendectomy now let's take a look underneath appendectomy we have an appendix excision and we have a laparoscopic both of these are appendectomies i this is a teachable moment for everyone any time you have equipment like laparoscopic it must be in your documentation it must say it it has to say the patient had a laparoscopic appendectomy in order to use this laparoscopic code now an appendix excision is pretty much excision removal of the appendix and that is indeed our situation that isn't an appendectomy so we're going to select appendix excision and it's driving us to three codes it's in hey you need to look at these three codes four four nine five zero four four nine five five four four nine six zero all right now that takes us to step two in step two we are going to verify the code in the chapter and remember this is done by going to the color pages in the cpt manual and remember the codes are arranged in numerical order according to the body system so i want to address that so what do i mean by that well as you can see we are going to the appendix heading these codes four four nine five zero five five and six zero are taking us to the appendix heading we are in the correct section trust how do we know well the patient's having an appendectomy what is an appendectomy it's the removal of the appendix so indeed we are in the correct section so the red bold is called heading and we'll talk about that later and now if we go down to the blue bold this is where you'll find your codes and so let's stop at four four nine five zero and this is the code for appendectomy i like this why do i like it because all the document all the documentation says is the patient had an appendectomy and the code at 44950 says the patient this is the code just for an appendectomy and i like it but we have two more codes that we have to verify we have to do our due diligence you never stop at the one code never unless you know what those codes are but i don't so if we look at the next code 99 excuse me four four nine five five this is the code for appendectomy when done for indicated purpose at the time of other major procedure not as a separate procedure list separately in addition to code for primary procedure okay stop so we learned about these plus codes these add-on codes anytime you have an add-on code it's only used in addition to a primary code it's never sequenced first and you never append a 51 modifier or a 50 modifier on it so our circumstance is this patient had an appendectomy that's all we need to code for we don't need to code for an appendectomy additionally so therefore based upon the fact that it has a plus in front of it or it's an add-on code we're going to eliminate four four nine five five all right coders how do you feel are you with me all right okay so we're gonna move on and if you're not it's okay to press pause and rewind it is okay all right next code 44960 this is the code for appendectomy for ruptured appendix with abscess or generalized peritonitis wait a minute hold up our documentation when i say documentation it's the section what we're reading and you may not be able to see it i'm gonna i'm gonna do this hopefully you can i know i'm having some issues but where it says patient had an appendectomy this is our documentation and this is what we have to code for only what's in the documentation nothing more nothing less and if we didn't tell you i think we told you in other subjects but if the doctor did not document it it did not happen so if we look at four four nine six zero four ruptured appendix with abscess or generalized peritonic peritonitis that's not mentioned in our documentation so if it doesn't apply we have to let it fly and the correct code is four nine five zero all right coders we're not going to stop there no no no we have to go ahead and move on to step three we have step three step three says confirm if guidelines or other directives apply and at this time we are looking for any parenthetical guidelines here's one right here it says incidental appendectomy during an intra-abdominal surgery does not usually warrant a separate identification so in other words it's telling you hey if you had another abdominal surgery you may not need to use this code if it's necessary to report this appendectomy you're going to add modifier 52 to it we didn't have any other surgery this does not apply so what do we say if it doesn't apply let it fly so our code our final answer 44950 okay coders if you got that correct outstanding all right i'm ready to move on i think we can do another scenario let's do it all right so this patient had a radical perineal prostatectomy all right so that's a little more you know than what we've been doing before and you'll see why in a moment we've got our three steps step one we're gonna look up the main term or the procedure in the index alright so we've got a radical perineal prostatectomy of the three what is our main term if you said prostatectomy outstanding i know you did so we're going to look up prostatectomy in our i see excuse me cpt what am i talking about our cpt and if you look under prostatectomy we've got a lot of procedures here so what do we do well this prostatectomy is specific right yeah we have some more sub terms we have a radical perineal prostatectomy so let's look for our terms and the first one that we come to is perineal yeah so perineal and underneath perineal either we're going to choose partial or radical absolutely we're going to choose radical so that's fair enough and it directs us to code series 5 five eight one zero three five five eight one five all right so we're ready to move on to step two step two let's go on and verify 5 5 8 10 through 8 15 in the chapter so if we go to the chapter and look where we are get my little pointer out we are right here in the prostate section and we're going to talk about how this is lying outlined very shortly but just want to point out some things so we're in the prostate section what is the prostatectomy that's the removal or excision of a prostate so we're in the prostate section and underneath it you'll see the procedure section and boom right under excision you'll find your prostatectomies all right so our first coat five five 55810 we have a green box around it it's saying it's correct so let's read it it says prostatectomy perineal radical coders this is our code indeed it matches our language exactly now let's take a look at the other codes to do our due diligence all right so 5 5 8 10 is prostatectomy with lymph node biopsies limited pelvic lymphadenectomy coders we only code what we see we only code what's in the documentation if there's no mention of lymph node biopsies if there's no mention of lymphadenectomies we are not going to code it so five five eight one two is incorrect and then we have five five eight one five this is a prostatectomy with bilateral pelvic lymphadenectomy we've just said it's not in our documentation we're not gonna code it i'll just read it out it says including external iliac hypogastric and obtruder oh excuse me operator nodes whoa sorry about that i'm gonna look at it again obturator that's what it looks like to me all right coders so we these procedures were not carried out so therefore it's gonna fly you gotta go so i like five five eight ten but we have to do our due diligence and we have one last thing to do we gotta confirm if the guidelines or other directives apply and at this point we're only looking at parenthetical guidelines and it says in the yellow box if or highlight if 55815 is carried out on separate days use eight seven seven zero with modifier fifty and five five eight one zero all right coders there's no mention in our documentation of a prostatectomy carried out on a separate day so we're going to go ahead and code 55810 all right so i don't want to stop here no let's go coders we have another exercise and we're going to pick up the pace just a bit what is the cpt code for total abdominal hysterectomy step one we have to look up our main term or procedure in the index what is our main term we have abdominal hysterectomy oh wait a minute a total abdominal hysterectomy of those three terms which one is our procedure if you said hysterectomy outstanding so yes we're going to go to the index we're going to look up hysterectomy and look right up underneath hysterectomy is abdominal and that is one of our key terms so let's even get more specific right what type of abdominal hysterectomy is it radical resection of ovary malignancy ovarian malignancy is it supracervical or is it total yes it's total so we've got three codes that it's telling us to reference five eight one five zero five eight two zero zero five eight nine five six so let's move on to step two we gotta verify these these um codes in the chapter five eight one five zero is coming up green that means it's correct let's read the code language it says total abdominal hysterectomy corpus and cervix with or without removal of tubes with or without removal of ovaries coders when you are reading this language these key words we call them game changers or really change the scenario so we have a total abdominal hysterectomy corpus and cervix they're saying the cervix in the uterus with or without removal of the tubes so it could be without with or without removal of the over ovaries it could be without like our documentation there's no mention of tubes or ovaries so this code looks good but i'm not going to stop there i'm going to follow my instructions it references 58200 and 58956 additionally so let's look at 58200 let's go ahead and take a look at it this is the code for total abdominal hysterectomy including partial vaginectomy with para aortic and paralymph node sampling there's no mention of that in this documentation we're just trying to code a total abdominal hysterectomy that's it and it says with or without removal of tubes with or without removal of ovaries and five eight two zero zero it's not going to happen because we're not doing all these procedures five eight nine five six this is bilateral salpingo oophorectomy with total omentectomy total abdominal hysterectomy for malignancy coders there's no mention that the the um tubes salpingo is the clinical term or the medical term for tubes oophorectomy this is the medical term for ovaries ectomy means removal so there was no removal of tubes and ovary and this documentation says for malignancy no mention that this patient has cancer so 58150 that's our code that we need to check out so let's get rid of two zero zero nine five six gotta go and that brings us to our final step step three confirm confirm if guidelines or other directives apply essentially we only have a parenthetical guideline at the bottom of these codes and it says do not report eight nine five six in conjunction with five eight one five zero we are not trying to do that so our answer is five eight one five zero all right so coders if you're coding along you got that correct outstanding now i'd like to move on but i have a question so what if you're unable to find your procedure let's say it's not listed in the index you will need to look for alternative procedures that's what i call it alternative procedures such as application incision drainage debridement introduction dilation excision we did see excision good example we saw appendectomy we know that's surgical removal of the appendix so is excision of the appendix it means the same thing so this is a good example of how you can find your code using these alternative um terms or alternative procedures such as exploration biopsy repair these are all examples of general procedures the and i like to call them alternative procedures whichever you want to refer to them as all right and you look them up in your alphabetic index and keep going verify in the chapters all right let's move on i have another kind of example all right so what if a patient has two procedures in one encounter what did you do what do you do and some of you might not even have even been thinking about that yeah so of course you're going to look up both procedures right and code them however there will be guidelines that govern or direct how you code them how you code them where you place the codes we call that sequencing which code is going to go before the other that's called sequencing and guidelines will tell you guidelines will tell you of course sequencing the proper codes to use and if you can even code both of those procedures in the same encounter so guidelines are pretty important let me show you alright so our scenario a patient had a cesarean section and a total abdominal hysterectomy in the same encounter we have our steps we're going to follow our steps step one we're going to look up the main terms or the procedures in the index and our main terms cesarean and abdominal hysterectomy now to speed things up let's assume that we looked up both of these in the in the index and then we are verifying these codes in the chapter now you remember we've already looked up total abdominal hysterectomy we've already looked it up and verified it and we've established that the code is 58150 now let's go ahead and look up cesarean section all right so when we get to that section it directs us to this code series 59510-59525 and if you look closely i like 59540 because it's coding for the cesarean delivery only i like it so you would think that we would code both one 59514 and five eight one five zero however when we get to step three it tells us to confirm guidelines or other directives if they apply and we learned to look at our parenthetical guidelines now i'm going to bypass i've read the first guideline let me go get my little pointer here i read this guideline here it doesn't apply so i'm moving on to these two and it tells you use five nine five two five in conjunction with five nine five one four so let's look at five nine 59525 what is it so this is the code for subtotal or total hysterectomy after caesarean delivery wait a minute so this add-on code is telling you that you coded well the guideline tells you that you use this code 59525 with five nine five one four and let's look down here for more guidance it says for extra peritoneal um cesarean section or cesarean section with subtotal or total hysterectomy c five nine five one zero one five and two five okay coders we've got some deciding to do and if nothing else coders are like machines we really are we have to think like machines we code what we see we code our documentation and we code to the guideline if the guideline says use this code with this code that's what you do all right so our guidelines are telling us that this is the hysterectomy code and this hysterectomy code will be used with cesarean deliveries not this one okay so the correct answer will be five nine five one four and five nine five two five now i sequenced my cesarean delivery first and i sequenced then i sequenced my hysterectomy after and the reason i knew to do that this add-on code this plus sign means that you add it to a primary procedure and that's a guideline you're going to learn later on not today but later on all right so hopefully that answers your questions or if you were thinking about it or maybe not but hopefully you learned something let's move on now again we talked about guidelines will drive your code selection and just know for complex scenarios and procedures we must understand cpt guidelines sequencing requirements and instructions to learn advanced coding concepts so first we have to understand the basic rules then you will move on and learn the advanced rules so don't um try and put the cart before the horse it is coming trust me it is alright so just to show you another part of your book in the back of your book at the beginning of the index if you want to learn how to select main terms read this section if you are in the amci guided course we provide you additional instruction on how to select main terms you will get it in class and now let's learn about the book what book cpt and that's what this discussion is about right i did kind of put the cart before the horse a little bit we learned how to look up a code before we actually learned the components of the book now it's time to do it alright so cpt has three categories of medical codes and descriptors for those codes and we call those descriptors nomenclature all right so essentially a nomenclature is a different name or descriptor assigned to a person place or thing used by an entity and their affiliates for instance serial numbers are assigned to equipment people who produce that equipment know are able to identify that piece of equipment based upon the serial number social security numbers are dis assigned to individuals people in social security administration they a patient or a person they can identify a person based upon the social security number and cpt codes they're signed assigned to procedures and you better believe that coders are able to understand that language that is nomenclature all right now cpt is divided into three categories of codes you have category one codes they are five digit numeric codes category two codes these are five digit codes but they measure performance all right and category three codes these are also five character codes and they are temporary codes and when we say temporary that means that they are waiting to become permanent all right so category one codes are the primary codes that you'll be using these are permanent codes and let's talk a little bit more about these category one codes category one codes this is where most of the cpt codes live yes these codes are five digit numerical codes like this one one zero zero four zero this is a typical category 1 codes cpt codes or cpt category 1 codes are mandatory what do we mean by mandatory well hipaa health insurance portability and accountability act mandates usage of these codes we're going to talk about that a little later but let's move on 1 codes are also referred to as hit picks level 1 codes yes not level 2 level 1 and there are six sections of codes let me get my pointer the sections are evaluation and management anesthesia surgery radiology pathology and medicine so this is pretty much i would say the codes that we're really going to be focusing on these are the codes that cpt coders or cpc coders and if you didn't know cpc coders are cpt coding masters and it is in this category one where all of the guidelines or the majority of the guidelines that we're going to deal with lives all right so let's move on and let's take a look at another type of another type of category one code and it's an unlisted procedure these are category one codes and pretty much these codes are um used when there is no specific procedure code for it no and you can recognize these codes often not always often by the 99 or 999 at the end all right so if you if a doctor performs a procedure that's not yet in cpt they'll use an unlisted code all right now let's move on and talk about category 2 codes category 2 codes category 2 codes are supplemental tracking codes used to measure performance they are optional meaning that hipaa does not mandate their usage however physicians and other providers are provided incentives to use them because they need to track or measure performance now you can identify these codes because they end with the letter f f and these codes will ultimately reduce a provider's administrative burden and this is an example of a category two code zero zero zero one f this is the code for heart failure assessed and this includes assessment of all of the following components zad and the blood pressure and level of activity and the clinical symptoms of volume overload accessed weight recorded clinical signs of volume overload assess excess assessed and it gives you the two different codes all right so basically if a patient's heart failure is being assessed you would use zero zero zero one f and it has to meet all of these elements beneath it and i apologize here's my pointer so pretty much category two codes are performance measurement codes and they're classified in the following manner according to patient management histories exams diagnostic screenings therapeutic or preventative measures follow-up services patient safety and non-measurement codes alright so these are used by physicians and healthcare professional advisory committee members all right let's move on and let's talk about category three codes category three codes are temporary codes yes and these are used for emerging technology these codes are up to five characters long and they end with the letter t and they can be reported separately and most important category three codes take precedence over an unlisted code remember an unlisted code has not has nines at the end often but category three codes look like this zero one zero seven t they're temporary and why do they take precedence over a category one code unlisted code because cpt has a protocol in which they review codes the first step is the doctors will use um unlisted codes all right and if there is enough usage of that unlisted code for a particular procedure then it becomes a category three code this is where they're analyzing if it's viable enough or is it being used or utilized enough to become a permanent category 1 code i know but just remember these are temporary codes and they do take precedence over unlisted codes so let's review all of the categories all right so category 1 codes these are five character codes these are the primary codes that cpc coders use these often describe surgical procedures and also services rendered by physicians category 2 codes these codes are not mandatory by hipaa and they are used for performance measurement category three these are temporary codes and they take precedence over unlisted codes so that's all three categories in a nutshell now let's move on and let's talk about some symbols the symbols that you'll find in cpt all right so symbols if you open up your cpt manual anywhere in this surgery let's say category where the category one codes are in the surgical section you'll see all of these symbols they're at the bottom of the page and if you just look at my page 91 in 90 90 and 91 you'll find my symbols okay here are your symbols now these symbols provide guidance and sometimes are considered guidelines yeah all right it's guidance because it helps you code appropriately now where do we get information about these symbols well in your appendices all right so in cpt you have appendices a through o this is where you can find more clarification about cpt nomenclature nomenclature is symbols signs definitions it's the language that medical coders speak when they're talking about in this case cpt now let's look at the cpt and appendices and learn about the nomenclature for each chapter a through zero and we're going to begin with appendix a this is where you can find modifiers we're not going to get too much into modifiers because you're going to study modifiers very shortly and just so you know modifiers are two character codes that go at the end of a category one or hit picks level two code and it gives your code more meaning and so what do you mean by that mrs j well i mean that if you are going to use any of the category one codes and let's say a patient had a hysterectomy so you would normally just code or use the hysterectomy code but what if you want to tell that payer hey this was a difficult procedure this patient had altered anatomy let's say the patient had some other surgical procedure and it made the hysterectomy or carrying out a hysterectomy difficult well if the coder codes uses the hysterectomy code then appends a 22 modifier this modifier will let the payer know that this was an increased procedural service meaning that this procedure was difficult it required more or increase technical um knowledge or more use of resources or skill that's what 22 modifier is so in other words these modifiers provide more clarification and gives the payer more understanding about a particular procedure or service rendered and these are very significant so significant that we are going to discuss it at length very in the next chapters all right so just so you know appendix a is where you'll find the definitions of all of cpt modifiers next appendix b this is where you'll find a summary of additions deletions and revisions so any new code you'll see a summary of them in appendixy any code that was deleted and any code that has revised language you'll find it in appendix b now just so you know when you see a red dot next to a code that tells you this is a new code when you see a strikethrough a code or even strikethrough language that means it was deleted when you see a uh not green but a blue triangle that means that the code has been revised yes often the language within it could be revised now we're moving on to appendix c this we're not going to go too deep into it appendix is where you'll find clinical examples of evaluation and management so when we get to evaluation and management and you want to practice you can go to appendix c to look at some of the examples but evaluation and management are pretty much doctor visits appendix d summary of cpt add-on codes all right coders do you remember we talked about add-on codes just earlier we said that you use these add-on codes in addition to a primary code so when you these codes are used in addition to a primary code you know it cannot be sequenced first your keyword is in addition can't be sequenced first also these add-on codes cannot be used with modifiers 51 and 50. that is a general rule that you'll need to remember you cannot use an add-on code with modifiers 51 and 50. you got to remember all of these rules because this add-on code um these add-on codes are guidelines so this is just one that you just have to remember appendix e this is a summary of cpt codes that are exempt from the usage of modifier 51 i know we have not discussed modifiers but just so you know modifier 51 is the modifier that you use when you have multiple procedures so the first procedure will be coded the subsequent procedures will have to use modifier 51 if it is applicable and later on you're going to discuss modifier 51. however there are some codes that don't that are exempt from using modifier 51 you don't have to append 51 in the setting of another procedure and when you see this do not symbol in front of the code it means that this is a modifier 51 exempt code in other words you don't have to append modifier 51. appendix f this is a summary of cpt codes exempt from modifier 63. yes there's that word modifier again when we get to modifiers in this instruction you're going to learn that modifier 63 is to be appended for use for infants that weigh less than four kilograms so if you if your code is on this list then it is exempt so there is no symbol that will tell you that however you'll often find the instruction and the guidance in your parenthetical guidelines so another reason why parenthetical guidelines are important appendix g we're not going to talk about it it's removed from cpt appendix x it's removed from cpt not going to talk about that either appendix i not going to talk about it removed from cpt so that brings us to appendix j this is the appendix for electro diagnostic medicine listing of sensory motor and mixed nerves so what is that this appendix helps you learn how to assign each sensory motor and mixed nerve to its appropriate nerve conduction study code so this is pretty intense but yeah you got to know where your nerves are in order to code it moving right along to appendix k this appendix describes product pending fta approval so you see we've only got three here nine zero six six six six six seven six six eight i wonder what they are but anytime you see this lightning bolt that means well it doesn't look exactly like this it only has two charges but that means that code is pending fda approval now let's move on to appendix l appendix l appendix l is for vascular families and typically when you're coding for the cardiovascular system this is what you'll use to code for arteries and veins yes in fact this is the vascular tree what do i mean by vascular tree well a vascular tree pretty much is like a family tree right so you have the the matriarch and the patriarch and then their children then their children it's the same thing when coding um for vascular families let me get my pointer out everything starts here let's say it's the aorta the vena cava the pulmonary artery or portal vein right here then you have your first order second order third order and third beyond third order essentially this maps the location of a vein or an artery in fact coders and physicians maybe some physicians will use appendix l to locate a particular vein or artery most often arteries so let me give you an example when a patient let's say a patient comes in and had a stroke let's say the physician carried out an mra and has determined that the stroke the place where the stroke is occurring is the right middle cerebral artery let's say the the physician located it and then the physician wants to treat it so the physician is going to need to insert a catheter into the thoracic artery thoracic aorta then the next place in the next place that the artery will be the catheter will be fished is first order specifically the right or left coronary artery then second order it will go to the right common carotid then third order the right internal carotid then the physician can locate the right middle cerebral artery so it's kind of like a route like a map yeah a map of how to locate a specific vein or artery and typically these um procedures are carried out when coding catheterizations they use a catheter to get to the location and that's what you use appendix l for i know that was advanced but i just had to tell you what it was because you will use it when you move further along in advanced cpt coding appendix m this appendix is for renumbered cpt codes and this is the crosswalk so if any of the codes have been renumbered you can find it here now let's move on to appendix n appendix n is for resequenced cpt codes whenever you see in the section a red code and it will also have a hashtag in front of that red code you'll know it has been resequenced you might say well why would they resequence it often it's resequenced when they want to classify the codes appropriately so let's say um sometimes they do it for classification purposes i can't tell you why you do that but one thing that i do want you to know sometimes it's a little frustrating you may not be able to find your code if you know the code is there and there's been no directive stating that it has you know been deleted always check the this appendix n to see if it's been resequenced so you just go look for your code look for the code in the appropriate order and then the red will tell you the category or the series of codes where you can find it all right let me get rid of my pointer and then i want to show you there's your hash tag when you see that hashtag in front of a code you know it's out of order all right let's move on to appendix o all right so this section is multi-analyte assays with algorithmic analysis and proprietary lab analysis coders this is for laboratory coders but just want to tell you that proprietary laboratory analysis or pla you'll see that these codes are used typically in addition to cpt codes all right and so when i say in addition they're not sequenced first so these are approved by the ama cpt editorial panel they are alpha numeric cpt codes yes they are with a corresponding descriptor for labs or manufacturer that want more specific id specificity to identify their tests so um we won't be using this too much but just so you know that if you have to these are used in addition to cpt codes we're going to say category 1 codes now category 1 proprietary lab analysis pla all right so there are some pla codes that can be sequenced first and you'll know it by this indicator the up down arrow category 1 pla but remember traditionally pla codes they don't fulfill category one status and they're not sequence first however you see this indicator it is now we have another indicator all right and finally when you have a duplicate proprietary lab analysis test you use this indicator right here to denote that it is a duplication i'm going to get rid of my pointer and now we're going to move on and do a summary of all of the appendices and let's do it now here you go all right so we have appendix a we know this is where you find your modifiers and those definitions you'll see definition well you'll actually see your modifiers in your front inside cover but it doesn't have the definitions or their meanings so you go to appendix a to read the modifier definitions appendix b this is a summary of new codes of deleted codes and revisions appendix c we know those are clinical examples for evaluation and management coding appendix d this is a summary of cpt add-on codes when you see that plus sign you know it's an add-on code don't sequence it first and do not append a modifier 51 or 50. that's new all right appendix e modifier 51 exempt you have that do not that means you don't need to up it's exempt from modifier 51 and it does not need it appendix f modifier 63 exempt appendix g cpt codes that include moderate conscious sedation has been removed appendix h has been removed and we're going to move on to appendix i appendix i is also removed appendix j this is for your electro diagnostic medicine listing of sensory motor and mixed nerves bunch of nerves appendix okay this is product pending fda approval appendix l don't forget this is where we have our vascular families all right appendix m this is renumbered or resequenced excuse me renumbered cpt codes and this is the crosswalk listing appendix n is for your resequenced cpt codes appendix o multi analyte assays with algorithmic analysis maa or math used for clinical laboratory so it's not for us typically all right coders i think it's time let me get your resequence symbol now it's time to review are you ready time for a quick review of cpt symbols all right coders let's do it don't forget a red dot next to a cpt code means that that code is new to the cpt manual that year a revised code means that the language at the code level has been revised and not just necessarily the code language as you can see the green language underneath the code i wish i had my um pointer out but i don't but you can see the green language which is parenthetical guideline language has been revised no i think i can get it out now there it is so not necessarily the code language but the language underneath the code as well next that lightning bolt when you see the lightning bolt next to the code it means that that code is pending fda approval all right so you can use it but it is pending approval next the hashtag when you see the hashtag next to the code it means that that code is resequenced or out of order see 7708 eight one followed by seven seven zero eight five it's out of order all right and it will tell you where if you underneath it'll tell you where you can locate it as well code is on numerical sequence and it'll tell you where to find it all right next the add-on code i think you all could get this when you see an add-on code it means you use this code in addition to a primary code and often in your parenthetical guidelines it will tell you what you can use the or which primary codes you can use the add-on code with not always but often and also remember that these add-on codes are never sequenced first and you never use them with modifiers 51 and 50. moving right along our circle with the slash means do not append this with this code with modifier 51 it is exempt yes so if this is a secondary code you do not have to append modifier 51 and it'll make more sense the modifiers will make more sense when we review modifiers all right and we also have these triangles we really didn't talk about it but when you see the inverted triangles it means that the new there is new and revised text so it's within the triangle see the inverted the left inverted triangle and the right one all of this text between it has been revised and here and here so this entire page has been revised also when you see these green and red dots with arrows and blue green red and blue dots with arrows this is this refers to ama resources and publications all right so when you move on to real world coding it will be so applicable but while you're studying for the exam or if you're studying for the exam it is not and know this when you have more than one symbol if you encounter more than one symbol like these make sure that you apply all of those rules when possible all right so um it's just important that you follow the rules when possible all rules when possible alright so that completes our review now we're going to move on now it's time to talk about cpt the book and we're going to begin by how cpt arranges the book all right so essentially here's the the where the codes are we'll start with that pretty much it goes in this order we're going to begin with evaluation and management these are office visits so the office visits will come first followed by anesthesia this is to be used by anesthesiologists and certified anesthesiology nurses also after the anesthesia we're going to begin the surgery section and the surgery section is classified according to the body system and they're in numerical order so we begin with the integumentary system that is if you notice the 10 000 series 1004 through one thousand excuse me nineteen thousand four hundred and ninety nine after integumentary you'll find musculoskeletal system that's the twenty thousand series followed by respiratory that begins the 30 000 series and they share their um um chapter with cardiovascular system that ends the 30 000 series then we're moving on to the 40 000 series your digestive system followed by your male genital series and the the male genital shear shares its 50 000 series along with female genital and urinary next we have our nervous system that's the 60 000 series and in that series you'll find i ocular and nexa and auditory system all right so coders as you can see the surgery section is the largest section it's and it's classified according to body systems and it's in numerical order and it begins with ten thousand and somewhere at the end of sixty thousand now after the surgical section we begin with radiology then pathology and lab and that's seventy thousand eighty thousand respectively and finally we end things with the medicine section all right so yes i do know these sections in order because you're going to be coding so much that you too will know where these sections are you're going to know that integumentary begins the search surgery section all right now really quickly there are six sections in cpt evaluation and management anesthesia surgery section radiology pathology and medicine so i know you're saying well why is mrs j repeating herself well i want to make sure that you're ready because i have a question for you can you name the six sections of cpt all right i'll give you a few more seconds and if you named all six outstanding all right we'll begin with the first section that's evaluation and management remember these are offices not office visits these are visits office visits hospital visits these are doctor visits next anesthesia followed by surgery section followed by radiology pathology medicine in that order and you too will learn the sections you'll know that evaluation management is first followed by anesthesia followed by the surgery section which is the largest section in cpt these are these are this is where you'll find your surgical procedures followed by radiology path and lab and medicine all right coders so i hope that you you've learned what the sections are in cpt because now we're going to move on to what is inside this book what is all in here and when you turn the page if you're following along you turn the page open up the manual turn the page until you come to the contents this pretty much is the table of contents and you will be able to read all about cpt how the cpt code set is maintained the ama cpt staff and your introduction this is the introduction section also the release of cpt codes how they're released the section number and their sequences instructions on how to use this cpt code book everything that you need to know to code properly using cpt codes you got your format you've got a lot of stuff here in you even see the guidelines add-on codes and modifiers things that we've already spoken about then you go into your your chapters and you'll see evaluation and management and if you were paying attention you'll know what comes after evaluation and management yeah anesthesia so it goes in order and after you've gone through the introduction here is the procedural review section and in this section this is some this lists some other items that you need for coding although this is not cpt coding but in order to code using cpt codes you'll need to know all about prefixes suffixes and root words yes that's medical terminology also numbers related numbers surgical procedures pretty much the suffixes and you're going to learn about that later if you're studying with amci we go more in depth in class also conditioned and if you go to the next page you'll learn about directions and positions very important when you're coding for radiology specific words and their meanings and additional references now after that you'll get to the anatomy references then a list of illustrations anatomical illustrations that you can find in this manual and then procedural illustrations which i love and in almost every chapter of procedure codes you'll find illustrations or pictures to help you see what those surgical procedures are while you're coding them so that is really helpful all right so we're going to end things by looking at the evaluation and management table to the right you see these tables here these tables help you code evaluation and management visits pretty much how it's done is a coder will look at the physician's documentation then based upon what the doctor has documented the coder will determine the score or the level of that office or visit doctor visit based upon the documentation so the more he writes or the more complex that visit is the coder will be able to assign a level or score and then assign the appropriate evaluation and management code so that's it now no you can't learn everything at one time so we can't talk about evaluation management now in fact that's in advanced coding so now we're going to leave this section and we're going to move on to guidelines yes this is a great time to talk about guidelines when you reach a particular section in the book remember we talked about section one two three four five six when you reach evaluation and management you're going to come across some green pages you're gonna encounter those green pages those green pages will be your general coding guidelines and they are applicable to all of the codes within that section so in our situation we're at the surgical guidelines section and all of these guidelines are applicable to all of the chapters within the surgical section so let's just take a quick look we're not going to learn them per se because i do think that they are more applicable when you are actually coding in this section and i think advanced um coding or the advanced cpt section of this course is more applicable but i will quickly review them um in the surgery guidelines section there are guidelines about services the types of services that are rendered also it discusses the cpt surgical package definition this is in this section then how to code for follow-up care for diagnostic procedures for therapeutic procedures and supplied materials also what to do when you're reporting more than one procedure or service also separate procedures and trust me if you are in the advanced cpt course you will master all of these because we talk about them so regularly now after your general coding guidelines you'll encounter your table of contents and in this section as you can see we are in the surgery section but we are well there are general guidelines that's a general coding section and there are only a few general codes and after that is integumentary and these general codes actually fall in the integumentary section all right so integumentary is pretty much first and without further ado let's take a look at how these chapters are laid out before we can talk about how codes are arranged let's take a look at these categories or these titles all right so the black bold anytime you see a black bold that denotes a new section and remember i said there are six sections in cpt when you see the green bold that's a subsection the red bold that's a heading and the blue bold that is a subheading all right so it's just important that you know their names and i'll make references to them very shortly now before i move on i want to make sure you know what a subheading heading subsection and section are and pretty much you can recognize them by the color of the title so at the very top the black bold in this case surgery what is it is it a subheading a heading a subsection or section if you said section outstanding remember there are six sections in cpt so you're only going to see six black bolded titles all right the green bold what does the green bold represent a subheading a heading or subsection if you said subsection out standing what about the red bold what does the red bold denote well if you said heading outstanding and you're blue bold that is a subheading and just so you know you can have guidelines at any uh any level here so we know at the surgery at the blue black bold you'll see general guidelines you can see specific guidelines at the green bolt level at the red bolt level you could see specific guidelines and at the blue bold just want to let you know that now now that we know these titles we can now talk about how codes are arranged in cpt right so we'll begin by identifying the types of codes in cpt so in front of you you see a code family right how do we know it's a family we know it's a family because it has a parent code and it has a child code in other words the parent i'm gonna get let me get my pointer the parent sticks out and the children are all indented not necessarily the code but the code language the language sticks out and the language of the child is indented all right so the parent sticks out the language of the child is indented and they are a family their family because they're related in other words the parent and the child share something okay in fact the child code will not make sense without the parent code for instance if you look at the parent code 20100 this is exploration of penetrating wound separate procedure neck but code 20101 just says chest 102 says abdomen and flanking back and 103 says extremity so as you can see the children don't make any sense but they will in a moment and they need their parent to do it so in other words just so you know a parent code has children or indented codes and a child remember it's always indented the language is indented and a parent code and a child code they make up a family so that's all you need to know for now now and most important a child needs a parent to make sense or have meaning so in other words the parent and the children they share language and we call this language common language and it is the semicolon at the parent that distinguishes all of the codes in the family well it helps to distinguish all of the codes within the family let let me show you all right so i'm going to highlight the common portion language the common portion language is the language that precedes or is before the semicolon that common portion language is also shared by the members of the family or the child or indented codes so let me go ahead and read it for you all right so we know two zero one zero zero that code language says exploration of penetrating wound separate procedure neck now two zero one zero one what we're gonna do is only read the common portion language and switch the language after the semicolon with the language at the code level so we'll say for 101 exploration of penetrating wound separate procedure chest 102 exploration of penetrating wounds separate procedure abdomen flank back and 103 exploration of penetrating wounds separate procedure extremity now coders this is done this technique is used by cpt it's a space-saving technique to save space so if they didn't use this technique where the common portion language precedes the semicolon we would have a lot of language throughout this book in fact that book would be a lot bigger so it's important that we understand how cpt has laid out the book but here are some important things to remember remember that the semicolon helps to distinguish each code also the common portion language this highlighted language is the language that precedes the semicolon or goes before the semicolon and it's shared by the entire family and remember a family is a parent with children so some of you may say well what if it doesn't have a family if it doesn't have a family then it's a standalone code yeah it's a standalone code so if you look at one zero zero four it has no indented family underneath no children one zero zero six it does have one child one zero zero eight has one child and one oh one two zero have none well on this sheet it could have more but i i don't know but on the sheet it doesn't so some of you might say well wait one second that is hard to read it is yeah it might be hard to read so if you do this let's say you take your families and you just circle all of your families like this we circle all of the families i'm going to grab the parenthetical guidelines too right because they're applicable to that family so if you do that i got a question for you how many standalones can you see on this page and very easily you say hey i can see two standalones right yeah two standalone codes here and here and you also see two families so why did i show you this why was this important it's important because it's an annotation technique it's a part of an annotation technique that we use at amci it's important because you have to be able to see the families at a glance yes and if you're studying for the cpc or ccs or any medical coding exam you don't want to make a mistake no and it is time-based and you're likely to make a mistake if you're going fast so we recommend that you annotate your manuals now this is not um instruction on how to annotate however i just want to make you aware that circling those families highlighting your key well highlighting your indented codes and highlighting your parenthetical guidelines and underlining keywords and making notations about guidelines and just keywords in a code or code language that's called chun so this is just the mentioning of chun and it does help you see the codes the codes family much much so just a little bit about chun it is it's it's amci cpt annotation technique and it is the acronym for circle highlight underline and notate and circling is an important part of chung and if you want to go ahead and circle your families go right ahead remember your parent code has a common portion language and that's the language before the semicolon indented code has only specific code language and you should circle the parent and the children or the indented to create a family a standalone code is independent it does not have a family and don't forget the semicolon that distinguishes or helps to distinguish each code all right and i believe there are there will be if you're in the amci cpt course there will be instruction on chun no doubt if you're looking at this lecture on youtube or any other platform we do have some lectures on how to chun your cpt manual all right time to move on and we're going to talk very briefly about sequencing cpt sequencing is pretty much determining which code comes first sometimes second and third yes you could have multiple procedures performed in one day or one encounter and it's important as a coder to know which code will come first so let's say a patient had acne surgery up here they had acne surgery and they also had incision and removal of a foreign body of the skin of the arm so they had both of these procedures that took place all right so just so you can see one zero zero four zero is your acne surgery code and one zero one two zero is your incision and removal foreign body code so as a coder it is your job to say which one goes first is it going to be sequenced one zero zero four zero then one zero one two zero with a 51 modifier all right we spoke briefly that 51 modifiers get appended um whenever codes are coded subsequently but that's a different subject i really want you to focus on these codes the primary codes so or is it going to be one zero one two zero and one zero zero four zero pretty much this makes a difference coders you will need to determine how it's sequenced how the codes will be sequenced specifically which one goes first and this is how it's done it's based on what we call r v use or relative value units and this is a standard set by medicare so medicare have determined for each code which or what the rvu value is and we're not going to get all into it you just need to know that rvus determine which code is sequenced first generally unless there is a guideline we're going to get to that but pretty much this is the formula for rvu you take the work rvus and that's set by medicare multiply it by the work geographic practice cost index in other words this is what it costs the practice to offer that procedure so you multiply the two then you add it to the practice expense rvu and you multiply that by practice expense geographic practice cost index then you add that to the malpractice rvus and multiply that by malpractice geographic practice cost index and that is your total and you're going to say are we going to be responsible for this formula no you're not you might need to know what an rvu is but i'm pretty sure you won't i just wanted you to know now this is basically how we sequence codes and rvu's pretty much the higher the rvu the more complex that code is so the most complex procedure always gets sequenced first right because that is how that is the value of the code that is what it it's going to cost more in other words the physician will get more money and i'm going to tell you something else those subsequent codes generally either they don't get coded if there's no modifier appended or the the doctor does not get reimbursed if there's no modifier appended to it or if that 51 modifier is appended to it that doctor's only typically not always going to get half of that amount for that service so the most complex procedure is often has the highest rvu and that will be sequenced first and then how do we know what's more complex we just said by the rvu value and you can find these rvu values at this web address so if you want to screenshot it go right ahead and finally typically typically the codes with the higher rvus appear after the lower rvus in cpt typically not always if it's a family believe it or not often that parent is a lower rvu than the child or indented code just thought i would let you know that now coders is time to move on and let's go ahead and talk about guidelines this is a good segue because guidelines also determine the sequencing order yeah in fact there are three types of guidelines in cpt three i would say three main types of guidelines you've got parenthetical guidelines specific coding guidelines and general guidelines and if we were to rank them in order of importance your parenthetical guidelines will reign supreme followed by your specific code coding guidelines coming in second and your general coding guidelines will come in first now generally when you're able you will use all three guidelines if applicable but if you can only use one always go with the highest ranking guideline now let's begin let's talk about parenthetical guidelines really quickly a parenthetical guideline is pretty much a guideline in the parenthesis so if we look at one nine three zero zero and if you look in the parenthesis it says for breast tissue removed for breast size reduction for other than gynecomastia use nine three one eight all right so pretty much this nine three one nine three zero zero this is a mastectomy for gynecomastia gynecomastia but the guideline within the parenthesis or the parenthetical guideline says hey do not use this code for breast tissue removed other than gynecomastia right so gynecomastia just so you know that is male breast tissue all right so these parenthetical guidelines reign supreme they can always change the game so always read them always always all right next guy specific guideline these guidelines are found underneath your titles underneath your black title your green title or your red title or blue title in this case we have some guidelines underneath the red tie title in fact when you see writing underneath a title often that is a guideline all right now finally we're going to move on to general guidelines and they are found on the green pages and we talked about that so your general guidelines apply to all of the guidelines all of the codes within the section all right now let's just take a quick look we're still in the surgery section and i said hey we'll talk a little later about and some of these guidelines maybe in advanced cpt then i changed my mind i said let me go ahead and have you take a look at one of the guidelines the general guidelines in the surgical section and we call these guidelines the cpt surgical package definition in a nutshell this guideline says hey every single procedure code in the surgery section includes not just that surgery it also includes the visit so the doctor visit let's say someone went to the doctor the day before they went they had surgery it's bundled it also includes local infiltration a metacarpal metatarsal digital block or topical anesthesia it also includes immediate post-operative care including dictating operative notes talking with the family and other physicians or other qualified health care professionals the cpt code in the surgery section also includes writing orders it also includes evaluating the patient in the post anesthesia recovery area and finally that cpt code includes typical post-operative follow-up care so a code a cpt code in the surgical section includes a lot of stuff now let's go ahead i think we're ready to do an example i've done a lot of talking now it's your turn and i want to demonstrate here is an example of bundling and that surgical package that we've just spoken about we have a 12 year old little boy who arrives to the physician's office who performed a comprehensive history and exam the physician decided that the little boy needed a tonsillectomy emergently the patient was taken to the surgery center then the physician carried out a tonsillectomy so what happened that's what we need to determine well we know that a comprehensive history and exam took place in other words there was an office visit and you're going to learn about evaluation and management a little later when you get to advanced coding but just remember anytime a patient goes to the doctor or the doctor sees or or if the doctor visits the patient the doctor can be billed for their visits so you can code for visits however a procedure took place on the same day as that visit and you might say well what are you talking about mrs j i'm talking about the cpt surgical package remember so we just said that when a procedure is carried out and you use a procedure code there's some other things bundled in it right and in this black box it says that evaluation and management services or e m services subsequent to the decision for surgery on the day before and or the day of surgery all right so coders pretty much if a patient has a doctor visit the day before or the day of surgery it gets bundled what does that mean that means you don't code for it separately you only use one code that's your procedure code and that's it all right so the moral of the story the procedure code used for this tonsillectomy includes the office visit therefore we would only code for the office visit and if it's included we call that bundled and there you go all right so let's put our knowledge of cpt the symbols the guidelines let's put it all together and let's go ahead and do some coding you ready all right let's do it and don't forget our three steps step one we're going to look up the main term or the procedure in the index step two we're going to verify that code in the chapter step three we're going to confirm any applicable guidelines let's do it all right so we have a 12 year old boy who had a tonsillectomy step one we're going to look for the procedure in the index our procedure is tonsillectomy boom tonsillectomy and it takes us to code series four two eight two zero through four two eight two six step two and here's our code series step two we're going to verify these the code or codes in the chapter they gave us a whole series so we're gonna have to read them okay so if we look at four two eight two zero this is the code for tonsillectomy and adenoidectomy coders there is no mention that the child's adenoids were removed so that's not correct step the next code in the series is four two eight two one this is tonsillectomy and adenoidectomy and 2-1 is age 12 or older that too is incorrect because i'mma tell you why it's incorrect if you if the parent is wrong the child is wrong okay now let's move on down to four two eight two five tonsillectomy primary or secondary younger than age twelve so i like the common portion language but i do not like this the um language that's specific to this code i don't like the language behind the semicolon so four two eight two five is wrong because this patient is not younger than age twelve the patient is twelve so 42825 is wrong but the parent the common portion language in this parent is correct right so let's go ahead and look at the indented code 42826 age 12 or over and you know what coders i like 42826 tonsillectomy primary or secondary age 12 or older or over i like that i hope you do too and look at my notation here at two eight two five it says 11 years or below that's my chun so if we were to come to this page and these notations were already here we could have probably jumped right to two 42826 and you arrive at the fact that this is our answer so the answer four two eight two six and the thing to take away be careful that patient is 12 years of age and in this section or any section in cpt where you see they are distinguishing that age make it make sense at amci we make it make sense whenever someone is younger than age 12 we'll say 11 or below or we can say 11 plus or below but not 12. all right coders so if you understand that outstanding and for some of you it might have been too much i know this is a basic and an introductory level class and know the only goal that i want you to achieve i really want you to understand that there are guidelines and i also want you to understand that there is a process to looking up a cpt code and that's pretty much it moving forward when you reach advanced cpt coding you're going to get all of this that i've mentioned and more all right and you'll be ready all right coders this completes part one of introduction to cpt coding i want you to remember to practice practice practice at this point you should be able to put your knowledge of cpt symbols guidelines and coding put it all together and really code you are there don't forget the three steps step one look up the main term in the index step two verify that code in the chapter the color pages step three confirm any applicable guidelines all right so let's review what we've accomplished we reviewed how to look up a cpt code cpt basic guidelines and scenarios to test your knowledge now congratulations you're ready for part two thank you for watching an amci exclusive presentation in partnership with aapc until next time