CPT & HCPCS Coding Questions Answered 100% correct

CPT & HCPCS Coding Questions Answered 100% correct CPT Current Procedural Terminology HCPCS Healthcare Procedure Coding System AMA American Medical Association CMS Centers for Medicare and Medicaid Services When & how frequently are CPT codes updated? Annually on January 1st Who created & maintains CPT? AMA What is the purpose of CPT? To provide a uniform language for describing & reporting the professional services performed by physicians. HCPCS is maintained by CMS What is the purpose of HCPCS? To provide a system for reporting the medical services received by Medicare beneficiaries. HCPCS is made up of how many parts? 2 - Level I & Level II Level I is composed Entirely of the current version of CPT Level II provides Codes to represent medical services that are not covered by the CPT system. Examples of HCPCS Level II codes are: Medical supplies & services performed by healthcare professionals who are not physicians. ICD-10-CM International Classification of Diseases, 10th Revision, Clinical Modification ICD-10-CM provides Used to describe & report the illnesses, conditions, & injuries of patients who require medical services. 6 main sections of Category I CPT codes 1. Evaluation & Management 2. Anesthesia 3. Surgery 4. Radiology 5. Pathology & Laboratory 6. Medicine 3 types of CPT Supplementary codes Category II codes Category III codes Modifiers CPT Category II codes provide Supplementary tracking codes designed for use in performance assessment & quality improvement activities. CPT Category II codes are composed of Five characters- four numbers & an alphabetic fifth character. Are CPT Category II codes billable? No CPT Category III Codes include temporary codes that represent emerging medical technologies, services & procedures that have not yet been approved for general use by the FDA & so are not otherwise covered by CPT codes. CPT Category III codes give physicians & other health care providers and researchers a system for documenting the use of unconventional methods so that their efficacy & outcomes can be tracked. CPT Category III codes are composed of five characters: four numbers and an alphabetic fifth character, capital letter T. CPT Modifiers can be reported along with many of the Category I CPT codes The two- character modifier codes are appended to Category I five- digit CPT codes to report additional information about any unusual circumstances under which a procedure was performed. The reporting of modifiers is meant to support the medical necessity of procedures that might not otherwise qualify for reimbursement. Most of the two- character modifiers for Category I codes are numerical Some two- character modifiers for Category I codes are alphanumeric modifiers to indicate the physical status of patients undergoing anesthesia. Anesthesia modifier P1 a normal healthy patient Anesthesia modifier P2 a patient with mild systemic disease Anesthesia modifier P3 a patient with severe systemic disease Anesthesia modifier P4 a patient with severe systemic disease that is a constant threat to life Anesthesia modifier P5 a moribund patient who is not expected to survive without the operation. Anesthesia modifier P6 a declared brain dead patient whose organs are being removed for donor purposes. NEC (not elsewhere classifiable) ICD-10 doesn't provide a code specific for patients condition. Provider documented more specific info regarding patients condition but there is not a code in ICD-10 that reports condition accurately. NOS (not otherwise specified) Equivalent of unspecified and is only used when the coder lacks the information necessary to report a more specific code. [ ] Brackets are used in the Tabulat list to enclose synonyms, alternate wording, or explanatory phrases. [ ] Brackets are used in the Alphabetic Index to indicate multiple codes required