Chapter_026.pptx

CHAPTER 26

MEDICINE

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Medicine Section

Diagnostic and Therapeutic Procedures

Most procedures noninvasive (not entering body)

Contains invasive procedures

Example: 92973, Percutaneous transluminal coronary thrombectomy

Numerous notes throughout

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The Medicine Section includes codes 90281-99607 and is used for coding diagnostic and therapeutic services that are generally noninvasive.

Some invasive procedures, such as cardiac catheterization and percutaneous thrombectomy, are included in this section.

The various subsections contain many specific notes to be used with certain groups of codes; these notes are important for coders to read so they can code services appropriately.

Subsections

Wide variety of services

Many specialized tests

Examples:

Audiology

Biofeedback

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The subsections cover a wide variety of services and many specialized diagnostic tests, such as audiologic function tests, electrocardiograms, and biofeedback.

The codes in the Medicine section usually do not include the supplies used in testing, therapy, or diagnostic treatment, unless specifically stated in the code description.

Immunizations

Often used

Two types of immunizations

Active and passive

Correct coding includes

Supply injected

Administration of injection

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Active immunization is given when it is anticipated that the person will be in contact with the disease.

Passive immunization does not cause an immune response. What happens instead? (Injected material [i.e., immune globulins] contains a high level of antibody against a disease.)

Active—Bacteria or Viruses

Bacteria that cause disease made nontoxic (toxoid)

Injected to build immunity

Small dose active virus injected (vaccine)

Injected to build immunity

Example: Poliovirus

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Active immunizations can be toxoids or vaccines.

Toxoids are bacteria that have been made nontoxic.

Vaccines are viruses that are given in small doses and cause an immune response.

Passive Immunization

Does not cause immune response

Contains antibodies against certain diseases—immune globulins

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Name a disease for which passive immunization is used. (Rabies, hepatitis B, or tetanus)

Immune Globulins (90281-90399) (1 of 2)

Identifies immune globulin product

Example: Botulism antitoxin

Report administration separately

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The Immune Globulin subsection is relatively new to the CPT manual.

The codes in this subsection report only the immune globulin product and must be reported in addition to the appropriate administration code from the appropriate subsection.

Immune Globulins (90281-90399) (2 of 2)

Codes divided by:

Type

e.g., Rabies, hepatitis B

Method

e.g., Intramuscular, intravenous, subcutaneous

Dose

e.g., Full dose, mini-dose

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Codes in this subsection are divided by type of immune globulin, method of injection, and type of dose.

Immunization Administration for Vaccines/Toxoids (90460-90474) (1 of 2)

Administration (performing the injection) of substance

Reported with substance given

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Codes in the Immunization Administration subsection are reported with the code for the substance given. In which subsection are these codes found? (Vaccines/Toxoids subsection)

Immunization Administration for Vaccines/Toxoids (90460-90474) (2 of 2)

90460, 90461 Patients through age 18 when physician counsels regarding immunization

90471-90474 = Patients 19 years of age or over

Patients of all ages (including under 19) if physician does not counsel regarding immunization

90471, +90472 = Percutaneous, intradermal, subcutaneous, or intramuscular injection

90473, +90474 = Oral or intranasal

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Immunization administration codes are divided by patient age and administration method.

Make sure you code for each injection that is administered.

Be careful when a combination immunization (DTP) is given. This is all combined in one injection even though there are 3 immunizations; they are given in one injection so only one administration code is used.

Methods of Administration

Percutaneous

Intradermal

Subcutaneous

Intramuscular

Intranasal

Oral

From Bonewit-West K: Clinical Procedures for Medical Assistants, ed 8, St. Louis, 2012, Saunders.

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Administration codes are divided according to method of administration and some by age of patient. Read descriptions carefully.

Report Administration for Each Dose—Single or Combination

Example: Patient (over age 8) receives three separate administrations:

90471 tetanus

90472 rubella (add-on code)

90472 diphtheria (add-on code)

OR depending on payer:

90471 tetanus

90472 x 2 rubella and diphtheria

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Each administered dose must be reported.

For example, multiple injections can be reported for a patient over age 8 by using 90471 for the first injection and 90472 for each injection thereafter.

Vaccines, Toxoids (Vaccine Product Codes) (90476-90749)

Many codes are age or dosage specific

Example:

90658, Trivalent (IIV3) influenza virus vaccine, split virus, 0.5-mL dosage

Codes for products for single diseases

Example:

90713, Poliovirus vaccine, inactivated (IPV)

Codes for combination of diseases

Example:

90700, Diphtheria, tetanus, and acellular pertussis (DTaP)

Caution: There are numerous code combinations of diphtheria

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The Vaccines/Toxoids subsection lists vaccine products given in immunizations.

Coders must carefully review the description of the vaccine product code to determine which disease is specified.

When is the combination code used? (When one code is available to describe multiple products given)

Be careful to select the correct code. For example, there are 8 combination codes for diphtheria.

Vaccines, Toxoids

Some vaccines given on schedule

Example:

90633, 2-dose hepatitis A vaccine

First dose, first visit

Second dose, second visit

90633 is reported for each visit

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What is a schedule based on? (The number of doses provided and the timing of administration)

Each time the vaccine is administered, the code is reported, along with the date the injection was given.

Remember

Do not assign modifier -51 with Vaccine/Toxoid codes

Rather, depending on payer:

List each code multiple times or

Use times (x) symbol and indicate number

Modifier -51 should not be reported for the vaccines, toxoids when performed with these administration codes (90460-90474)

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List the codes multiple times, or use the “times” (x) symbol and indicate the number of injections given.

Important Reporting Rules

If vaccine administered during office visit (not related to E/M)

Report E/M service with modifier -25 + Vaccine + administration

Depends on local carrier

Office visit for vaccine only, code only vaccine, NO E/M service

Depends on local carrier

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If the office visit takes place only because of the immunization, report the immunization administration code first and the vaccine/toxoid code second.

Routine Vaccinations

Influenza

Administration

G0008 HCPCS (Medicare only)

90471/90472

Substance (trivalent (IIV3) influenza virus vaccine) 90657, 90658

Pneumococcal

Administration

G0009 HCPCS (Medicare only)

90471/90472 administration

Substance (23-trivalent pneumoccal polysaccharide vaccine) 90732

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These two vaccinations are commonly provided. (Influenza and pneumococcal)

What does trivalent mean? (3 viruses)

The third-party payer may require CPT codes or CPT with HCPCS codes for the service.

For Medicare patients, the coder reports only an administration code for an immunization if no E/M service is reported; E/M office visits include the administration of an immunization.

Psychiatry (90785-90899) (1 of 3)

Psychiatric treatment at same time as E/M service, report

One code for therapy with E/M

Example: 90833, psychotherapy and E/M

Time major billing factor

Codes divided on time

Medical record indicates session time

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The Psychiatry section has a lengthy note under the heading that details the use of psychiatric codes in conjunction with hospital and clinic E/M services.

If psychiatric treatments are rendered on the same day as E/M service, both are reported with one code from the Psychiatry section.

If these treatments are provided on a different day from the E/M service, a code from the E/M section is listed.

Some codes reflect evaluation or diagnostic services, some reflect therapeutic procedures, and some reflect psychological testing.

When selecting a psychotherapy code ask these questions:

How much face-to-face time is spent with the patient?

Does documentation support an evaluation and management code in addition to psychotherapy?

If rendering psychotherapy, is the approximate “time” of the psychotherapy noted in the medical record?

Psychiatry (90785-90899) (2 of 3)

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Psychiatry (90785-90899) (3 of 3)

Many services provided in partial hospital settings

Patient in hospital during day, returns to home for evenings and weekends

Interactive psychotherapy is typically furnished to children

It uses play equipment, physical aides, nonverbal communications, or other mechanisms of communication

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E/M Initial Hospital Care and Subsequent Hospital Care codes (99221-99233) are used to report inpatient stays.

Biofeedback (90901, 90912-90913) (1 of 2)

Used to help patients gain control over body processes

Example: High BP or chronic pain

Medicare Coverage Issues Manual 35-27 restricts the use of biofeedback

Medicare doesn’t cover biofeedback for psychosomatic disorders

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Biofeedback is a process by which individuals can monitor and manage physiological processes that are normally out of their control.

Biofeedback (90901, 90912-90913) (2 of 2)

Patient training in biofeedback by professional

Continues on own

Services often part of psychophysiologic (mind/body) therapy

90912 reports initial 15 minutes, 90913 add-on code, reports each additional 15 minutes

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When biofeedback is part of individual psychophysiological therapy, codes are listed for both the biofeedback and the individual psychophysiological therapy.

Dialysis (90935-90999)

Cleanses blood

Temporary (non-ESRD)

Permanent (ESRD)

Two parts to report ESRD dialysis services:

Physician service

Hemodialysis procedure

Patient receiving hemodialysis. (From Lewis SL, Dirksen SR, Heitkemper MM, Bucher L, Camera IM: Medical-Surgical Nursing: Assessment and Management of Clinical Problems, ed 8, St. Louis, 2011, Mosby.)

Figure 26.4

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What is the specific purpose of dialysis? (It removes waste products from the blood when the body [the kidneys] cannot perform this function adequately.)

End-stage renal disease (ESRD) requires permanent, ongoing dialysis.

End Stage Renal Disease Services(90951-90970)

Include

Establishment of dialyzing cycle

Physician services

E/M outpatient dialysis visits

Patient management during dialysis

Reported for month: 90951-90966

Less than full month of service: 90967-90970 per day

Codes divided on age and number of visits

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Dialysis services are usually billed as a monthly fee and are performed on an outpatient basis.

How are physician services for dialysis reported? (By the type of dialysis the patient is receiving, the number of doctor visits)

Hemodialysis Service (90935-90940)

Hemodialysis is the procedure

Used for ESRD and non-ESRD

Billed per day for inpatients receiving ESRD + non-ESRD

Includes all physician E/M services related to procedure

Use modifier -25 if separate E/M service provided

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What is the function of hemodialysis? (To route blood outside of the body for filtration of waste products)

How long does a patient suffering from ESRD need to be on dialysis? (Forever or until he or she can have a kidney transplant.)

Miscellaneous Dialysis Procedures (90945-90947)

Describes other dialysis procedures

Example:

Peritoneal dialysis in which toxins are passively absorbed into dialysis fluid

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Peritoneal dialysis uses the peritoneal cavity as a filter.

Peritoneal dialysis is a continuous renal replacement therapy.

If a physician sees a patient during the dialysis session, how would this be coded? (If the physician sees a patient during the dialysis session for something other than what pertains to the function of his/her kidneys, for example the patient has a cough and is diagnosed with an upper respiratory infection, you would code a separate E/M code with a -25 modifier attached.)

Peritoneal Dialysis

Services billed on per day basis for inpatient ESRD patients

From Goldman L, Ausiello D, editors: Cecil Textbook of Medicine, ed 22, Philadelphia, 2004, Saunders.

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Peritoneal dialysis is reported monthly or if less than a month, for each day the service is provided.

How is peritoneal dialysis reported for Medicare? (Monthly or per day, using temporary HCPCS codes)

Dialysis Training

Patients can receive training in self-dialysis

Reported with 90989, 90993

Codes divided by complete or partial training program

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Where are dialysis teaching codes located? (Under Miscellaneous Dialysis Procedures)

Most third-party payers allow training to be billed for one time only.

Gastroenterology (91013-91299)

For tests and treatment of esophagus, stomach, and intestine

Codes usually reported with E/M or consultation service code

Caution: Many bundled services

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Several intubation codes are listed in the Gastroenterology subsection; coders must carefully review the code descriptions to determine which services are bundled into the code.

Ophthalmology (92002-92499) (1 of 2)

Contains E/M codes

Not E/M codes from front of CPT

Definitions for new and established patients same as for E/M section

Most codes are for bilateral services

If only one eye, use modifier -52(reduced service)

Read the definitions of intermediate and comprehensive services in the CPT!

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Extensive subsection notes explain levels of service and present examples to clarify the codes.

Codes are based on whether the patient is new or established, and on the complexity of service received.

For coding purposes, what is the definition of a new patient? (One who has not received any professional service within the past 3 years from the physician or another physician of the same specialty in the same group practice)

It is important to note the difference between intermediate and comprehensive as it pertains to this subsection.

Example, Intermediate: Review of history, external examination, ophthalmoscopy, biomicroscopy for an acute complicated condition (e.g., iritis) not requiring comprehensive ophthalmological services

Intermediate and comprehensive ophthalmological services constitute integrated services in which medical decision making cannot be separated from the examining techniques used

Ophthalmology (92002-92499) (2 of 2)

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Special Otorhinolaryngologic Services (92502-92700) (1 of 2)

For special evaluations of audiologic system

Go beyond those usually provided in evaluation

May be reported in addition to basic audiologic service

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The services in this subsection deal with special testing or studies for the ears, nose, and larynx.

Who can perform an audiology test? (A physician or trained audiologist)

Special Otorhinolaryngologic Services (92502-92700) (2 of 2)

Special treatments and diagnostic services

Example:

Nasal function tests (rhinomanometry) or audiometric tests

All hearing tests bilateral unless indicated one ear in description

Use modifier -52 for 1 ear

Nasal function test equipment. (From Flint PW, Haughey BH, Lund VJ, Niparko JK, Richardson MA, Robbins KT, Thomas JR: Cummings Otolaryngology-Head & Neck Surgery, ed 5, Philadelphia, 2010, Mosby.)

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Otorhinolaryngologic diagnostic and treatment services are usually reported using codes from the Surgery section; only special services are reported using codes from the Medicine section.

How would a test be coded if the procedure was only performed on one ear and the description did not state one ear or unilateral? (With a modifier -52)

Coronary Therapeutic Services and Procedures

PTCA (92920-92921)

Access through the femoralor brachial artery

Catheter with balloon tip threaded up to heart

Balloon is expanded and widens vessel

If an angioplasty and an atherectomy are performed during the same session, only the atherectomy is billed

If a stent is placed in a coronary vessel, the stent placement takes precedence over the atherectomy

Stent(s) placement(s) includes coronary angioplasty when performed (92928, 92929)

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PTCA codes are found under the Coronary Therapeutic Services and Procedures category.

There are three main vessels that can be coded. They are the left anterior descending (-LD), right coronary artery (-RC), and the left circumflex (-LC).

What is the purpose of an angioplasty? (To open up a vessel of the heart that is blocked with plaque [ASHD])

Cardiac Catheterization

Diagnostic medical procedure

Three components included in most Cardiac Catheterization Codes:

Catheterization

Injection

Imaging

Congenital cardiac catheterization codes (93530-93533) do not include injection or imaging

Reviewed in Chapter 17 of text

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Cardiac Catheterization is a diagnostic procedure that includes the introduction, positioning, and repositioning of a catheter to aid in diagnoses of the heart. Also included is recording of pressures, obtaining blood samples, and cardiac output measures.

The first component of coding heart catheterization is the positioning of the catheter. Code selection is made based on where the catheter will be placed. (LHC), (RHC), (BHC)

The second component is the injections. These are coded by what vessel is being injected.

Last is the imaging. Only 2 codes. Read the description carefully.

Anticoagulant Management (93792, 93793)

Outpatient management of warfarin therapy

Training for INR monitoring

93793 billed once per day, any number of tests reviewed

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The Anticoagulant Management codes are 93792 and 93793. Anticoagulants are warfarin and Coumadin. The notes in this subheading are a must read to know how to properly report these codes.

Noninvasive Vascular Diagnostic Studies (93880-93998)

Vascular codes for procedures on noncoronary veins and arteries

Includes

Patient care

Supervision and interpretation (S&I)

Copy of results

Reviewed in Chapter 17 of text

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These procedures use the same devices as those used in heart and great vessel echocardiography.

What distinguishes these procedures from coronary procedures? (The divisions are based on the location of the vein or artery that is being studied.)

Pulmonary (94002-94799)

For ventilation management, therapies, and diagnostic tests

Includes procedure and interpretation of test results

Additional E/M service reported separately

Ventilator management codes

Further divided by place of service

Facility is billed per day

Home billed by time once per month

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What modifier should you add when reporting the physician interpretation of the test? (-26)

What pulmonary therapy might be used? (Nebulizer treatments, incentive spirometry)

Several tests might be administered to help the physician form a diagnosis. Each test should be reported separately unless otherwise indicated in the code description.

Allergy and Clinical Immunology (95004-95199)

Divided into three subheadings:

Allergy Testing (95004-95070)

Ingestion Challenge Testing (95076, 95079)

Allergen Immunotherapy (95115-95199)

Allergy Testing—consists of performance, evaluation, and interpretation of allergens

Ingestion Challenge—test for sensitivity to food, drugs, and other substances

Immunotherapy—indicated for patients with allergic rhinitis due to seasonal pollinosis caused by trees, grasses, weeds, etc.

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You are strongly encouraged to read the notes that appear at the beginning of the Allergy and Clinical Immunology subsection (95004-95199).

Allergy Testing (95004-95070)

Sensitivity testing using various types of tests

Example:

Percutaneous, intracutaneous, inhalation

Tests use numerous substances

Example:

Extracts, venoms, biologics, and foods

Type and number of tests based on physician’s judgment

Medical record will indicate the

Number of tests

Type of test

Method of testing

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Allergy Testing describes testing by various methods and defines the types of tests.

Why must the number of tests always be specified for billing purposes? (Because payment is made per test for most of these codes.)

What are some types of allergy testing? (Allergenic extracts, venoms, biologicals, food)

What are some methods of allergy testing? (Percutaneous, intracutaneous, inhalation)

Ingestion Challenge Testing (95076, 95079)

Sensitivity to food, drugs, and other substances

95076 reports initial 120 minutes testing time

95079 reports each additional 60 minutes

Services less than 60 minutes, report E/M code

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What are some types of allergy testing? (Allergenic extracts, venoms, biologicals, food)

What are some methods of allergy testing? (Percutaneous, intracutaneous, inhalation)

Allergen Immunotherapy (95115-95199) (1 of 2)

Codes divided into three types of services:

Injection only

Prescription and injection

Provision antigen (substance) only

Codes 95115 and 95117 are payable in an office setting

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All codes for allergen immunotherapy have specific notes that describe the service.

How are these codes divided out? (Injection only, prescription and injection, and substance only)

Allergen Immunotherapy (95115-95199) (2 of 2)

Physician service bundled into immunotherapy codes

If separate E/M service provided, report separately with modifier -25

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An office visit code is not usually reported. When is it reported? (When the physician provided another identifiable service at the time of immunotherapy)

Neurology and Neuromuscular Procedures (95700-96020)

Contains codes to report tests, such as:

Sleep testing

Muscle and range of motion testing

Electroencephalography (EEG)

Neurostimulator procedures

Functional brain mapping

Many bundled services

Services usually provided in addition to E/M service

These are often consultative services (e.g., 99241-99242)

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These codes are usually used by neurologists.

To code sleep tests accurately, the coder must know the parameters (what is being measured during the sleep test) and the stages of testing. In addition, many codes include a time component.

What is polysomnography? (Measurement of the brain waves during sleep with the added feature of recording the various stages of sleep, i.e., excited, relaxed, drowsy, asleep, or deep sleep)

Central Nervous System (CNS) Assessments/Tests (96105-96146)

Used to report:

Psychological tests

Speech/language assessments

Developmental progress assessments

Thinking/reasoning examinations

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Codes from this section are used for psychological tests, speech/language assessments, developmental progress assessments, and thinking and reasoning examinations.

CNS Assessments/Tests

Codes based on time

Minimum of 16 minutes to report 30 minute codes

Minimum of 31 minutes to report 1 hour codes

Includes written report of results

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These codes are mainly billed on a per hour basis.

The results are put on a report that goes in the patient’s record.

Hydration (96360, 96361)

96360-96361

Infusion: Therapeutic procedure to introduce fluid into body

Example:

Fluid into vein for patient rehydration

Codes represent infusion service and “prepackaged fluid and electrolytes”

Other than prepackaged, report separately

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An infusion is the introduction of a liquid into the body over a long time.

The physician must administer or supervise administration of the infusion.

What are the codes based on? (The time it takes for the infusion to be completed)

The drug that is infused would be reported using an HCPCS code or CPT code 99070.

If an infusion lasts 90 minutes, the service is reported as 90765 (first hour). The additional time over 60 minutes would need to be 31 minutes or greater to count for an additional hour, 90766.

Hydration, Therapeutic Infusions, and IV Pushes

Only one initial service per encounter

Patient presents for hydration (initial service)

Has drug therapy while being hydrated

Drug therapy is subsequent

Report with add-on code

Example: 3 hours hydration with antiemetic by IV push for 15 minutes

96360 = hydration, 1 hr

96361 × 2 = hydration, hr 2 and 3

96375 = antiemetic IV push

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The key to billing for hydration, therapeutic infusions, and IV pushes is that only one initial service is billable per encounter. All others must be coded with an add-on code listed as each additional hour or sequential push.

Remember the subsequent infusions or pushes are add-on codes and do not require a -51 modifier.

Watch the notes carefully as they are a good indicator of what can be billed together and what is bundled.

Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (Excludes Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration) (96365-96379)

Types of Drug Administration

Therapeutic• Prophylactic• Diagnostic

Codes divided by administration method

Subcutaneous• Intramuscular• IV Push

• Intra-arterial• Intravenous push

A push takes 15 minutes or less

Over 15 minutes is an infusion

Also report the substance administered (J code)

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Infusions are based on time. The second hour must be 31 minutes or more.

Sequential means a second drug is given after the first.

Concurrent means an additional drug is given at the same time as the first drug.

Injections are divided based on the method of injection. A physician must be present for these injections.

Less than 15 minutes is a push; 15 minutes or more is an infusion.

Chemotherapy Administration (96401-96549) (1 of 5)

Represents only preparation and administration chemotherapy

If separate E/M service provided, report E/M code and modifier -25

Chemical can be administered (injected) into

Lesion

Vein

Tissue

Muscle

Artery

Cavity

Nerve

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Chemotherapy may be provided by several modalities.

Coders should read the patient record carefully before coding to ensure that the correct modality is identified.

Chemotherapy Administration (96401-96549) (2 of 5)

Intravenously injected chemicals: two methods of delivery of chemical

IV push quickly puts into vein (15 minutes or less)

IV infusion delivers over longer period time (15 minutes or more)

Chemotherapy administration codes are covered only when drug being used is an antineoplastic and diagnosis is cancer

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Why should a coder be familiar with the coding requirements of third-party payers for chemotherapy? (Some third-party payers will pay for both an IV push and an infusion on the same day; others will not. Knowing this helps to assure the correct reimbursement.)

Chemotherapy Administration (96401-96549) (3 of 5)

Codes often divided on time of infusion/injection procedure

Example:

96413, Chemotherapy administration, intravenous infusion, up to 1 hour, single or initial substance/drug

When multiple drugs are given by different routes of administration, a separate fee will be paid for each route of administration

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What determines the code to be used? (The method of treatment and the length of time taken to complete the treatment)

Some codes include several hours of treatment time, and others specify each hour of treatment time.

Unit billing or multiple coding may be necessary to accurately reflect the services provided.

Chemotherapy Administration (96401-96549) (4 of 5)

Chemical agent (substance) reported separately

Special supplies (e.g., special needles) reported separately using 99070 or Level II HCPCS code

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When are codes from the Chemotherapy Administration subsection used? (In a clinical setting)

Are both the drug and the administration billable? (Yes)

Where would you find the codes for the drugs? (HCPCS book, J codes)

Chemotherapy Administration (96401-96549) (5 of 5)

Report any intra-arterial catheter placement (cutdown) with 36640

Intra-arterial route has coverage restrictions for Medicare (e.g., coverage is for patients with liver cancer) and colon cancer that is metastatic to the liver

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What is meant by intra-arterial placement? (The injection is made into the artery.)

Injections with Chemotherapy

Report separately any analgesic or antiemetic (for vomiting)

Before or after chemotherapy

Report both the administration and J-code

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If the patient is given an additional medication before or after chemotherapy, such as an analgesic or antiemetic, administration of this medication is reported separately.

Only one initial code can be billed per session so if a patient had chemotherapy infusion, 1 hour (96413), and an IV push of an antiemetic, you would not use the code 90774 for the push as you have already used an initial code 96413. The correct codes to use would be 96413 for the chemotherapy agent administration and 90775 for the IV push of the antiemetic. The drugs would also be billed with the proper J codes.

The drugs given are also coded separately.

Photodynamic Therapy (96567-96574)

Used in addition to bronchoscopy or gastrointestinal codes

Injected agent remains in premalignant cells longer than normal cells

After agent dissipates from normal cells, lesion is exposed to laser light

Agent absorbs light

Photosensitizing agent produces oxygen and premalignant cells are destroyed

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How are codes for endoscopic application divided? (On the basis of time—the first 30 minutes and then each additional 15 minutes)

External application is based on each exposure session.

Special Dermatological Procedures (96900-96999)

Usually specialized procedures provided on consultation basis

Separate E/M consultation code then appropriate

Treatment of skin conditions:

Actinotherapy—with ultraviolet light

Photochemotherapy—with light-sensitive chemicals and light rays

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What common dermatological condition is treated with actinotherapy? (Acne)

By what means is actinotherapy delivered? (With ultraviolet light)

Contact third-party payers regarding reimbursement as some of these procedures may be deemed cosmetic and not reimbursable.

Physical Medicine and Rehabilitation (97010-97799) (1 of 2)

Used by physicians and therapists to report services for variety of treatments

Traction

Electrical stimulation (used to help heal fractures)

Therapeutic exercise

Patient training:

Gait training

Functional activities

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Codes report treatments and patient training.

What is another modality of treatment that may be provided in addition to traction and electrical stimulation? (Whirlpool)

Physical Medicine and Rehabilitation (97010-97799) (2 of 2)

Codes often have time components

Example: 97761 reports prosthetic training, per 15 minutes

Codes divided by type of therapy

Example: physical or occupational

Modalities are divided by supervised or constant attendance

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Codes are reported on the basis of time or treatment area, as stated in the code description.

When is unit coding necessary? (When the time spent administering the treatment exceeds the time listed in the code)

How are test and measurement codes listed? (By type of testing and by time the testing takes)

Active Wound Care Management (97597-97610) (1 of 2)

Debridement

Nonselective healthy tissue removed along with necrotic tissue (97602)

Removal of necrotic tissue without anesthesia (97597, 97598)

Negative pressure wound therapy (NPWT) is controlled application of subatmospheric pressure to a wound (97605, 97606)

Each code for ongoing care reported on per session basis

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Allied health professionals perform these procedures—not physicians.

Codes are not used with, or to replace, the surgical debridement codes 11042-11047. What determines the codes that can be used? (The area [number of square centimeters] treated)

Must document debridement was performed, level of tissue debrided, method of debridement

Document the size and character of wound before and after debridement

Document a treatment plan and patient education

Direct (one-to-one) patient contact

Active Wound Care Management (97597-97610) (2 of 2)

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Osteopathic and Chiropractic Services (98925-98943)

Both inpatient and outpatient settings

Physician services bundled into codes

Codes divided by number of body regions involved

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What is osteopathic manipulative treatment? (A form of manual treatment applied by a physician to eliminate bodily dysfunction and related disorders)

Codes are categorized on the basis of the number of body regions treated.

What is chiropractic manipulation? (Manipulation of the spinal column and other structures)

The Chiropractic Manipulative Treatment subsection is broken down according to the number of regions manipulated.

If a separate identifiable service is provided, an E/M code with modifier -25 may be reported.

Codes 98966-98972 are specifically for reporting whose services? (Nonphysicians)

Telephone/Online Services (98966-98972) and Special Services, Procedures, and Reports (99000-99091)

Non-Face-to-Face Nonphysician Services (98966-98972) report telephone and online E/M services by nonphysicians

Handling and conveyance of laboratory specimens

99000-99002

Postoperative follow-up visits included in surgical package

99024

Office visits after posted hours or in locations other than office

99053 (24-hour facility)

Medicare bundles most of the Special Services procedures

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This is a miscellaneous section that includes codes that do not fit into other sections.

This includes postoperative follow-up visits. When a patient comes in for a routine postop E/M visit and is in a global period, 99024 would be the correct code to use if there were no complications or other complaints. This has no reimbursement value. It just states that the patient was there and was seen.

Special Services, Procedures, and Reports

Supplies and materials (99070)

Hospital mandated on-call services (99026, 99027)

Medication Therapy Management Services (99605-99607) report pharmacist’s services in medication management

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Other codes include medical testimony, the completion of complicated reports, education services, and unusual travel.

ConclusionCHAPTER 26

MEDICINE

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