Introduction to Clinical Coding - Ch. 1 / Ch.2 Conventions and Characteristics of CPT Flashcards
Which codes are used in the following settings?:
- Physician offices
- Hospital outpatient services
- Hospital inpatient services
- Physician offices: ICD-10-CM, CPT, and HCPCS
- Hospital outpatient services: ICD-10-CM, CPT, and HCPCS
- Hospital inpatient services: ICD-10-CM and ICD-10-PCS
vertiginous
causing, relating to, or affected by vertigo
enterobiasis
Enterobiasis or pinworm infection is a common, contagious, parasitic infestation found mainly in children. The disorder is spread by swallowing or inhaling the tiny eggs of the pinworm. Enterobiasis rarely causes any serious physical problems except for the main symptom, which is severe rectal itching.
What question does HCPCS Level 2 answer?
With some exceptions, the question is “What did the provider use?”
Explain the coding system used by dentists.
Dentists use the CDT (Current Dental Terminology). CDT is part of HCPCS level 2.
The entire D section is devoted to CDT. CDT is maintained exclusively by the American Dental Association.
Explain the sections of HCPCS Level 1 and 2 and the codes associated with those sections.
HCPCS Level 1 is CPT.
CPT codes consists of three categories: Category I, Category II, and Category III.
Category I is the most common and widely used set of codes within CPT. It describes most of the procedures performed by healthcare providers in inpatient and outpatient offices and hospitals. Category I codes are 5-digit numbers (e.g. 28103).
Category II codes are used to help measure performance on quality metrics. Category II codes are made up of five characters: 4 numbers followed by the letter F (e.g. 0575F).
Category III codes are temporary and are assigned for new and emerging technologies. They are made up of five characters: 4 numbers followed by the letter T (e.g. 0085T).
HCPCS Level 2 is often just called HCPCS. It is used for reporting medical services not covered in CPT, as well as injectable drugs, ambulance services, and prosthetic devices. The codes are made up of five characters: a letter followed by four numbers (e.g. A4550).
Compare ICD-10-CM codes with ICD-10-PCS codes.
ICD-10-CM codes have a minimum of three characters and a maximum of seven characters. As a result, an ICD-10-CM code can be anywhere from 3-7 characters.
The first three characters represent a family of codes; they consist of a letter followed by two numbers (e.g. A83). The last four characters provide additional information.
The first three and last four are always separated by a decimal (e.g. A83.4, S12.350A).
ICD-10-PCS codes are seven-character alphanumeric codes not separated by any decimal point (e.g. 0FT44ZZ)
What are the six sections of Category I in CPT?
Evaluation and Management Anesthesiology Surgery Radiology (Including Nuclear Medicine and Diagnostic Ultrasound) Pathology and Laboratory Medicine (except Anesthesiology)
;
semicolon symbol: CPT
The semicolon is used to save space in CPT. The common portion of a main entry comes before a semicolon, and after it come all the subordinate descriptions and procedures.
Example:
27705 Osteotomy; tibia
27707 fibula
27709 tibia and fibula
In the above example, the osteotomy (surgery that cuts and reshapes your bones) has three different codes in can refer to. Osteotomy of the tibia alone (27705), osteotomy of the fibula (27707), and osteotomy of the tibia AND fibula (27709). Instead of repeating osteotomy three times, you do it once and use the semicolon to show that the rest is subordinate and supplementary information.
●
bullet symbol: CPT
A bullet before a code identifies that code as a new addition. Example:
● 30468 Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s)
▲
triangle symbol: CPT
A triangle before a code identifies a revision made to the narrative description accompanying that code. In other words, the code has been changed and differs from a previous version. Example:
▲ 19318 Breast reduction
(facing triangles: CPT)
The facing triangles symbol is used to indicate the beginning and end of new or revised text within the guidelines and instruction notes. The coder should carefully review the information found within the triangles to ensure correct code assignment.
Example:
▶(For breast tissue removed for breast-size reduction for other than gynecomastia, use 19318)◀
+
plus symbol: CPT
The plus symbol is used when a procedure is commonly carried out with another procedure. These are called add-on codes, and should not be used alone.
Example below:
11000 Debridement of extensive eczematous or infected skin; up to 10% of body surface
+11001 each additional 10 percent of body surface, or part thereof
(List separately in addition to code for primary procedure)
(null symbol: CPT)
The null symbol indicates that this code may not be appended with modifier 51. For example, modifier 51 cannot be used with code 17004.
(pending symbol: CPT)
The pending symbol indicates that the CPT code is for a vaccine that is pending approval from the Food and Drug Administration (FDA).
(duplicate PLA symbol: CPT)
This is used when an identical description is shared among several different codes. These are Proprietary Laboratory Analyses (PLA) codes, used for labs or manufacturers that want to specifically identify their test with a code.
For example, BioFire Respiratory Panel (0202U) and QIAstat-Dx Respiratory SARS
CoV-2 Panel (0223U) both have a description of “NFCT DS 22 TRGT
SARS-COV-2”.
(Category I PLA symbol: CPT)
This symbol indicates that the Proprietary Laboratory Analyses (PLA) code has met the criteria to put it in Category I but that it will remain outside Category I.
