Cpt Code 60300 Descriptive Essay

CPT® Codes

The Current Procedural Terminology (CPT), published annually by the American Medical Association, provides information on the correct use of codes. A current copy of the CPT is required in order to acquire the knowledge necessary to properly report procedures provided by physicians and non-physician practitioners. The most up-to-date information and is always current in AAPC Coder. You have access CPT at your fingertips. If you have internet access and your laptop, tablet, or smartphone --- are ready to code.

To code properly, it is important to have both an awareness and understanding of the support structure underlying the CPT coding system. CPT codes do not exist by themselves. They are supported by a system of rules, symbols, notations, and formatting. AAPC Coder uses symbols and alerts that make this easier than coding from books. Coders code an average of 33% faster using AAPC Coder because of this and other features.

The CPT itself is a part of a complex coding system.

  • CPT is part of Level I coding and is primarily for procedures provided to patients. It is comprised of CPT (Current Procedural Terminology), a numeric coding system maintained by the American Medical Association (AMA). The CPT is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals. These health care professionals use the CPT to identify services and procedures for which they bill public or private health insurance programs. Decisions regarding the addition, deletion, or revision of CPT codes are made by the AMA. The CPT codes are republished and updated annually by the AMA. Level I of the HCPCS, the CPT codes, does not include codes needed to separately report medical items or services that are regularly billed by suppliers other than physicians.
  • In October of 2003, the Secretary of HHS delegated authority under the HIPAA legislation to CMS to maintain and distribute HCPCS Level II Codes. As stated in 42 CFR Sec. 414.40 (a) CMS establishes uniform national definitions of services, codes to represent services, and payment modifiers to the codes. Within CMS there is a CMS HCPCS Workgroup which is an internal workgroup comprised of representatives of the major components of CMS, as well as other consultants from pertinent Federal agencies. Prior to December 31, 2003, Level III HCPCS were developed and used by Medicaid State agencies, Medicare contractors, and private insurers in their specific programs or local areas of jurisdiction. For purposes of Medicare, level III codes were also referred to as local codes. Local codes were established when an insurer preferred that suppliers use a local code to identify a service, for which there is no level I or level II code, rather than use a "miscellaneous or not otherwise classified code." The Health Insurance Portability and Accountability Act of 1996 (HIPAA) required CMS to adopt standards for coding systems that are used for reporting health care transactions. We published, in the Federal Register on August 17, 2000 (65 FR 50312), regulations to implement this part of the HIPAA legislation. These regulations provided for the elimination of level III local codes by October 2002, at which time, the level I and level II code sets could be used. The elimination of local codes was postponed, as a result of section 532(a) of BIPA, which continued the use of local codes through December 31, 2003.
  • CPT is a standardized system of 5-digit codes and descriptive terms used to report the medical procedures and services performed by physicians. It was developed by the American Medical Association (AMA) and is updated annually.
  • The first edition of CPT was developed and published by the AMA in 1966. The 1966 manual contained four digit codes with brief descriptions that do not really correlate to today’s CPT.
  • The second edition, published in 1970, began to approximate the current coding manual. It contained guidelines to various sections, five digit codes, and two modifiers. A third edition was published in 1973, adding more modifiers, starred procedures, and an appendix of deleted codes. The fourth edition appeared in 1977. Every year there are significant revisions that affect coding and billing. AAPC Coder makes it easier for coders to stay on top of these changes. It makes it easy for auditors to reference retrospective coding audits with the correct codes for the year under review.
  • CPT is still in its fourth edition. The AMA continues to update it annually, with 400-700 changes that are effective the beginning of each year. The AMA is planning the next edition, CPT-5, however; in the meantime, there will be deletions, additions, and changes to the narratives in CPT-4. It is extremely important to use the most current edition of the manual for accurate and complete coding. CPT is also known as "Level I HCPCS", it does not include codes needed to report medical items or services that are regularly billed by suppliers other than physicians.
  • The AMA released CPT Category II and III codes for implementation January 1, 2004. Category II codes are supplemental tracking codes used for performance measurement. These codes are intended to facilitate data collection about quality of care by coding certain services and test results that support performance measures and have been decided on as contributing to good patient care. Category III codes are temporary codes for emerging technology, services, and procedures. Category II codes are reviewed by the Performance Measures Advisory Group (PMAG), an advisory body to the CPT Editorial Panel and the CPT/HCPAC Advisory Committee. The PMAG is composed of performance measurement experts representing the Agency for Healthcare Research and Quality (AHRQ), the American Medical Association (AMA), the Centers for Medicare and Medicaid Services (CMS), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the National Committee for Quality Assurance (NCQA) and the Physician Consortium for Performance Improvement. The PMAG may seek additional expertise and/or input from other national health care organizations, as necessary, for the development of Category II codes. These may include national medical specialty societies, other national health care professional associations, accrediting bodies and federal regulatory agencies. Category II codes make use of an alphabetical character as the 5th character in the string (i.e., 4 digits followed by the letter F). These digits are not intended to reflect the placement of the code in the regular (Category I) part of the CPT codebook. Appendix H in CPT section contains information about performance measurement exclusion of modifiers, measures, and the measures' source(s). These codes are used in Value Based Payment programs like QPP, PQRS, MACRA, MIPS, and Advanced APMs. CPT II codes are billed in the procedure code field, just as CPT Category I codes are billed. CPT II codes describe clinical components usually included in evaluation and management or clinical services and are not associated with any relative value. Therefore, CPT II codes are billed with a $0.00 billable charge amount.
  • Coding in AAPC Coder makes it easy for you navigate the codes. Each section of the CPT provides special instructions for using the codes in that section. Before selecting a code, a coder must look for these instructions – These guidelines are in the section guidelines, at the beginning of the subsections, headings and/or subheadings, and above and/or below the code itself. AAPC Coder makes the easy by bringing them to the coder’s attention real-time as they are coding.

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Earlier, we introduced you to Current Procedural Terminology, or CPT. This expansive, important code set is published and maintained by the American Medical Association (AMA), and it is, with ICD, one of the most important code sets for medical coders to become familiar with. Note also that all the codes featured in this course, and every course that touches on CPT codes, are copyrighted by the AMA.

CPT codes are used to describe tests, surgeries, evaluations, and any other medical procedure performed by a healthcare provider on a patient. As you might imagine, this code set is extremely large, and includes the codes for thousands upon thousands of medical procedures.

CPT codes are an integral part of the billing process. CPT codes tell the insurance payer what procedures the healthcare provider would like to be reimbursed for. As such, CPT codes work in tandem with ICD codes to create a full picture of the medical process for the payer. “This patient arrived with these symptoms (as represented by the ICD code) and we performed these procedures (represented by the CPT code).

Like ICD codes, CPT codes are also used to track important health data and measure performance and efficiency. Government agencies can use CPT codes to track the prevalence and value of certain procedures, and hospitals may use CPT codes to evaluate the efficiency and abilities of individuals or divisions within their facility.

Format

Let’s look a little closer at what these codes look like and how they’re organized. Each CPT code is five characters long, and may be numeric or alphanumeric, depending on which category the CPT code is in. Don’t confuse this with the ‘category’ in ICD. Remember that in ICD codes the ‘category’ refers to the first three characters of the code, which describe the injury or disease documented by the healthcare provider.

With CPT, ‘Category’ refers to the division of the code set. CPT codes are divided into three Categories. 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 II codes are supplemental tracking codes used primarily for performance management. Category III codes are temporary codes that describe emerging and experimental technologies, services, and procedures.

Note that while CPT codes have five digits, there are not 99,000-plus codes. CPT is designed for flexibility and revision, and so there is often a lot of “space” between codes. Unlike ICD, each number in the CPT code does not correspond to a particular procedure or technology.

Here’s a closer look at the three categories of CPT codes.

Category I

Medical coders will spend the vast majority of their time working with Category I CPT codes. For the sake of simplicity, we’ll refer to the CPT codebook when we’re describing the code set. This book, which is updated yearly by the AMA and the CPT Editorial Board, is an essential tool for every medical coder. In the next few minutes, you’ll learn the basic layout, format, and instructions found in the CPT codebook.

Like the ICD code set and its division into chapters by type of injury or illness, Category I CPT codes are divided into six large sections based on which field of health care they directly pertain to. The six sections of the CPT codebook are, in order:

  • Evaluation and Management
  • Anesthesiology
  • Surgery
  • Radiology
  • Pathology and Laboratory
  • Medicine

CPT codes are, for the most part, grouped numerically. The codes for surgery, for example, are 10021 through 69990.

In the CPT codebook, these codes are listed in mostly numerical order, except for the codes for Evaluation and Management. These Evaluation and Management, or E&M, codes are listed at the front of the codebook for ease of access. Physician’s offices frequently use E&M codes for reporting a number of their services. The code 99214, for a general checkup, is listed in the E&M codes, for example.

Note also that some codes appear out of numerical sequence but near similar procedures. This may seems slightly confusing, but having these codes clustered near similar procedures prevents having to delete and resequence codes, and so is seen as a sort of necessary evil.

Here’s a quick look at the sections of Category I CPT codes, as arranged by their numerical range.

  • Evaluation and Management: 99201 – 99499
  • Anesthesia: 00100 – 01999; 99100 – 99140
  • Surgery: 10021 – 69990
  • Radiology: 70010 – 79999
  • Pathology and Laboratory: 80047 – 89398
  • Medicine: 90281 – 99199; 99500 – 99607

Within each of these code fields, there are subfields that correspond to how that topic—say, Anesthesia—applies to a particular field of healthcare. For instance, the Surgery section, which is by far the largest, is organized by what part of the human body the surgery would be performed on. If you’d like to learn more about the anatomy and physiology terms used in the Surgery section, follow this link to Course 2-10. Likewise, the Radiology section is organized into sections on diagnostic ultrasound, bone and joint studies, radiation oncology, and other fields. Please refer to the eBook for a complete breakdown of the subfields used in each of the code fields.

Each of these fields has its own particular guidelines when it comes to use. For example, the Surgery section has a guideline for how to report extra materials used (such as sterile trays or drugs) and how to report follow-up care in the case of surgical procedures.

Like ICD codes, many CPT codes are arranged by indentation. If a procedure is indented below another code, the indented procedure is an important or noteworthy variation on the above procedure, and would replace the first code. Let’s take a look at an example of an indented code.

The code for “management of liver hemorrhage; simple suture of liver wound or injury” is 47350. This is a surgical procedure, and would be found in the surgery/digestive system portion of the CPT book.

It’s helpful to look at a code like this in two parts. The first, which comes before the semicolon, is the general procedure. In this case, that’d be “liver management.” The phrase that comes after the semicolon is additional, specific information. In this example, we could read the code as “liver management, with a simple suture of liver wound or injury.”

If, however, a doctor performed a more complicated procedure on a patient’s liver, 47350 would no longer be the correct code to use. If we look in the CPT manual, we find the code 47360 below 47350. Code 47360 reads “complex suture of liver wound or injury, with or without hepatic artery ligation.” That phrase is meant to take the place of the phrase that comes after the semicolon in code 47350.

You could therefore read code 47360 as “liver management, with complex suture of liver wound or injury, with or without hepatic artery ligation.”

CPT codes also have a number of modifiers. These modifiers are two-digit additions to the CPT code that describe certain important facets of the procedure, like whether the procedure was bilateral or was one of multiple procedures performed at the same time. CPT modifiers are relatively straightforward, but are very important for coding accurately. For this reason, we’ll cover them in a later video.

Like ICD codes, many CPT codes also have additional instructions featured below the code. These instructions, which are in parentheses below the code you’ve looked up, tell the coder that, in certain situations, another code might be better suited than the present code. For now, just recognize that the CPT code set has a number of instructions that inform the medical coder on how to best code the procedure performed. Remember that you always need to code to the highest level of specificity, and a miscoded procedure can be the difference between an accepted and rejected claim.

The CPT code set also instructs coders on when to use multiple codes, when to use codes in tandem with one another (add-on codes), and which codes are “modifier exempt.”

This is an awful lot of information to take in regarding Category I CPT codes, so let’s review briefly.

Category I CPT codes are numeric, and are five digits long.

They are divided into six sections: Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine.

Each of these sections has its own subdivisions, which correspond to what type of procedure, or what part of the body, that particular procedure relates to.

The sections are grouped numerically, and, aside from Evaluation and Management, are in numerical order. That is, the codes for Anesthesia come before, or are “lower” than the codes for Pathology and Laboratory.

Each of these sections also has specific guidelines for how to use the codes in that section.

Certain codes have related procedures indented below them. These indented codes are important variations on the code above them, and denote different methods, outcomes, or approaches to the same procedure. For example, the code for the elevation of a simple, extradural depressed skull fracture is 62000. The code for the elevation of a compound or comminuted, extradural depressed skull fracture is 62005.

There are a few important CPT Modifiers, which provide additional information about the procedure performed. We’ll cover these in just a little bit.

Some codes have instructions for coders below them. These instructions are found in parentheses below the code, and they instruct the coder that there may be another, more accurate code to use.

Now that we’ve given you a brief glimpse of Category I CPT codes, let’s take a look at the next section of CPT.

Category II

These codes are five character-long, alphanumeric codes that provide additional information to the Category I codes. These codes are formatted to have four digits, followed by the character F. These codes are optional, but can provide important information that can be used in performance management and future patient care.

Here’s a quick example. If a doctor records a patient’s Body Mass Index (BMI) during a routine checkup, we could use Category II code 3008F, “Body Mass Index (BMI), documented.”

These codes never replace Category I or Category III codes, and instead simply provide extra information. They are divided into numerical fields, each of which corresponds with a certain element of patient care. For a list of these fields in oder as well as examples, please refer to our ebook and powerpoints.

  • Composite codes
    • These codes combine a number of procedures that typically occur in conjunction with one main procedure.
      • Example: 0001F: heart failure assessed (includes all of the following):
        • Blood pressure measured
        • Level of activity assessed
        • Clinical symptoms of volume overload assessed
        • Weight recorded
        • Clinical signs of volume overload assessed
    • Patient Management
      • Includes patient care provided for specific clinical purposes like pre- and postnatal care.
        • Example: 0503F: Postpartum care visit
    • Patient History
      • Describes measures for select elements of patient history or symptom review
        • Example: 1030F: Pneumococcus immunization status assessed
    • Physical Examination
      • Example: 2014F: Mental status assessed
    • Diagnostic/Screening Processes or Results
      • Includes results of tests ordered, including clinical lab tests and radiological procedures
        • Example: 3006F: Chest X-ray documented and reviewed
    • Therapeutic, Preventive, or Other Interventions
      • Describes pharmacologic, procedural or behavioral therapies
        • Example: 4037F: influenza immunization ordered or administered
    • Follow-up or Other Outcomes
      • These codes describe the review and communication of test results to a patient, patient satisfaction, patient functional status, and patient morbidity or mortality
        • Example: 5005F: patient counseled on self-examination for new or changing moles
    • Patient Safety
      • Includes codes that describe patient safety precautions
        • Example: 6015F: Patient receiving or eligible to receive foods, fluids, or medication by mouth
    • Structural Measures
      • This short section includes codes that describe the setting of the delivered care, and also covers the capabilities of the healthcare provider
        • Example: 7025F: patient information entered into a reminder system with a target due date for the next mammogram

    There are not nearly as many Category II CPT codes as there are in Category I, and in general you will not use Category II nearly as much. Still, it is an important element of the CPT code set, and you should be familiar with the basics of Category II codes as you prepare for a career in the field.

    Category III

    The third category of CPT codes is made up of temporary codes that represent emergent or experimental services, technology, and procedures. In certain cases, you may find that a newer procedure does not have a Category I code. There are codes in Category I for unlisted procedures, but if the procedure, technology, or service is listed in Category III, you are required to use the Category III code.

    Category III codes allow for more specificity in coding, and they also help health facilities and government agencies track the efficacy of new, emergent medical techniques.

    Think of Category III as codes that may become Category I codes, or that just don’t fit in with Category I. Category I codes must be approved by the CPT Editorial Panel. This Panel mandates that procedures or services must be performed by a number of different facilities in different locations, and that the procedure is approved by the FDA. Due to the nature of emerging medical technology and procedures, it’s not always possible for an experimental procedure to meet these criteria, and thus become a Category I code.

    Whether a Category III code becomes a Category I code or not, all Category III codes are archived in the CPT manual for five years. If at the end of this five year period the code has not been converted to Category I, this procedure must be marked with a Category I “unspecified procedure” code. When flipping through the Category III section of the CPT manual, you’ll notice that each of the codes has a phrase listing its sunset date below the code. Think of the sunset dates as expiration dates on the code.

    Like Category II, these codes are five characters long, and are comprised of four digits and a terminal letter. In this case, the last letter of Category III codes is T. For example, the code for the fistulization of sclera for glaucoma, through ciliary body is 0123T.

    Now that you have a better idea of what CPT looks like, how it’s formatted, and when to use which category of codes, let’s dive a little deeper into modifiers and how CPT codes look in action.

Video: Introduction to Cost Procedural Terminology (CPT)

CPT codes allow coders to describe exactly what service a healthcare provider has performed for a patient. Learn more about these invaluable codes in this video.

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