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Medicine Section (90281-99607)
 Non-invasive Procedures (not entering a body cavity)
 Invasive Procedures (entering a body cavity)
 Index on pages 429-432 CPT
 Medicine Guidelines – Pg 433-434 CPT
 Most of the CPT codes listed do not include the supply of the product
 Must bill for the supply separately. Depending on the CPT code, the supplies will be listed in
the 90,000 section of CPT or in your HCPCS book.
 Various CPT and HCPCS modifiers will apply
Introduction to Immunizations
 Active – type of immunization given when the person anticipates or thinks they may come in
contact with the disease. (ex. Going overseas to another country, you get vaccinations for
malaria)
 Passive – the injected material contains a high level of antibodies against a disease (e.g.
measles, chicken pox, tetanus)

Immune Globulins (90281 – 90399), pg 709-710 SBS TB, pg 435 CPT
 This section is categorized according to the type of immune globulins, the method of injection,
and the type of dose.
 Admin codes are: 96365-96368, 96372, 96374, 96375, pg 709 SBS TB, 487-488 CPT
o Note: These admin codes are also used for non-chemotherapy drug treatment. 96372
are used for various types of admin for other drugs also.
Immunization Admin for Vaccines / Toxoids, (90465-90468)
 pg 710-713 SBS TB, 435-440 CPT
 90465-90468 – immunization admin for patients under the age of 8 and for which the
physician has counseled the patient’s family regarding the injection
 90465-90466 – for percutaneous, intradermal, subcutaneous or intramuscular injections
 90467-90468 – intranasal or oral routes of admin
 See coding examples on pages 710-713 in SBS TB
 Need to know the method of administration, the drug name, and in some cases, the
patient’s age
 Routes of admin – pg 239 SBS TB, also in HCPCS book (Separate Handout on
Wednesday)
INJ - Injection
IT – Intrathecal
IV – Intravenous
IM – intramuscular
SC – Subcutaneous
INH – Inhalant solution
VAR – Various routes
OTH – Other routes
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 Example of an immunization: Flu Vaccination
90741 - administration of the vaccination
90658 – vaccination itself inside the syringe
Diagnosis of V04.81 – in the ICD-9-CM book under the “V” codes
 H1N1 – 90663 (drug), 90470 (admin), V04.81 (ICD-9)
 Tetanus Diphtheria – 90632 (drug), 90471 (admin), V05.3 (ICD-9)
o Ex. If you step on a rusty nail and haven’t had your TD, the doctor will give you this
immunization, renew every 10 years
 NOTE: If patients are Medicare age, the admin code is replaced with a “G” code from the
HCPCS book.
o Ex. H1N1 - Note: if Medicare age, bill as follows: G9141 for the admin and G9142
for the product, same diagnosis of V04.81
Note: Diagnosis for vaccines can be found under “Vaccination” in ICD-9-CM
http://www.cms.gov/mlnproducts/downloads/qr_immun_bill.pdf
Medicare Preventive Services Quick Reference Information:
Medicare Part B Immunization Billing (Seasonal Influenza, Pneumococcal, and Hepatitis B)
Note: See page 712 SBS TB for more examples.
Also read the coding shots and NCCI edits on pages 710-713 SBS TB
Therapeutic, Prophylactic, and Diagnostic Injections and Infusions and Hydration
733-737 SBS TB, 488-490 CPT
NOTE: All administration codes listed below are time based. The nurses must document start and
stop times of all drugs that are pushed or infused. Hospital coders and clinic coders use the same
administration codes
Terms: pg 733 SBS TB
 Infusion – used when a drug is being administered through a port placed in the patient’s body.
o Time – 16 minutes or more
 Push – used when a drug is being administered through a port and placed in the patient’s body
o Time = 15 minutes or less
 Sequential – one drug followed by a different drug during the same session. Time - 16 minutes or
more
 Concurrent – one site, two lines. For chemotherapy purposes, concurrent infusion is one
chemotherapy drug and one non-chemotherapy drug given and stopped at the same time
 Injections – can be subcutaneous (under the skin) or intramuscular (injected into the muscle)
 Intra-arterial – into the artery
 Intravenous – into the vein
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96360 and 96361 – Administration codes for hydration. Saline is used for hydration. Saline starts
with a “J”.
Ex. Elderly 75 year old patient had the flu over the weekend. Symptoms include nausea and
vomiting, weakness, diarrhea, and fatigue. Patient receives 2 hours of 1000 ml of saline.
Code: 96360 – first hour
96361 – second hour
J7030 – Saline
Diagnosis: 787.01 (nausea and vomiting), 787.91 (diarrhea)
780.79 (weakness and fatigue)
96365 – 96369 – Administration codes used for all non-chemo therapy drugs. Drugs are found in the
HCPCS book. These start with something other than J9.
96401 – 96549 – Administration codes used for all chemotherapy drugs. Drugs are found in the
HCPCS book. All start with J9
Coding Scenario
Non-chemotherapy administration example.
11/4/08 Hydrocortisone sodium succinate
100 mg IV
0940
(SOLU-CORTEF) 100 mg in NS 100 mL IV
Piggyback
11/4/08 hydrocortisone sodium succinate
100 mg IV
0915
(SOLU-CORTEF) 100 mg in NS 100 mL IV
Piggyback
11/4/08 immune globulin -very low IgA- 35,000 35000 IV
1215
mg injection
mg
11/4/08 immune globulin -very low IgA- 35,000 35000 IV
0955
mg injection
mg
Chemo/Infusion
Stopped
Chemo/Infusion
Started
Chemo/Infusion
Stopped
Chemo/Infusion
Started
96365 x 1 (9:55 to 10:55)
96366 x 1 (10:55 to 11:55)
(11:55 to 12:15 cannot code, you need an additional 12 minutes to bill another hour)
J1566 x 70 (Drug IVIG) formula (35000 divided by 500 = 70)
J1720 x 1
(Drug Solu-cortif)
Note: 96365 – first hour of the initial drug IVIG
96366 – 2nd hour of IVIG
96367 – first hour of the additional/sequential drug (Solu-cortef, used to prevent side effects of
drugs, like nausea, etc.)
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Psychiatry (90801 – 90899), pg 714-716 SBS TB, pgs 440 – 441 CPT
READ YOUR CODING GUIDELINES IN THE CPT BOOK
Note: Time is the major billing factor so look for the times listed under the visit types.
If psychiatric treatments are rendered on the same day as E/M services, both the E/M service and the
psychiatric treatment are reported with one code from the Psychiatry subsection
Partial hospitalization – patient is in the hospital during the day and goes home in the evening and on
the weekends.
Psychiatrist – one who specializes in psychiatry
Psychologist – specialist in psychiatry
Biofeedback (90901, 90911), PG 716 SBS TB, PG 443 CPT
 The process of giving a person self information
 Will find these in the index under “Training” and “Biofeedback”
o Can be used for patients who have headaches and need to visualize something to
lessen the intensity of the pain
Dialysis – (90935 – 90999), see pg 718 SBS TB, PG 443 CPT
 End Stage Renal Disease Services – reported once per month to distinguish age-specific
services related to the patients ESRD.
 Bill according to patient age and number of services received.
 Services are provided in an outpatient setting at a hospital, but can be provided at other
facilities also. Ex. Here in the cities is “Davita Dialysis”. They are free-standing facilities.
Terms:pg 717-720 SBS TB and pg 443-445 CPT
 Dialysis – cleaning of the blood of the waste products
 Hemodialysis – separating blood and its waste products
 Peritoneal dialysis - involves using the peritoneal cavity as a filter
 Types of Dialysis – pg 718, Table 25-1, SBS TB
Note: Medicare patients use temporary HCPCS codes – G0308 – G0319 (check local policies)
Gastroenterology (91000 – 91299), pg 720 SBS TB, pg 445-447 CPT
 Many types of tests and treatments performed on the esophagus, stomach, and intestine. May
also bill for screenings
Optometry and Ophthalmology (92002 – 92499), pg 721-723 SBS TB, pg 447-451 CPT
 92002 and 92004 (new eye patient exam visits)
 92012 and 92014 (established patient eye visits)
 Special eye testing (92015 – 92287) – some of the tests are inherently bilateral, others use the
modifiers RT or LT (never -50), some use TC and 26
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 Glasses and Contact Lens Fittings (92310 – 92548)
 To bill insurance for the glasses frames and lenses or contact lens for Aphakia or Keratoconus,
supply codes are listed in the HCPCS book in the (V) section

Audiology (92502-92700) pg. 724 SBS TB, pg 451-454 CPT
 Information for hearing tests, etc.
Cardiovascular Coding in the Medicine Section (92950 – 93799) pg 495 SBS TB
See Chapter 16 handout for all information regarding the above listed CPT code range
Pulmonary (94002 – 94799), pg 726 SBS TB, pg 472-473 CPT
 Has codes for therapies such as nebulizer treatments, etc.
Allergy and Clinical Immunology (95004 – 95199), pg 727-728 SBS TB, 475-477 CPT
Note: Read the notes that appear at the beginning of the Allergy and Clinical Immunology
Subsection.
Endocrinology (95250 – 95251), pg 728-729 SBS TB, pg 477 CPT
 This section only contains codes used to report glucose monitoring
Neurology and neuromuscular procedures (95803 – 95811), pg 729-731 SBS TB, pg 477-478 CPT
 Sleep studies
 Polysomnography – measurement of the brain waves during sleep, especially in the
various stages
 Parameters – what is being measure, ex. Snoring or blood pressure
Note - Many codes include a time component
Central Nervous System Assessment/Tests (96101 – 96125), pg 731 SBS TB, pg 484-485 CPT
 Identifies psychological testing, speech/language assessment, developmental progress
assessments, and thinking/reasoning status examination
Health and Behavior Assessment/Intervention (96150 – 96155)
pg 732-733 SBS TB, pg 485-486 CPT
 Used to report assessment and/or intervention for behavioral, emotional, social,
psychological, or knowledge factors that are affecting the patient’s heath
Photodynamic Therapy (96567 – 96571), pg 737 SBS TB, pg 490 CPT
Current PDT involves a variety of incubation times for the light-sensitizing drug and a variety of
light sources depending on the target tissue. The basic premise of PDT is selective tissue destruction.
Although the photosensitizer may be absorbed all over by many cells, atypical or cancerous cells take
up more of the drug and retain the drug for a longer duration than normal tissues.
Currently used for cancer patients, dermatology, and cosmetic surgery
http://www.medicinenet.com/photodynamic_therapy/article.htm
http://dermnetnz.org/procedures/photodynamic-therapy.html
Special Dermatological Procedures (96900 – 96999), pg 737-738 SBS TB, pg 490 CPT
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Treatment for skin issues
Physical Medicine and Rehabilitation (97001 – 97799), pg 738 SBS TB, pg 491 CPT
Physical therapy
Active Wound Management
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Medical Nutrition Therapy (97802 – 97804), pg 741 SBS TB, 491-492 CPT
The use of nutrition science to treat nutritional symptoms that causes disease
Acupuncture (97810-97814), CPT 493-494
Time increments of 15 minutes
Osteopathic Manipulative Treatment (98925-98929, pg 741 SBS TB, pg 493 CPT
It involves using the hands to diagnose, treat, and prevent illness or injury
Chiropractic Manipulative Treatment (98940 – 98943, pg 741 SBS TB)
Manipulation of the spinal column and other structures
Education and Training for Patient Self-Management (98960-98962, pg 495 CPT
Teaches the patient or caregiver how to take care of themselves while being sick or to prevent
being sick
Non Face-to-Face Nonphysican Services (98699 – 98968), pg 742 SBS TB
Telephone services and On-line Medical Evaluation
Special Services, procedures, and reports (99000 – 99091), pg 742 SBS TB
Miscellaneous subsection
Qualifying circumstances for anesthesia – discussed in Chapter 11
Moderate (conscious) Sedation (99143 – 99150 – discussed in Chapter 11
Other services and procedures (99170 – 99199)
Variety is the spice of life
Home health procedures/services (99500 – 99602)
Services provided at a patient’s house
Medication therapy management services (99605 – 99607)
Patient assessments and interventions by a pharmacist upon request
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