Medical Coding Basics
Diagnosis & Procedural Coding 2015
Presenters: Susana Martinez CPC, COC, CPMA, CEMC
and
Kyra Jones, CMIS, RCM Consultant
ICD
1700
John
GrauntLondon
1837
William
Farr- Great
Britain
1893
Jacques
BertillionFrance
1898
U.S.A began
use of
Bertillion
Classification
of Diseases
1900
1938
First
International
International Classification
conference
of Diseases
• John Graunt- one of the first experts in epidemology
(disease control)
• William Farr- one of the founders of medical statistics
(collection of data for healthcare use)
• Jacques Bertillion- developed Bertillion classifications of
Causes of Death
1977
WHO- 3 volume set
Today- Condensed into one book
either containing two or three
volumes
CM- Clinical Modification
Volumes 1 and 2
• Codes diseases
• Illnesses
• Injuries
• Both outpatient & inpatient
settings
1978
International Classification of
diseases, Ninth Revision, Clinical
Modification
ICD-9-CM
PCS- Procedural Coding System
Volume 3
• Codes surgical
• Diagnostic
• Therapeutic Procedures
• Inpatient Setting
Purpose
 Intent- ICD system to provide morbidity statistics for
the WHO
 Today-medical offices use the coding system
 Provide information
 Verify the need for patient care/treatment
 Provide statistics for analysis of health care costs
 ICD coding translates written medical terminology
into diagnosis codes
 Payers determine if the services are medically
necessary and, therefore; reimbursable
Purpose cont’d:
“Coding is a language”
• Used by insurance
companies
• Used by health care
providers
• Vital to care and
treatment of
patients
• Coder needs to be
able to “translate”
this language
Medical Coder-Role
• Accurate coding essential to healthcare
industry
• Review documentation in medical record,
translate into ICD
“ If it wasn’t documented… it didn’t happen”
• Service must be reasonable and
necessary
• Patient underwent blood glucose testing
(procedure) for hyperglycemia (excess glucose)
• Diagnosis codes submitted in claims to
payers
Compliance
In the beginning…
Simple phrase for
illness or condition or
1-3 digit diagnosis
code
ICD-9
Today
5-6 digit diagnosis
code
ICD-10
October 1, 2015
7 digit diagnosis code
“Clavicle Fracture”
810.02
Clavicle fracture,
closed; shaft of
clavicle
S42.022A
Displaced fracture of
shaft or left clavicle;
initial encounter for
closed fracture
 Coding must meet federal guidelines
 Basis for studies and research into quality of
healthcare
 Consistency and Accuracy
What does ICD-9 mean to
patients?
•
Each diagnosis to a patient may be given has a code, a numbered
designation, that identifies it.
•
That code means that every medical professional in the United States
and many other parts of the world will understand the diagnosis the
same way.
•
Documented Dx’s become a permanent part of the patient’s medical
record.
•
Continuity of Care – Documenting patient care so that others who treat
the patient have a source of information on which to base additional
care.
What does ICD-9 mean to
patients… A Coder’s role
• Be a responsible
coder/biller:
– Accuracy (Example: Elevated
BP vs. Hypertension and
Benign Neoplasms vs.
Malignant Neoplasms)
– Information stored in data
banks (locally, nation-wide,
etc.,.)
– Affordable Care Act – took
effect in 2014 (Pre-existing
health conditions)
A Coder’s/Biller’s Role (cont’d)
• Cross-lines of
“abuse & fraud”:
– Abuse - Actions that are
inconsistent w/ accepted
standards
– Fraud – Actions that are
“intentional”, or knowing it is
false
Contents
 The introduction to each book provides
important information to help coders
understand the basic uses of the ICD-10CM books
Volume understanding
 Volume I – tabular list
 Numerical listing of diseases/injuries
 17 chapters grouped by etiology (cause) or anatomical (body)
site.
 Volume II – alphabetic index
 Listing of codes to assist in locating the complete code in
volume I
 Index to Diseases and Injuries
 Alphabetic Index to Poisoning and External causes
 Table of Drugs and Chemicals
 Volume III – alphabetic index & tabular
index
 Used by hospitals (procedures and surgeries)
 Tabular list of procedures by anatomical site
 Miscellaneous diagnostic and therapeutic procedures
Why are the Volumes of ICD-9
out of sequencing???
Format of ICD-9 CM
Diabetes mellitus
250
Diabetes mellitus
without mention of
complication
250.0
Range (0-9)
Diabetes mellitus
without mention of
complication; type II or
unspecified type not
stated as uncontrolled
250.00
Range (0-3)
4th digit needed:
patient’s condition
5th digit needed:
higher specificity
Diagnosis
Completion
Conventions
 Coders need to understand the
symbols, abbreviations and other
conventions used within the ICD-9-CM
 Conventions are found in the
introduction of the volume. These are
some of them:
Print type
 Bold face
 Volume I - All title and codes are printed in bold type
 Volume II – main term is printed in bold face
Italics
•
Both volumes to highlight all exclusion notes and
to identify codes that should NOT be used as the
primary code
ICD-9 785.4 Gangrene
•
ICD-10 I96 Gangrene, not
elsewhere classified
Instructions for this code are written in italics to
code first the underlying disease, such as
Diabetes
• Diabetes is the primary diagnosis followed by
the Gangrene (manifestation) or secondary
diagnosis.
ICD-9 250.70 Diabetes with peripheral ICD-10 E08.52 Diabetes Mellitus due
circulatory disorders
to underlying condition with diabetic
785.4 Gangrene
gangrene
Volume 1
• Tabular List of Diseases and Injuries
• Three major subdivisions:
– Classification of Diseases and Injuries
– Supplementary Classifications
(V and E codes)
– Appendices
Volume 1 (cont’d)
Other ICD-9-CM Elements
 V-codes supplemental classification codes
for factors that influence a patient’s care
 Used when a patient sees the doctor without a complaint or
problem (sports exam, etc.) or to describe conditions that
could influence patient care (allergies, etc.). There are 3
main categories:
 Problems – something that could affect overall health
 V10.04- Personal History of Malignant Neoplasm
stomach
 Services – patient seen for a problem/treatment
 V70- General Medical Examination
 Factual findings – description of facts for statistics
 V30.01- Single liveborn, born in hospital, delivered by
cesarian delivery
Using E Codes
 E-codes are optional codes that describe the following
 Events or circumstances
 Causes of injury or poisoning
 Other adverse effects
 Should never be used as a primary or stand-alone code
 Provide details of an incident or injury and help identify the
following
 Automobile accident liability
 Worker compensation situations
 Third-party insurance liability
Injury coding example
Harold was playing basketball with friends at the park when the ball
accidentally hit him in the nose; his nose is bleeding and he goes to see his
doctor because the bleeding does not stop.
•
•
•
•
ICD-9
784.7 Epistaxis (nose bleed)
E917.0 Striking against or
struck accidently by objects
or persons in sports
E007.6 Activities involving
other sports and athletics
played as a team
E849.4 Place of occurrencerecreation and sport
•
•
•
•
ICD-10
R04.0 Hemorrhage from
respiratory passages
W21.89XA Striking against
or struck accidentally by
other sports equipment,
initial encounter
Y93.67 Activity basketball
Y92.830 Public park as the
place of occurrence of the
external cause
Volume 2
•
•
Alphabetic list of conditions
Major subdivisions:
– Index to Diseases and Injuries
– Table of Drugs and Chemicals
– Alphabetic Index to Poisoning and
External Causes (E-codes)
Volume 2 (cont’d): The Key
• Volume 2—Alphabetic Index
• Main terms:
– Disease
– Sign
– Symptom
– Condition
– Injury
Vol 2 (cont’d):
Table of Drugs and Chemicals
• This table contains a classification of
drugs and other chemical substances
– Identify poisoning states(poisoning
classification range 960-989)
– External causes of adverse effects
(external causes code range E850E982).
Vol 2 (cont’d):
Table of Drugs and Chemicals
Volume 3
• Tabular List and Alphabetic Index
of Procedures
• Procedures and surgeries
• Organized by location of procedure
• Used in facility setting
ICD-9
How to Find ICD-9-CM Code
 Have good research habits 
 Basic steps to finding the correct code:
1.
2.
3.
4.
5.
Correctly identify the main term/condition (Vol 2)
Use the index to locate the condition/problem
Review information given following all instructions
Locate and confirm the correct code in the tabular list and select
the correct code
Put codes in correct sequence when using multiple diagnoses
Ex: Patient with peptic ulcer (unspecified as acute or chronic was
seen for pharyngitis
462- Acute pharyngitis
533.9X- Peptic Ulcer unspecified as acute or chronic
*0-without mention of obstruction
*1-with obstruction
Alphabetic Index to Diseases
and Injuries
• The “key” to
locating diagnoses
codes
• The index is
organized by main
terms
•
•
•
DX: “Low Back Pain”
Main term is pain
The coder then asks, what type of
pain…back
Code: 724.2
Code the confirmed diagnosis
whenever possible
• If you have confirmed a
diagnosis based on the
results of the diagnostic test,
you should code that
diagnosis.
• If there’s no confirmed
diagnosis or the results are
normal, code the signs and
symptoms that prompted
you to order the test.
For example:
• Patient in your office for
chest pain, EKG
performed.
• The EKG is normal, and
the final diagnosis is chest
pain due to suspected
gastroesophageal reflux
disease (GERD).
• The primary diagnosis code
for the EKG should be
chest pain, because the
EKG was normal and you
did not determine a
definitive cause for the
chest pain
Symptoms and Signs
• Used when
definitive diagnosis
has not been
established
• Not assigned a
code if it is part of a
disease process
with definitive
diagnosis
Acute and Chronic Conditions
• Acute – A condition that is
of a sudden onset or short
duration
• Chronic – A condition that
is ongoing, typically
permanent, but some can
eventually resolve and
disappear altogether. More
correctly, chronic refers to a
time frame of 3-months or
more.
• How to code acute
& chronic
conditions is
addressed in the
Official Coding
Guidelines. A
coder should code
both if
documented, but
select the acute
condition first.
Impending or Threatened
Conditions
• The coder must ask
“Did the condition
actually occur?”
• If it did, the
diagnosis is
confirmed
• If it did not, further
research is
necessary
ICD-10-CM: Preview
 Released by the WHO in 1992
 U.S. lagged implementation; effective
October 1, 2015
 Volumes 1 and 2 -replaced by ICD-10CM
 Volume 3 -replaced by ICD-10-PCS
(developed by the Centers for Medicare
and Medicaid Services CMS)
Why ICD-10-CM?
 Three objectives of the ICD-10-CM
coding system
 Completeness – unique code for each illness or disease
 Expandability – new injury or disease can be incorporated
easily into the existing structure
 Standardization – terminology defined for standardization
with each term being assigned a specific meaning
Comparison
ICD-9-CM
ICD-10-CM









Tabular
Alphabetic index
Procedures
17 chapters
Numerical code system
4th and 5th digit specificity
Category for unspecified codes
Supplementary class for V and E
codes
Based on outdated technology
and reduces coding
effectiveness (left vs. right)








Tabular
Alphabetic index
Procedures
21 chapters
Alpha-numerical code system
6th and 7th digit specificity
Limited use of unspecified codes
Supplementary class for V and E
codes
 New chapters for disease of eye
and ear instead of inclusion in
nervous system
• Terminology has been modernized
and reflects current usage of
medical terminology
Structure difference
ICD-10… Keeping it Interesting
V61.8- Other specified family
circumstance
Z63.1- Problems in relationship
with the in-laws
E917.4- Striking against or struck
accidentally by other stationary
object without subsequent fall
(lamp post)
W22.02XD- Walking into
lamppost, subsequent encounter
T71.231D- Asphyxiation due to
being trapped in a (discarded)
refrigerator, accidental,
subsequent encounter
E844.9- Other specified air
transport accidents injuring other
person
V97.33XD- Sucked into jet engine,
subsequent encounter
W16.221D- Fall into bucket of
water causing drowning and
submersion, subsequent
encounter
E928.4- External constriction
caused by hair
W49.01XA- Hair causing external
constriction, initial encounter
Getting Ready for the Change
Tips:
 Document specific to
visit
 Choose the
diagnosis that fits
your documentation
 Keep informed of
changes
CMS- Recommended Approach
•
Step 1- Make a plan
•
Step 2- Train your staff
•
Step 3- Update your processes (claim forms, superbills and
replace ICD-9 diagnosis codes with ICD-10)
•
Step 4- Talk to your vendors and health plans (clearinghousesconfirm systems are ready)
•
Step 5- Test your systems and processes (verify you can
generate claims- test with health plans, clearinghouses and
vendors)
•
For more information: visit CMS website at cms.gov/ICD10
The fundamentals
of ICD-9 will still be
important after the
October 1st
implementation.
Not all carriers will be
ready or even accept the
ICD-10 code set. Some
of those carriers are:

Workmen’s Compensation

Auto & Liability Agencies
Current Procedural Terminology
CPT Code Set
 CPT is a coding
nomenclature (system of
names or terms) that allows
medical procedures to be
transformed to numbers
 CPT is based on
professional services
provided by healthcare
providers such as a
physician, nurse practitioner
or physician assistant
• CPT services include office
visits, surgery, laboratory,
radiology, pathology,
anesthesia and medical
procedures
Background
 CPT was developed by the American
Medical Association and CPT is still
currently maintained by the AMA
 CPT code sets
 HCPCS level I
 CPT codes maintained by AMA
 HCPCS level II
 HCPCS codes maintained by Federal
Government
Background (cont’d)
• 1966: Published by
AMA (four-digit
codes)
• 1970: Five-digit codes
• 1983: Adopted as part
of HCPCS
• 1992: Implementation
of E&M codes
• Updated yearly (January)
and AMA panel reviews
codes quarterly (May,
August, November &
February)
Purpose
 Reimburse physician services
 Trending services provided nationally
 Future coding and reimbursement
planning
 Benchmarking facilities, costs and
services
 Measuring quality of care and patient
outcomes nationally
Code Requirements
ALL CPT CODES MUST BE:
 Commonly performed by physicians
across the nation
 Consistent with mainstream medical
practice
 Approved by the AMA CPT Editorial
Board
CPT Code Organization
 Each code is followed by a unique
code descriptor explaining the service
 More than 8,800 unique CPT codes
(2015)
 CPT codes are 5 digits long
 CPT manual includes parenthetical
notes
Introduction to CPT
 Category I codes are permanent codes
 6 Sections of Category I codes-each with
a set of guidelines at the beginning of
each






Evaluation and Management (E/M)
Anesthesia
Surgery
Radiology
Pathology/Laboratory
Medicine
CPT Category I Code
Number Format
• Five-digit code number and narrative
description for each procedure and
service
– Stand-alone code – includes complete
description of procedure or service
– Indented code – appears below standalone code, requiring coder to refer back
to common portion of code description
located before semicolon
CPT Category I Code
Number Format (cont’d)
EXAMPLE:
59514 Cesarean delivery only;
59515
including postpartum care
Category I Codes
Evaluation and Management: 99201-99499 Services performed to determine care of patient
Anesthesia: 00100-01999 Routine care: pre-op, intra-op, post-op
Surgery:
10021-69990 (largest section) Divided by body systems: (pre-op, intra-op, post)
Integumentary
Musculoskeletal
Respiratory
Cardiovascular
Hemic and Lymphatic
Mediastinum/Diaphragm
Digestive
Urinary
Male Genital
Female
Maternity Care and Delivery
Endocrine
Nervous
Eye and Ocular Adnexa
Auditory
10021-19499
20005-20205
31600-31628
33010-37799
38100-38999
38747-39599
40490-49999
50010-53899
54000-55899
56405-58999
59000-59899
60000-60699
61000-64999
65091-68899
69000-69990
Category I Codes Continued
Radiology: 70010-79999 selected based on the body part and number/type of
view
Pathology/Laboratory: 80048-89398
Complete procedure includes:
Ordering test
Taking/handling the sample
Performing the test
Analyzing/reporting on the test results
Medicine: 90281-99607 include many types of evaluation, therapeutic and
diagnostic procedures that physicians and other health care providers perform.
Category II Codes
 Used to track physician performance
in measuring and monitoring patient
care
 Are alphanumeric codes, starting with
4 numbers followed by the letter F
 Improve quality of care but are not
“billable”
Category III Codes
 Introduced in 2002
 Are alphanumeric codes, starting with 4
numbers followed by the letter T
(temporary code)
 They are used to report new technology,
services or procedures that do not
currently have a CPT code assigned
 Located directly after the Category II
codes
 Allow researchers to track emerging
technology
CPT Appendices
•
•
•
•
•
•
•
•
Appendix A
• Lists/examples of modifiers
Appendix B
• Summary of additions/deletions/revisions
Appendix C
• Clinical Examples of E/M Codes
Appendix D
• Summary of CPT Add-on Codes
Appendix E
• Summary of CPT codes exempt from -51
Appendix F
• Summary of CPT codes exempt from -63
Appendix G
• Summary of CPT codes which include conscious sedation
Appendix H
• Alphabetical index of performance measures by clinical condition or topic
CPT Appendices (cont’d)
• Appendix I
• Genetic Testing Code Modifiers
• Appendix J
• Electro diagnostic Medicine Listing of Sensory, Motor and
Mixed Nerves
• Appendix K
• Product Pending FDA Approval
• Appendix L
• Vascular Families
• Appendix M
• Crosswalk to deleted CPT codes
CPT Appendices (cont’d)
• Appendix N
• Re-sequenced codes
• Appendix O
• Administrative codes for multi-analyte assays
Punctuation and Symbols
;
Semicolon
(Divides the common portion of a code descriptor from the unique portion)
●
Bullet
(New Code)
▲ Triangle
(Revised code)
+
Plus Symbol
(Add on code)
Modifier 51 Exempt (Circle w/slash)
(Indicates the code cannot be assigned with -51)
Punctuation and Symbols (cont’d)
 FDA approval pending
 Hollow Circle
(Indicates a reinstated or recycled code)
#
Number symbol
(Re-sequenced code)
 Bull’s Eye
(That conscious sedation is included in code)
Punctuation and Symbols
(cont’d)
►◄ Facing Triangles
(Revised guidelines and note)
 Green Arrow
(Refer to CPT Assistant or CPT changes)
 Red Arrow
(Refer to Clinical Examples in Radiology for guidance)
CPT/HCPCS Modifiers
 Reported as 2-digit numeric & alpha characters
added to CPT and HCPCS codes
 Used to communicate special circumstances
surrounding the assigned code
 May increase or decrease the amount of
reimbursement
 Three types of modifiers
 CPT Modifiers
 Facility Modifiers
 HCPCS Modifiers (CPT and HCPCS book)
CPT Modifiers (continued)
Description of Modifiers
21 prolonged evaluation and management services
22 – unusual (increased) procedural services
• Morbidly obese patient with massive adhesions require extra time to
lyse (cut down)
23 – unusual anesthesia
24 – unrelated evaluation and management service by the same physician
during a postoperative period
• Pt had hysterectomy two weeks ago (90 day period); comes in today
for UTI (totally unrelated to surgical procedure). E/M for today will need
24 for reimbursement
25 – significant, separately identifiable evaluation and management
service by the same physician on the same day of the procedure or other
service
• Pt comes in for routine checkup for hypertension medication refill, In
addition pt has abscess on their back so an ID was performed. Modifier
25 is appended to E/M
Description of Modifiers (cont’d)
26 – professional component
27 – multiple outpatient hospital E/M encounters on the same date
32 – mandated services
47 – anesthesia by surgeon
50 – bilateral procedure
51 – multiple procedures
52 – reduced services
• CPT 92550 (Use modifier 52 if a test is applied to one ear instead of
two ears) bilateral by CPT guidelines
53 – discounted procedure
54 – surgical care only
Description of Modifiers (cont’d)
55 – postoperative management only
• Patient goes to ophthalmologist for cataract surgery, returns for post
operative management for visit(s)
56 – preoperative management only
57 – decision for surgery
58 – staged or related procedure or service by the same physician
during the postop period
59 – distinct procedural service
62 – two surgeons
63 – procedure performed on infants less than 4 kg
Description of Modifiers (cont’d)
66 – surgical team
73 - discontinued out-patient hospital/ambulatory surgery center
procedure prior to the administration of anesthesia
74 - discontinued out-patient hospital/ambulatory surgery center
procedure after administration of anesthesia
76 – repeat procedure by same physician
77 – repeat procedure by another physician
78 – return to the operating room for a related procedure during the
postoperative period
• Dr. Smith performs a C-section. A week later, the pt returns to OR for
a post-operative infection (complication) and an ID is performed.
79 – unrelated procedure or service by the same physician during the
postoperative period
• Dr. Jones performs a vasectomy (90 day global). Two weeks later, pt
returns for skin tag removal off back.
Description of Modifiers (cont’d)
80 – assistant surgeon
81 – minimum assistant surgeon
82 assistant surgeon (when qualified resident surgeon not available)
90 – reference (outside) laboratory
Description of Modifiers (cont’d)
91 – repeat clinical diagnostic laboratory test
99 – multiple modifiers
Description of Modifiers (cont’d)
“Eyelids, Fingers & Toes”
EYELIDS:
E1- upper left eyelid
E2- lower left eyelid
E3- upper right eyelid
E4- lower right eyelid
FINGERS:
FA-left hand thumb
F1- left hand second digit
F2- left hand third digit
F3- left hand fourth digit
F4- left hand fifth digit
F5- right hand thumb
F6- right hand second digit
F7- right hand third digit
F8- right hand fourth digit
F9- right hand fifth digit
TOES:
TA- left foot great toe
T1- left foot second digit
T2- left foot third digit
T3- left foot fourth digit
T4- left foot fifth digit
T5- right foot great toe
T6- right foot second digit
T7- right foot third digit
T8- right foot fourth digit
T9- right foot fifth digit
CPT Physical Status Modifiers
-P1 normal healthy patient
-P2 patient with mild systemic disease
-P3 patient with moderate systemic disease
-P4 patient with severe systemic disease that is constant threat
to life
-P5 moribund patient who is not expected to survive without
operation
-P6 declared brain-dead patient whose organs are being
removed for donor purposes
HCPCS Level II
Anesthesia Modifiers
-AA anesthesia services performed personally by
anesthesiologist
-AD medically supervised by a physician for
more than four concurrent procedures
-G8 monitored anesthesia care (MAC) for deep
complex, complicated, or markedly invasive
surgical procedure
-G9 MAC for patient who has a history of severe
cardiopulmonary condition
HCPCS Level II
Anesthesia Modifiers (cont’d)
-QK medical direction of two, three, or four
concurrent anesthetic procedures involving qualified
individuals
-QS monitored anesthesia care service
-QX CRNA service, with medical direction by
physician
-QY medical direction of one CRNA by an
anesthesiologist
-QZ CRNA service, without medical direction by
physician
HOW TO ASSIGN CPT CODES
AND MODIFIERS
Step 1: Read the introduction in the CPT manual.
Step 2: Review the complete medical documentation
Step 3: Abstract the medical procedures that should be coded
•
•
Code what is documented in source document
Obtain clarification from provider if necessary
Step 4: Identify the main terms and related terms in the CPT
Index
‒ Main terms can be located by referring to:
•
•
•
•
•
•
•
Procedure or service documented
Organ or anatomic site
Condition documented in the record
Substance being tested
Synonym
Eponym
Abbreviation
HOW TO ASSIGN CPT CODES
AND MODIFIERS (cont’d)
Step 5: Locate sub-terms and follow cross referencing
Step 6: Review the description of codes and section notes in
the appropriate CPT section
Step 7: Verify the code against the documentation
Step 8: Assign codes for all significant services, applicable add
on codes and modifiers
Step 9: Cross check your NCCI edits
CPT UPDATES
 New, deleted and changed CPT codes
are updated yearly, in October by the
AMA and go into effect January 1st of
the following year.
 Category III codes are updated twice a
year, July 1 and January 1.
CPT
Unlisted Procedures/Services
• Assigned for procedure or service for
which there is no CPT code
• Special report (e.g., copy of procedure
report) is attached to claim to
describe:
–
–
–
–
Nature
Extent
Need for procedure or service
Time, effort, and equipment necessary
CPT Index
• Organized by alphabetical main terms
• Main terms represent:
–
–
–
–
Procedures or services
Organs or anatomic sites
Conditions
Synonyms, eponyms, and abbreviations
CPT Index – Single Codes
and Code Ranges
• Index code numbers are represented
by:
– Single code number
– Range of codes, separated by:
• Dash
• Series of codes separated by commas
• Combination of single codes and ranges of
codes
Evaluation and Management
Section
• Located at beginning of CPT because
these codes describe services most
frequently provided by physicians
• Accurate assignment is essential to
success of physician practice because
most revenue is generated by these
services
Professional vs.
Technical Component
• Professional component – covers
supervision of procedure and
interpretation/documentation of report
describing examination and findings
• Technical component – covers use of
equipment, supplies provided, and
employment of radiologic technicians
Professional vs.
Technical Component (cont’d)
• When two separate billings are required:
‒ CPT modifier -26 (professional component) is
added to CPT Radiology code number by
physician
‒ HCPCS level II modifier -TC (technical
component) is added to CPT Radiology code by
hospital
• Exception to this rule:
‒ When code description restricts use of code to
“supervision and interpretation”
Surgery Section
• Organized by body system
• Subsections are subdivided into
categories by specific organ or
anatomic site
• To code surgeries properly, ask the
following questions:
1.What body system was involved?
2.What anatomic site was involved?
3.What type of procedure was performed?
Surgical Package
• Global period –
number of days
associated with
surgical package;
designated as 0, 10,
or 90 days
HELPFUL CODING RESOURCES
 Medical Dictionary
 Anatomy & Physiology Text
 Current ICD-9-CM, CPT, and HCPCS
codebooks
 Physician’s Desk Reference
 Contractor’s Provider Manual
 Subscription to AMA Coding Assistant
 www.cms.hhs.gov/NationalCorrectCodInitEd
 www.cms.hhs.gov/center/coverage.asp
 http://www.icd10data.com/Convert
Thank you.
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