Understanding CURRENT PROCEDURAL TERMINOLOGY & HCPCS Coding Systems 2022

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Preface How to Use the Textbook ix xiii Chapter 1: Introduction to Current Procedural Terminology 1 Introduction 1 History of Current Procedural Terminology 2 The Structure and Design of C... PT 2 The Introduction 3 Symbols 3 Sections, Subsections, Categories, Subcategories, and Headings of the CPT Manual 6 Guidelines 7 Index 8 Appendices 8 CPT as Part of HCPCS 10 HCPCS 10 Summary 11 Internet Links 11 Chapter Review 11 Coding Assignments 12 Short Answer 12 Chapter 2: Modifiers 14 Introduction 15 Definition and Purposes of Modifiers 15 Use of Modifiers for Various Procedures and Service Locations 16 Modifiers Used with Physician Services 16 Use of Multiple Modifiers— Modifier 99 17 Modifiers Used for Hospital Outpatient Services 18 Modifiers Approved for Ambulatory Surgery Center Hospital Outpatient Use 18 CPT Level I Modifiers 19 Increased Procedural Services— Modifier 22 19 Unusual Anesthesia—Modifier 23 19 Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During Postoperative Period—Modifier 24 19 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service—Modifier 25 20 Professional Component— Modifier 26 20 Multiple Outpatient Hospital E/M Encounters on the Same Date—Modifier 27 20 Mandated Services—Modifier 32 21 Preventive Service—Modifier 33 21 Anesthesia by Surgeon— Modifier 47 21 Bilateral Procedure—Modifier 50 21 Multiple Procedures—Modifier 51 22 Reduced Services—Modifier 52 22 Discontinued Procedure— Modifier 53 22 Surgical Care Only—Modifier 54 23 Postoperative Management Only—Modifier 55 23 Preoperative Management Only—Modifier 56 23 Decision for Surgery—Modifier 57 23 Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period—Modifier 58 24 Distinct Procedural Service— Modifier 59 24 Two Surgeons—Modifier 62 25 Procedure Performed on Infants Less Than 4 kg—Modifier 63 25 Surgical Team—Modifier 66 25 Discontinued Outpatient Hospital/ Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia—Modifier 73 26 Discontinued Outpatient Hospital/ Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia—Modifier 74 26 Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional— Modifier 76 26 Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional— Modifier 77 26 Unplanned Return to the Operating/ Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period— Modifier 78 27 Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period— Modifier 79 27 Assistant Surgeon—Modifier 80 27 Minimum Assistant Surgeon— Modifier 81 27 Assistant Surgeon (When Qualified Resident Surgeon Is Not Available in a Teaching Facility)— Modifier 82 28 Reference (Outside) Laboratory— Modifier 90 28 Repeat Clinical Diagnostic Laboratory Test—Modifier 91 28 Alternative Laboratory Platform Testing—Modifier 92 28 Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System—Modifier 95 29 Habilitative Services— Modifier 96 29 Rehabilitative Services— Modifier 97 29 Multiple Modifiers—Modifier 99 30 HCPCS Level II Modifiers 30 Level II—HCPCS Alphanumeric Modifiers 30 Additional Modifiers F to G9 32 G Modifiers 33 Modifiers J through V 33 Ambulance Origin and Destination Modifiers 35 Summary 35 Internet Links 36 Chapter Review 36 Case Studies 37 Chapter 3: Evaluation and Management 40 Introduction 41 Documentation Guidelines for Evaluation and Management Services 41 Overview of the Evaluation and Management Section 42 Evaluation and Management Coding 43 New Patients versus Established Patients 43 Location of the Service Provided 45 Office or Other Outpatient Services (99202–99215) 47 Levels of Evaluation and Management Services for Other E/M Services 51 Hospital Coding 66 Hospital Observation Services (99217–99226) 69 Consultations 71 Emergency Department Services (99281–99288) 73 iv Table of ConTenTs Critical Care Services (99291, 99292) 74 Nursing Facility Services (99304–99318) 77 Domiciliary, Rest Home, and Custodial Care Services 80 Home Services (99341–99350) 82 Preventive Medicine Services (99381–99429) 85 Non-Face-to-Face Physician Services (99091, 99421–99423, 99441–99458, 99473, 99474) 87 Special Evaluation and Management Services (99450–99456) 87 Newborn Care (99460–99463) 87 Delivery/Birthing Room Attendance and Resuscitation Services (99464, 99465) 88 Care Management Services (99424–99427, 99437, 99487, 99489, 99490, 99491, 99439) 88 Transitional Care Management Services (99495, 99496) 89 Advance Care Planning (99497, 99498) 89 Other Evaluation and Management Services (99499) 89 Summary 89 Internet Links 90 Chapter Review 90 Case Studies 92 Chapter 4: Anesthesia 97 Introduction 98 Guidelines Related to the National Correct Coding Initiative (NCCI) 98 Abbreviations Relating to Anesthesia 98 What Is Anesthesia, and How Is It Administered? 99 Types of Anesthesia 99 Coding and Billing Anesthesia Services 100 Arrangement of the Anesthesia Section 100 Locating Anesthesia Procedure Codes 100 Anesthesia Modifiers 101 Calculating Anesthesia Charges 102 Basic Value 103 Time Units 103 Modifying Units 103 Special Billing Consideration— Anesthetic Administered by Physician 105 Moderate or Conscious Sedation 106 Billing Concerns 106 Summary 106 Internet Links 106 Chapter Review 107 Coding Assignments 107 Case Studies 108 Chapter 5: Surgery and the Integumentary System 112 Introduction 113 Surgery Guidelines 114 Services 114 Surgical Package 114 Follow-Up Care for Diagnostic and Therapeutic Surgical Procedures 116 Supplied Materials 116 Reporting More Than One Procedure/Service 116 Separate Procedure 116 Unlisted Service or Procedure and Special Reports 116 Imaging Guidance 116 Surgical Destruction 116 Foreign Body/Implant Definition 116 The National Correct Coding Initiative (NCCI) 117 Guidelines Related to the National Correct Coding Initiative (NCCI) 118 Unbundling 118 Abbreviations Related to the Integumentary System 119 Anatomy of the Integumentary System 119 Procedures Performed on the Integumentary System 121 General (10004–10021) 121 Paring or Cutting (11055–11057) 123 Routine Foot Care 123 Pilonidal Cyst (11770–11772) 128 Introduction (11900–11983) 128 Other Procedures (15780–15879) 138 Pressure Ulcers (Decubitus Ulcers) (15920–15999) 138 Burns, Local Treatment (16000–16036) 138 Destruction (17000–17286) 139 Other Procedures (17340–17999) 141 Breast (19000–19499) 141 Summary 142 Internet Links 142 Chapter Review 143 Coding Assignments 143 Case Studies 144 Chapter 6: Musculoskeletal System 149 Introduction 150 Guidelines Related to the National Correct Coding Initiative (NCCI) 150 Abbreviations Related to the Musculoskeletal System 150 Anatomy of the Musculoskeletal System 152 General Procedures (20100–20999) 153 Wound Exploration—Trauma (20100–20103) 153 Excisions (20150–20251) 154 Introduction or Removal (20500–20705) 155 Replantation (20802–20838) 156 Grafts or Implants (20900–20939) 158 Other Procedures (20950–20999) 159 Procedures for Musculoskeletal System by Body Site 160 Incision 161 Excision 162 Introduction and Removal 162 Repair, Revision, and Reconstruction 163 Fracture/Dislocation 166 Arthrodesis 169 Application of Casts and Strapping (29000–29799) 169 Cast Removals or Repairs (29700–29750) 170 Endoscopy/Arthroscopy (29800–29999) 171 Summary 172 Internet Links 173 Chapter Review 173 Coding Assignments 173 Case Studies 174 Chapter 7: Respiratory System 179 Introduction 180 Guidelines Related to the National Correct Coding Initiative (NCCI) 180 Abbreviations Related to the Respiratory System 180 Anatomy of the Respiratory System 181 Procedures Completed on the Nose (30000–30999) 183 Incision (30000, 30020) 183 Excisions (30100–30160) 183 Introduction (30200–30220) 184 Removal of Foreign Body (30300–30320) 184 Repair (30400–30630) 185 Destruction and Other Procedures (30801–30999) 186 Procedures Completed on the Accessory Sinuses (31000–31299) 187 Incisions (31000–31090) 188 Excisions (31200–31230) 189 Endoscopy (31231–31298) 189 Procedures Completed on the Larynx (31300–31599) 190 Excision and Introduction (31300–31502) 190 Endoscopy of the Larynx (31505–31579) 191 Repair and Other Procedures Completed on the Larynx (31580–31599) 192 Table of ConTenTs v Procedures Completed on the Trachea and Bronchi (31600–31899) 192 Incision (31600–31614) 193 Endoscopy of Trachea and Bronchi (31615–31654) 193 Bronchial Thermoplasty (31660–31661) 194 Introduction, Excision Repair, and Other Procedures Completed on the Trachea and Bronchi (31717–31899) 194 Procedures Completed on the Lungs and Pleura (32035–32999) 195 Incision (32035–32225) 195 Excision/Resection, Removal, Introduction and Removal, and Destruction (32310–32562) 196 Thoracoscopy (Video-Assisted Thoracic Surgery [VATS]) (32601–32674) 197 Stereotactic Radiation Therapy (32701) 197 Repair (32800–32820) 198 Lung Transplantation (32850–32856) 198 Surgical Collapse Therapy, Thoracoplasty, and Other Procedures (32900–32999) 198 Summary 199 Internet Links 200 Chapter Review 200 Coding Assignments 201 Case Studies 202 Chapter 8: Cardiovascular System 206 Introduction 207 Guidelines Related to the National Correct Coding Initiative (NCCI) 207 Abbreviations Relating to the Cardiovascular System 207 Anatomy of the Cardiovascular System 208 Coding Cardiovascular Procedures 210 Pericardium, Cardiac Tumor, and Transmyocardial Revascularization (33016–33141) 210 Pacemaker or Pacing CardioverterDefibrillator (33202–33275) 211 Electrophysiologic Operative Procedures, Subcutaneous Cardiac Rhythm Monitor, Implantable Hemodynamic Monitors, and Wounds of the Heart (Including Valves) and Great Vessels (33250–33340) 214 Cardiac Valve Procedures (33361–33496) 215 Coronary Artery Anomalies and Endoscopy (33500–33509) 216 Coronary Artery Bypass Grafts Procedures 217 Venous Grafting Only for Coronary Artery Bypass (33510–33516) 217 Combined Arterial-Venous Grafting for Coronary Bypass (33517–33530) 218 Arterial Grafting and Code for Coronary Artery Bypass (33533– 33548) 218 Anomaly Repair and Other Procedures (33600–33926) 218 Heart/Lung Transplantation (33927–33945) 219 Extracorporeal Membrane Oxygenation or Extracorporeal Life Support Services (33946–33989) 221 Cardiac Assist (33967–33997) and Other Procedures (33999) 221 Arteries and Veins 222 Embolectomy/Thrombectomy (34001–34490) 222 Venous Reconstruction (34501–34530) 223 Endovascular Repair of Abdominal Aortic and/or Iliac Arteries (34701–34834) and Fenestrated Endovascular Repair of the Visceral and Inferenal Aorta (34839–34848) 224 Direct Repair of Aneurysm or Excision (Partial or Total) and Graft Insertion for Aneurysm, Pseudoaneurysm, Ruptured Aneurysm, and Associated Occlusive Disease (35001–35152) 227 Repair of Arteriovenous Fistula (35180–35190) 227 Repair of a Blood Vessel for Reasons Other Than Fistula (35201–35286) 227 Thromboendarterectomy (35301–35390) 227 Angioscopy (35400) 227 Bypass Graft—Vein (35500–35572) and In-Situ Vein (35583–35587) 228 Bypass Graft—Other Than Vein (35600–35671) 228 Composite Grafts, Adjuvant Techniques, and Arterial Transposition (35681–35697) 228 Excision, Exploration, Repair, and Revision (35700–35907) 228 Vascular Injection Procedures (36000–36598) 229 Arterial and Arteriovenous Procedures (36600–37799) 229 Arterial and Intraosseous Codes (36600–36680) 229 Hemodialysis Access, Intervascular Cannulation for Extracorporeal Circulation or Shunt Insertion (36800–36861) 230 Dialysis Circuit (36901–36909) 230 Portal Decompression Procedures (37140–37183) 230 Transcatheter Procedures (37184–37218) 230 Endovascular Revascularization (Open or Percutaneous, Transcatheter) (37220–37239) 231 Vascular Embolization and Occlusion (37241–37244) and Intravascular Ultrasound Services (37252–37253) 231 Endoscopy (37500–37501) 231 Ligation and Other Procedures (37565–37799) 232 Summary 232 Internet Links 232 Chapter Review 232 Coding Assignments 233 Case Studies 234 Chapter 9: Hemic and Lymphatic Systems 238 Introduction 239 Guidelines Related to the National Correct Coding Initiative (NCCI) 239 Structures of the Hemic and Lymphatic Systems 239 Procedures Completed on the Spleen (38100–38200) 239 Excisions (38100–38102) 239 Repair (38115) 240 Laparoscopy of the Spleen (38120 and 38129) . . . . . . . . . . . . 241 Introduction (38200) 241 General Procedures (38204–38232) and Transplantation and Post-Transplantation Cellular Infusions (38240–38243) 241 Procedures Performed on the Lymph Nodes and Lymphatic Channels (38300–38999) 242 Incision (38300–38382) 243 Excisions (38500–38555) 243 Limited Lymphadenectomy for Staging (38562, 38564) 244 Laparoscopy (38570–38589) 244 Radical Lymphadenectomy (Radical Resection of Lymph Nodes) (38700–38780) 244 Introduction and Other Procedures (38790–38999) 245 Summary 246 Internet Links 246 Chapter Review 246 Coding Assignments 247 Case Studies 247 Chapter 10: Mediastinum and Diaphragm 250 Introduction 250 Guidelines Related to the National Correct Coding Initiative (NCCI) 251 Procedures Completed in the Mediastinum (39000–39499) 251 Procedures Completed on the Diaphragm (39501–39599) 252 vi Table of ConTenTs Summary 253 Internet Links 253 Chapter Review 253 Coding Assignments 254 Case Studies 254 Chapter 11: Digestive System 256 Introduction 257 Guidelines Related to the National Correct Coding Initiative (NCCI) 258 Abbreviations Related to the Digestive System 259 Procedures Completed on the Lips, Mouth, Tongue, Teeth, Palate, Uvula, and Salivary Glands and Ducts (40490–42699) 259 Lips (40490–40799) 259 Vestibule of the Mouth (40800–40899) 261 Tongue and Floor of Mouth (41000–41599) 261 Dentoalveolar Structures (41800–41899) 262 Palate and Uvula (42000–42299) 263 Salivary Glands and Ducts (42300–42699) 263 Procedures Completed on the Pharynx, Adenoids, and Tonsils (42700–42999) 264 Procedures Completed on the Esophagus (43020–43499) 265 Endoscopy Procedures (43180–43278) 266 Repairs (43300–43425) 268 Manipulation Codes and Other Procedures (43450–43499) 268 Stomach (43500–43999) 269 Incision (43500–43520) 269 Excision (43605–43641) 270 Laparoscopy (43644–43659) 271 Introduction (43752–43763) 271 Bariatric Surgery (43770–43775) 271 Other Procedures Completed on the Stomach (43800–43999) 271 Intestines, Except Rectum (44005–44799) 272 Incision (44005–44055) 274 Excision (44100–44160) 274 Laparoscopy (44180–44238) 274 Enterostomy—External Fistulization of Intestines (44300–44346) 276 Endoscopy, Small Intestine, and Stomal (44360–44408) 276 Codes 44500 to 44799 276 Meckel’s Diverticulum and the Mesentery (44800–44899) 277 Appendix (44900–44979) 277 Colon and Rectum (45000–45999) 277 Anus (46020–46999) 278 Liver (47000–47399) 280 Biliary Tract (47400–47999) 280 Pancreas (48000–48999) 282 Abdomen, Peritoneum, and Omentum (49000–49999) 283 Repair—Hernioplasty, Herniorrhaphy, Herniotomy, Suture, and Other Procedures (49491–49999) 283 Summary 284 Internet Links 284 Chapter Review 284 Coding Assignments 285 Case Studies 286 Chapter 12: Urinary System 292 Introduction 293 Guidelines Related to the National Correct Coding Initiative (NCCI) 293 Abbreviations Related to the Urinary System 293 Anatomy of the Urinary System 294 Procedures Completed on the Kidneys (50010–50593) 296 Incision (50010–50135) 296 Excision (50200–50290) . . . . . . . . .296 Renal Transplantation (50300–50380) 298 Introduction (50382–50396 and 50430–50437) 299 Repair (50400–50540) 299 Laparoscopy (50541–50549) 299 Endoscopy (50551–50580) 300 Other Procedures (50590–50593) 300 Procedures Completed on the Ureter (50600–50980) 301 Incision, Excision, and Introduction (50600–50695) 301 Repair (50700–50940) 302 Laparoscopy and Endoscopy Procedures (50945–50980) 302 Procedures Completed on the Bladder (51020–52700) 302 Incision, Removal, Excision, and Introduction (51020–51720) 303 Urodynamics (51725–51798) 304 Repair (51800–51980) 304 Laparoscopy and Endoscopy (51990–52010) 305 Transurethral Surgery (52204–52356) 306 Vesical Neck and Prostate (52400–52700) 306 Procedures Completed on the Urethra (53000–53899) 307 Incision, Excision, and Repair (53000–53520) 307 Manipulation and Other Procedures (53600–53899) 307 Summary 307 Internet Links 308 Chapter Review 308 Coding Assignments 308 Case Studies 309 Chapter 13: Male Genital System 314 Introduction 315 Guidelines Related to the National Correct Coding Initiative (NCCI) 315 Abbreviations Related to the Male Genital System 315 Procedures Completed on the Penis (54000–54450) 316 Procedures Completed on the Testis (54500–54699) 317 Procedures Completed on the Epididymis and Tunica Vaginalis (54700–55060) 317 Procedures Completed on the Scrotum, Vas Deferens, Spermatic Cord, and Seminal Vesicles (55100–55680) 318 Scrotum (55100–55180) 319 Vas Deferens (55200–55400) 319 Spermatic Cord and Seminal Vesicles (55500–55680) 319 Procedures Completed on the Prostate (55700–55899) 319 Reproductive System Procedures (55920) and Intersex Surgery (55970–55980) 320 Summary 320 Internet Links 320 Chapter Review 321 Coding Assignments 321 Case Studies 322 Chapter 14: Female Genital System 327 Introduction 328 Guidelines Related to the National Correct Coding Initiative (NCCI) 328 Abbreviations Associated with the Female Genital System 329 Vulva, Perineum, and Introitus (56405–56821) 329 Procedures Completed on the Vagina (57000–57426) 332 Procedures Completed on the Cervix Uteri (57452–57800) 334 Procedures Completed on the Corpus Uteri (58100–58540) 335 Laparoscopy and Hysteroscopy (58541–58579 and 58674) 336 Procedures Completed on the Oviduct and Ovary (58600–58960) 336 In Vitro Fertilization (58970–58976) and Other Procedures (58999) 338 Summary 338 Internet Links 338 Table of ConTenTs vii Chapter Review 339 Coding Assignments 339 Case Studies 340 Chapter 15: Maternity Care and Delivery 344 Introduction 345 Guidelines Related to the National Correct Coding Initiative (NCCI) 345 Abbreviations Associated with Maternity Care and Delivery 345 Antepartum and Fetal Invasive Services (59000–59350) 346 Vaginal Delivery, Antepartum and Postpartum Care (59400–59430), and Cesarean Delivery (59510–59525) 349 Delivery after Previous Cesarean Delivery (59610–59622) 350 Abortion and Other Procedures (59812–59899) 351 Summary 351 Internet Links 352 Chapter Review 352 Coding Assignments 352 Case Studies 353 Chapter 16: Endocrine System 357 Introduction 357 Guidelines Related to the National Correct Coding Initiative (NCCI) 359 Abbreviations Associated with the Endocrine System 360 Thyroid Gland (60000–60300) 360 Parathyroid, Thymus, Adrenal Glands, Pancreas, and Carotid Body (60500–60605) 361 Laparoscopy and Other Procedures (60650–60699) 362 Summary 362 Internet Links 362 Chapter Review 362 Coding Assignments 363 Case Studies 363 Chapter 17: Nervous System 367 Introduction 368 Guidelines Related to the National Correct Coding Initiative (NCCI) 368 Abbreviations Associated with the Nervous System . . . . . . . . . 368 Anatomy of the Nervous System 368 Procedures Completed on the Nervous System (61000–64999) 373 Skull, Meninges, and Brain (61000–62258) 373 Spine and Spinal Cord (62263–63746) 377 Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System (64400–64999) 379 Summary 379 Internet Links 380 Chapter Review 380 Coding Assignments 380 Case Studies 381 Chapter 18: Eye and Ocular Adnexa 385 Introduction 386 Guidelines Related to the National Correct Coding Initiative (NCCI) 386 Abbreviations Relating to the Eye and Ocular Adnexa 386 Anatomy of the Eye . . . . . . . . . . 387 Procedures Completed on the Eyeball (65091–65290) . . . . . . . 388 Procedures Completed on the Anterior Segment (65400–66999) 390 Procedures Completed on the Posterior Segment (67005–67299) 392 Procedures Completed on the Ocular Adnexa (67311–67999) 394 Procedures Completed on the Conjunctiva (68020–68899) 395 Summary 395 Internet Links 396 Chapter Review 396 Coding Assignments 397 Case Studies 398 Chapter 19: Auditory System and Operating Microscope 401 Introduction 402 Guidelines Related to the National Correct Coding Initiative (NCCI) 402 Abbreviations Associated with the Auditory System 402 Anatomy of the Auditory System 403 Procedures Completed on the External Ear (69000–69399) 404 Incision (69000–69090) 405 Excision (69100–69155) 405 Removal of Foreign Body (69200–69222) 405 Repairs and Other Procedures (69300–69399) 405 Procedures Completed on the Middle Ear (69420–69799) 406 Incision (69420–69450) 406 Excision (69501–69554) 406 Repair (69601–69676) 406 Osseointegrated Implants (69714–69719, 69726, 69727) 407 Other Procedures (69700–69799) 407 Procedures Completed on the Inner Ear and the Temporal Bone, Middle Fossa Approach (69801–69979) 408 Operating Microscope 408 Summary 409 Internet Links 409 Chapter Review 409 Coding Assignments 409 Case Studies 410 Chapter 20: Radiology 413 Introduction 414 Guidelines Related to the National Correct Coding Initiative (NCCI) 414 Terminology Associated with Radiology 414 Abbreviations Associated with Radiology 417 Coding for Radiology 417 Diagnostic Radiology (70010–76499) 417 Vascular Procedures (75600–75893) 418 Transcatheter Procedures (75894–75989) . . . . . . . . . . . . . . .420 Other Procedures (76000–76499) 420 Diagnostic Ultrasound (76506–76999) 421 Radiologic Guidance (77001–77022) 422 Breast Mammography (77046–77067) 422 Bone/Joint Studies (77071–77092) 423 Radiation Oncology (77261–77799) 423 Nuclear Medicine (78012–79999) 426 Summary 427 Internet Links 427 Chapter Review 427 Coding Assignments 428 Case Studies 429 Chapter 21: Pathology and Laboratory 434 Introduction 434 Guidelines Related to the National Correct Coding Initiative (NCCI) 435 Coding for Pathology and Laboratory Services 436 Abbreviations Associated with Laboratory Coding 436 Sections 436 Organ or Disease-Oriented Panel viii Table of ConTenTs Drug Procedures 438 Drug Assay (80305–80377 and 83992) 438 Therapeutic Drug Assays (80143–80299) 438 Evocative/Suppression Testing (80400–80439) 438 Pathology Clinical Consultations (80503–80506) 439 Urinalysis (81000–81099) 439 Molecular Pathology (81105–81408 and 81479) 439 Genomic Sequencing Procedures and Other Molecular Multianalyte Assays (81410–81471) 439 Multianalyte Assays with Algorithmic Analyses (81490–81599) 439 Chemistry (82009–84999) 440 Hematology and Coagulation (85002–85999) 440 Immunology (86000–86849) 440 Transfusion Medicine (86850–86999) 440 Microbiology (87003–87999) 440 Anatomic Pathology (88000–88099) 440 Cytopathology (88104–88199) 440 Cytogenetic Studies (88230–88299) 440 Surgical Pathology (88300–88399) 441 In Vivo (e .g ., Transcutaneous) Laboratory Procedures (88720–88749) 441 Other Procedures and Reproductive Medicine Procedures (89049–89398) 441 Proprietary Laboratory Analyses (0001U–0284U) 441 Summary 441 Internet Links 441 Chapter Review 441 Coding Assignments 442 Chapter 22: Medicine 443 Introduction 444 Guidelines Related to the National Correct Coding Initiative (NCCI) 445 Immune Globulins (90281–90399) 445 Immunization Administration for Vaccines and Toxoids (90460–90474) and (0001A–0042A) 445 Vaccines and Toxoids (90476–90756) and (91300–91304) 446 Psychiatry (90785–90899) 447 Biofeedback (90901–90913) 449 Dialysis (90935–90999) 449 Hemodialysis (90935–90940) 449 Miscellaneous Dialysis Procedures (90945–90947) and Other Dialysis Procedures (90989–90999) 450 End-Stage Renal Disease Services (90951–90970) 450 Gastroenterology (91010–91299) 451 Ophthalmology (92002–92499) 451 Other Specialized Services 452 Special Otorhinolaryngologic Services (92502–92700) 452 Cardiovascular (92920–93799) 452 Noninvasive Vascular Diagnostic Studies (93880–93998) 453 Pulmonary (94002–94799) 454 Allergy and Clinical Immunology (95004–95199) 454 Endocrinology (95249–95251) 454 Neurology and Neuromuscular Procedures (95700–96020) 454 Medical Genetics and Genetic Counseling Services (96040) and Adaptive Behavior Services (97151–97158) 455 Central Nervous System Assessments and Tests (96105–96146), and Health Behavior Assessment and Intervention (96156–96171) 455 Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and Other Highly Complex Drug or Highly Complex Biologic Agent Administration (96360–96549) 456 Photodynamic Therapy (96567–96574) 457 Special Dermatological Procedures (96900–96999) 457 Physical Medicine and Rehabilitation (97010–97799) 457 Additional Procedures (97802–99607) 458 Summary 458 Internet Links 458 Chapter Review 458 Coding Assignments 459 Case Studies 460 Chapter 23: HCPCS Codes 461 Introduction 461 Certificate of Medical Necessity for DME Items and Advance Beneficiary Notice 462 Organization and Use of HCPCS Level II Codes 463 HCPCS Sections 465 A Codes—Transportation Services Including Ambulance, Medical and Surgical Supplies 465 B Codes—Enteral and Parental Therapy 466 C Codes—HCPCS Outpatient PPS 466 D Codes—Dental Procedures 467 E Codes—Durable Medical Equipment 467 G Codes—Temporary Procedures/ Professional Services 467 H Codes—Behavioral Health and/ or Substance Abuse Treatment Services 468 J Codes—Drugs Administered Other Than Oral Method 468 K Codes—Temporary Codes Assigned to DME Regional Carriers 468 L Codes—Orthotic and Prosthetic Procedures and Devices 468 M Codes—Medical Services and Quality Measures 469 P Codes—Pathology and Laboratory Services 469 Q Codes—Temporary Codes 469 R Codes—Diagnostic Radiology Services 469 S Codes—Temporary National Codes 469 T Codes—Temporary National Codes Established for State Medicaid Agencies 470 U Codes—Other 470 V Codes—Vision Services and Hearing Services 470 Appendices 470 Summary 471 Internet Links 472 Chapter Review 472 Coding Assignments 472 Case Studies 473 Appendix I: Billing Forms (CMS-1500 and UB-04) 475 Appendix II: Surgical Positions 477 Appendix III: Abdominopelvic Divisions 478 Appendix IV: 2021 Anesthesia Code Base Units 479 Appendix V: Locality-Adjusted Anesthesia Conversion Factors as a Result of the CY 2021 Final Rule 482 Appendix VI: Case Studies 486 Glossary 504 Index 518 [Show More]

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