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How to Use the CPT Book
CPT Coding Principles
I. CPT-4 represents the “WHAT” was done to the patient (procedure)
Ex. Procedure Code - 93010 (EKG)
Organization of the CPT Manual (6 major sections):
- Evaluation and Management (99201 – 99499)
- Anesthesiology (00100 – 01999, 99100-99140)
- Surgery (10040 – 69990)
- Radiology (70010 – 79999)
- Pathology and Laboratory (80049 – 89399)
- Medicine (90281 – 99199)
Navigating around the CPT Manual:
- Find desired term (procedure, organ, condition, synonyms) in Alphabetical Index in the back of the manual.
- Look up the procedure code in the Tabular Index which was found in the Alphabetical Index to find the exact procedure code that applies to the procedure.
- The guidelines at the beginning of a section of the CPT Manual’s Tabular Index must be carefully read to make sure the correct code is applied. This is critical to using CPT correctly.
▲ Description has been substantially altered
● Appears the first year the code is added to the manual
+ Add on codes that never stand alone; code primary procedure first, then add on code.
►◄ New or revised text
Ө Codes exempt from the modifier, but that do not have designated add-on procedures or services
Format of the CPT-4:
- Developed as a stand-alone description of the procedures
- To conserve space, some are not printed in their entirety but refer back to a common portion listed in a preceding entry**
25100 arthrotomy, wrist joint; for biopsy
25105 for synovectomy
25105 arthrotomy, wrist joint: for synovectomy
** commonly referred to as indented codes
Ten Steps to Basic CPT Coding
- Read the source document. Never assume.
- Using information in the record, analyze procedure statement provided by physician. Identify main term and modifying terms. If source document is unclear, always verify service performed with the physician.
- Locate main term in the CPT index.
- Look for sub-terms indented below the main term.
- Jot down the tentative code range for each procedure.
- Locate each tentative code in the book.
- Read any instructional notes and watch for diagnoses or specific procedures within code descriptions.
- Verify that the code matches the procedure statement provided in the record.
- Assign a modifier if necessary.
- Assign the code.
Appendix A: Modifiers
Appendix B: Summary of additions, deletions and revisions
Appendix C: Update to short descriptor
Appendix D: Clinical examples supplement
Appendix E: Summary of add on codes
Appendix F: Summary of CPT codes exempt from modifier -51
- Adding an appropriate modifier to a procedure code provides more complete information to the insurance company about the service performed.
- Can affect the rate of reimbursement for the service.