For example, if the diagnostic scope and the surgical scope procedure were performed in separate knees, may be billed separately with modifier appended because it represents a separate anatomical location.
You could also apply the appropriate LT left side and RT right side modifiers to both the and to designate which procedure occurred on which knee. Rules and Guidelines exist for a reason: to guide us to the correct and compliant way of doing things.
There are exceptions to the rules and knowing when to exercise those exceptions is what due diligence is for. Comment on this article. Terry is the author of several coding and reimbursement publications, as well as a practice auditor for multiple specialty practices around the country. Register to listen.
Not true. First, you must consider: Were there other procedures performed during the same encounter? Did you consult the NCCI edits? The separate procedure may be truly separate, and that condition is identified by adding the modifier Distinct procedural service to the designated separate procedure code. Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.
Email Editor to Discuss. Tags cpt coding coders surgery ncci. Pollard, Director of Coding…. Severe maternal morbidity often intersects with cesarean deliveries. Reducing the number of cesarean deliveries can lower the maternal mortality rate, and one of the drivers of cesarean rates is thought to be induction of labor IOL. In , the American…. Coding blood transfusions on maternity patients saves lives.
We often hear of the importance…. Print this article. Back to top. Free eNews Sign Up. Please select 1 field to search. Keyword [? Author - Search by Author - Adele L. Dombro, MD Andrew N. Nichols, MD Joseph J. Brodt, PhD Julie A. 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,plus codes.
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:. CPT codes are, for the most part, grouped numerically. The codes for surgery, for example, are through In the CPT codebook, these codes are listed in mostly numerical order, except for the codes for Evaluation and Management.
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.
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.
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. 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. The first, which comes before the semicolon, is the general procedure. If we look in the CPT manual, we find the code below 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 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. 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.
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
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