current procedural coding expert · 2013. 2. 25. · 2complex repair radical resection of cutaneous...

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Current Procedural Coding Expert

NoticeThe 2011 Current Procedural Coding Expert is designed to be an accurate and authoritative source of information about the CPT® coding system. Every effort has been made to verify the accuracy of the listings, and all information is believed reliable at the time of publication. Absolute accuracy cannot be guaranteed, however. This publication is made available with the understanding that the publisher is not engaged in rendering legal or other services that require a professional license. If you identify a correction or wish to share information, please email the Ingenix customer service department at [email protected] or fax us at 801.982.4033.

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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

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AcknowledgmentsJulie Ortan Van, CPC, CPC-P, Product ManagerKaren Schmidt, BSN, Technical DirectorStacy Perry, Manager, Desktop PublishingLisa Singley, Project ManagerWendy Gabbert, CPC, CPC-H, PCS, FCS Clinical/

Technical EditorKaren H. Kachur, RN, CPC, Clinical/Technical EditorKelly V. Canter, BA, RHIT, CCS, Clinical/Technical EditorToni R. Stewart, Desktop Publishing SpecialistKate Holden, Editor

CopyrightCopyright © 2012 Optum

All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means electronic or mechanical, including photocopy, recording or storage in a database or retrieval system, without the prior written permission of the publisher.

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About the ContributorsWendy Gabbert, CPC, CPC-H, PCS, FCSMs. Gabbert has more than 25 years of experience in the health care field. She has extensive background in CPT/HCPCS and ICD-9-CM coding. She served several years as a coding consultant. Her areas of expertise include physician and hospital CPT coding assessments, chargemaster reviews, and the outpatient prospective payment system (OPPS). She is a member of the American Academy of Professional Coders and American College of Medical Coding Specialists.

Karen H. Kachur, RN, CPCMs. Kachur is a clinical/technical editor for Ingenix with expertise in CPT/HCPCS and ICD-9-CM coding, in addition to physician billing, compliance, and fraud and abuse. Prior to joining Ingenix, she worked for many years as a staff RN in a variety of clinical settings, including medicine, surgery, intensive care, and psychiatry. In addition to her clinical background, Ms. Kachur served as assistant director of a hospital utilization management and quality assurance department and has extensive experience as a nurse reviewer for Blue Cross/Blue Shield. She is an active member of the American Academy of Professional Coders and the American College of Medical Coding Specialists.

Kelly V. Canter, BA, RHIT, CCSMs. Canter is a clinical/technical editor for Ingenix with expertise in hospital inpatient and outpatient coding and reimbursement; ambulatory surgery coding; and ICD-9-CM, CPT, and HCPCS coding. Ms. Canters' experience includes conducting coding audits and coding staff education, revenue cycle management, and concurrent review. Most recently she was responsible for auditing and compliance of a health information management services company. She is an active member of the American Health Information Management Association (AHIMA).

ContentsIntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i

Anatomical Illustrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

Interventional Radiology Illustrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxx

Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Index–1

00100–01999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

10021–19499 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

20000–29999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

30000–39599 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208

40490–49999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328

50010–60699 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408

61000–64999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 489

65091-69990. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541

70010–79999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581

80047–89356 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 672

90281–99607 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 783

Evaluation & Management. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 927

0001F–6020F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 972

0016T–0187T . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1006

Appendix A—Modifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1029

Appendix B—New, Changed, Deleted, and Modified Codes . . . . . . . . . . . . . . 1040

Appendix C—Crosswalk of Deleted Codes. . . . . . . . . . . . . . . . . . . . . . . . . . . 1058

Appendix D—Resequenced Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1060

Appendix E—Add-on Codes, Modifier 51, 63, and Moderate Sedation Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1063

Appendix F—Place of Service and Type of Service . . . . . . . . . . . . . . . . . . . . 1066

Appendix G—Pub 100 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1073

Appendix H—Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1295

Appendix I— Listing of Sensory, Motor, and Mixed Nerves . . . . . . . . . . . . . . 1311

Appendix J—Vascular Families . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1314

Appendix K—Physician Quality Reporting Program (PQRI). . . . . . . . . . . . . . 1317

Appendix L—Medically Unlikely Edits (MUEs) . . . . . . . . . . . . . . . . . . . . . . . 1331Professional . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1331OPPS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1348

Appendix M—Inpatient Only Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . 1361

CEC.book W ednesday, November 23, 2011 11:54 AM

Current Procedural Coding Expert Anatomical Illustrations

© 2012 Optum CPT only © 2011 American Medical Association. All Rights Reserved. xxv

Anatomical Illustrations

Anatomical Illustrations

ENDOCRINE SYSTEM

Thyroidcartilage

Thyroidgland

Parathyroidglands (behind

thyroid)

Hyoid bone

Isthmus

Pyramidlobe

Thyroid Glands

Epiglottis

Hyoid bone

Thyroid cartilage

Thyroid gland Isthmus

Cricoid cartilage

Pyramidlobe

Epiglottis

Constrictormuscle ofpharynx

Horn ofhyoid

Right lobeof thyroid

Parathyroidglands

Superiorand

inferiorglands

Esophagus

Posterior view

Superior view

Thyroid

Thyroidgland

Hyoidbone

EpiglottisThyrohyoidmembrane

Thyrohyoidcartilage

Larynx

Cricoidcartilage

Proximal esophagus

Trachea

Thyroglossalduct

Inferiorpharyngeal

muscle

Thyroidgland

Sternum

Thyroid

The pituitary gland and its controller, thehypothalamus, control body growth and

stimulate and regulate other glands

Anterior andposterior pituitaryglands

(hypophysis)

Pinealgland

Hypothalamus

Pituitary Glands

Fetus

Uterus

Amniotic sac

Pubicsymphysis Bladder

Rectum

Urethra

Vagina

Placenta

The placenta is considered part of theendocrine system, secreting chorionicgonadotropin, estrogen, progesterone,

and somatomammotropin

Placenta

28039-28047 [28039, 28041] Excision Soft Tissue Tumors Foot/Toe1 Any necessary elevation of tissue planes or dissection

Measurement of tumor and necessary margin at greatest diameter prior to excisionResection without removal of significant normal tissueSimple and intermediate repairsTypes of Excision:

Fascial or subfascial soft tissue tumors: simple and marginal resection of most often benignand intramuscular tumors found either in or below the deep fascia, not involvingbone

Radical resection soft tissue tumor: wide resection of tumor, mostly malignant or aggressivebenign, involving large margins of normal tissue and may involve tissue removal fromone or more layers

Subcutaneous: simple and marginal resection of most often benign tumors found in thesubcutaneous tissue above the deep fascia

2 Complex repairRadical resection of cutaneous tumors (e.g., melanoma) (11600-11646)Significant exploration of vessels, neuroplasty, or reconstruction

Resequenced code, See code following 28043.28039

Resequenced code, See code following 28045.28041

Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5cm sTc8

28043

5 7.84 6 10.87 Global Days 090

1.5 cm or greater sTdc28039#5 10.01 6 14.34 Global Days 090

Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular);less than 1.5 cm sTec8

28045

5 10.33 6 14.46 Global Days 090

1.5 cm or greater uTec28041#5 13.16 6 13.16 Global Days 090

Radical resection of tumor (eg, malignant neoplasm), soft tissue of foot ortoe; less than 3 cm uTc8

28046

5 21.98 6 21.98 Global Days 090

3 cm or greater iTdc280475 27.34 6 27.34 Global Days 090

28050-28160 Resection Procedures Foot/ToesArthrotomy with biopsy; intertarsal or tarsometatarsal joint gTc8280505 8.61 6 12.51 Global Days 090

metatarsophalangeal joint gTc8280525 8.22 6 12.16 Global Days 090

interphalangeal joint gTec8280545 7.16 6 10.92 Global Days 090

Neurectomy, intrinsic musculature of foot gTe280555 11.20 6 11.20 Global Days 090

Fasciectomy, plantar fascia; partial (separate procedure) gTc8

2 Plantar fasciotomy (28008, 28250)28060

5 10.46 6 14.59 Global Days 090

AMA: 2009, Jan, 11-31; 2008, Mar, 14-15

28039—

28060M

usculoskeletal System

# ResequencedNot CoveredUnlistedy Agex Maternitys Revised Codel New Code

t PQRSK Mod SedationL Mod 63 Exempt* Mod 51 Exempt+ Add-on8 CCIm Reinstated

191Medicare (Red Ink)CPT only © 2010 American Medical Association. All Rights Reserved. (Black Ink)© 2010 Ingenix (Blue Ink)

28060Current Procedural Coding Expert – Musculoskeletal System

Appendix C — Crosswalk of Deleted Codes Current Procedural Coding Expert

1012 CPT only © 2011 American Medical Association. All Rights Reserved. © 2012 Optum

Appe

ndix

C —

Cro

ssw

alk

of D

elet

ed C

odes

APPENDIX C — CROSSWALK OF DELETED CODESThe deleted code crosswalk is meant to be used as a reference tool to find active codes that could be used in place of the deleted code. This will not always be an exact match. Please review the code descriptions and guidelines before selecting a code. The AMA has revised the cardiac catheterization codes and guidelines for 2011. Because of the many changes made to the guidelines and the new codes added to this section, there is not a code crosswalk for the cardiac catheterization codes.

Code Cross reference

11040 To report, see ~16020-16030, 97597-97598

11041 To report, see ~16020-16030, 97597-97598

20000 To report, see ~10060-10061

33861 To report, see ~33864

35454 To report, see ~37220-37223

35456 To report, see ~37224-37227

35459 To report, see ~37228-37235

35470 To report, see ~37228-37235

35473 To report, see ~37220-37223

35474 To report, see ~37224-37227

35480 To report, see ~0234T-0235T

35481 To report, see ~0236T


35483 To report, see ~37225, 37227


35485 To report, see ~37229, 37231, 37233, 37235

35490 To report, see ~0234T-0235T



35493 To report, see ~37225, 37227


35495 To report, see ~37229, 37231, 37233, 37235

39502 To report, see ~43332-43333, 43335, 43337

39520 To report, see ~43334-43335

39530 To report, see ~43336-43337

39531 To report, see ~43336-43337

43324 To report, see ~43327-43328

43326 To report, see ~43327-43328, 43332-43338

49420 To report, see ~49060-49081, 49418-49062, 49418-49421

61795 To report, see ~61781-61783


75992 To report, see ~0238T, 37225, 37227, 37229, 37231

75993 To report, see ~0238T, 37233, 37235




76880 To report, see ~76881-76882








89135 To report, see ~43754-43755

89136 To report, see ~43754-43755










91052 To report, see ~43754-43755



92135 To report, see ~92133-92134

93012 To report, see ~93268-93272

93014 To report, see ~93268-93272









0016T To report, see ~67299













Code Cross reference

Current Procedural Coding Expert Appendix M — Inpatient Only Procedures

© 2012 Optum CPT only © 2011 American Medical Association. All Rights Reserved. 1361

Appendix M —

Inpatient Only ProceduresAppendix M

— Inpatient Only Procedures

APPENDIX M — INPATIENT ONLY PROCEDURESInpatient Only Procedures—This appendix identifies services with the status indicator C. Medicare will not pay an OPPS hospital or ASC when they are performed on a Medicare patient as an outpatient. Physicians should refer to this list when scheduling Medicare patients for surgical procedures. CMS updates this list quarterly.

00176 Anesth pharyngeal surgery00192 Anesth facial bone surgery00211 Anesth cran surg hemotoma00214 Anesth skull drainage00215 Anesth skull repair/fract00452 Anesth surgery of shoulder00474 Anesth surgery of rib00524 Anesth chest drainage00540 Anesth chest surgery00542 Anesth remvl pleura00546 Anesth lung chest wall surg00560 Anesth heart surg w/o pump00561 Anesth heart surg < 1 yr00562 Anesth hrt surg w/pmp age 1+00567 Anesth cabg w/pump00580 Anesth heart/lung transplnt00604 Anesth sitting procedure00622 Anesth removal of nerves00632 Anesth removal of nerves00670 Anesth spine cord surgery00792 Anesth hemorr/excise liver00794 Anesth pancreas removal00796 Anesth for liver transplant00802 Anesth fat layer removal00844 Anesth pelvis surgery00846 Anesth hysterectomy00848 Anesth pelvic organ surg00864 Anesth removal of bladder00865 Anesth removal of prostate00866 Anesth removal of adrenal00868 Anesth kidney transplant00882 Anesth major vein ligation00904 Anesth perineal surgery00908 Anesth removal of prostate00932 Anesth amputation of penis00934 Anesth penis nodes removal00936 Anesth penis nodes removal00944 Anesth vaginal hysterectomy01140 Anesth amputation at pelvis01150 Anesth pelvic tumor surgery01212 Anesth hip disarticulation01214 Anesth hip arthroplasty01232 Anesth amputation of femur01234 Anesth radical femur surg01272 Anesth femoral artery surg

01274 Anesth femoral embolectomy01402 Anesth knee arthroplasty01404 Anesth amputation at knee01442 Anesth knee artery surg01444 Anesth knee artery repair01486 Anesth ankle replacement01502 Anesth lwr leg embolectomy01634 Anesth shoulder joint amput01636 Anesth forequarter amput01638 Anesth shoulder replacement01652 Anesth shoulder vessel surg01654 Anesth shoulder vessel surg01656 Anesth arm-leg vessel surg01756 Anesth radical humerus surg01990 Support for organ donor11004 Debride genitalia & perineum11005 Debride abdom wall11006 Debride genit/per/abdom wall11008 Remove mesh from abd wall15756 Free myo/skin flap microvasc15757 Free skin flap microvasc15758 Free fascial flap microvasc16036 Escharotomy addl incision19271 Revision of chest wall19272 Extensive chest wall surgery19305 Mast radical19306 Mast rad urban type19361 Breast reconstr w/lat flap19364 Breast reconstruction19367 Breast reconstruction19368 Breast reconstruction19369 Breast reconstruction20661 Application of head brace20664 Application of halo20802 Replantation arm complete20805 Replant forearm complete20808 Replantation hand complete20816 Replantation digit complete20824 Replantation thumb complete20827 Replantation thumb complete20838 Replantation foot complete20936 Sp bone agrft local add-on20937 Sp bone agrft morsel add-on20938 Sp bone agrft struct add-on20955 Fibula bone graft microvasc20956 Iliac bone graft microvasc20957 Mt bone graft microvasc20962 Other bone graft microvasc20969 Bone/skin graft microvasc20970 Bone/skin graft iliac crest21045 Extensive jaw surgery21141 Reconstruct midface lefort21142 Reconstruct midface lefort21143 Reconstruct midface lefort

25 CEC Appendix.fm Page 1361 W ednesday, November 23, 2011 12:35 PM

current procedural coding expert · 2013. 2. 25. · 2complex repair radical resection of cutaneous...

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