USING CPT

GETTING STARTED

● Analyze what kind of service you need to

code
● Is this service …
● A surgical procedure?
● A prescription for medicine?
● A patient evaluation?
● A diagnostic X-ray or CAT scan?
● This will inform where in the CPT code set
you will look
 EXAMPLE 1

● A patient breaks his arm and must go to the

emergency room. His injury is serious, but is
not a risk to the patient’s life or major
physiological functions.
● This is a hospital visit, so we’d use an E&M
code
● Turn to E&M Section
● Then to subsection for Emergency Room Services
 EXAMPLE 1 CONT.

● There are a number of Emergency Room

Services codes, based on severity and threat
to life
● Since our patient is injured but is not in any
immediate danger, we can use a code for
low-to-moderate severity
● We select code 99282
 EXAMPLE 2

● A patient requires the biopsy of a deep,

intramuscular cyst in his elbow
● This is a surgical procedure, since it involves
an incision into the human body
● We turn to the Surgery section, and then to
the musculoskeletal subsection
● We find the section of codes related to the
elbow and lower arm
● Then we look at codes for excision (removal),
because the provider removed a piece of the
patient’s cyst for a biopsy
 EXAMPLE 2 CONT.

● We find code 24065: “Biopsy, soft tissue of

upper arm or elbow area; superficial”
● This is a parent code, and is not exactly what
we’re looking for
● The code indented below the parent code is
much closer: 24066: “Biopsy, soft tissue of
upper arm or elbow area; deep (subfascial or
intramuscular)”
● We’d select this code as our procedure code
 OUT OF ORDER CODES

● There are some codes that have been

resequenced or are out of order in the code
book
● This is done to group similar procedures
together, which helps coders find the correct
code
● Out-of-order codes always have a note
instructing coders to flip back to the original
location of the code
 GUIDELINES

● Each major section of the CPT codebook lists

the guidelines for the codes in that section
● Familiarize yourself with the guidelines in the
CPT codebook’s sections
● Certain codes must be used in conjunction
with one another
● As in the case of “add-on” codes
● Other codes instruct you not to use this code
with a specific other code
● These codes may be mutually exclusive or
contradictory
 GUIDELINES CONT.

● Some codes also have instructions, listed in

parentheses
● These instructions inform the coder that there
may be other, more accurate codes
● They are similar to the “See” instructions in the
ICD code set
● See the next slide for an example
 EXAMPLE 3
● A patient had the ACL in his knee
reconstructed during a surgical procedure
● Coder turns to the Surgery section of the
code book, then to the musculoskeletal
subsection
● Find the section on the femur and knee joint,
and look at code 27407 – “repair, primary,
torn ligament and/or capsule, knee; cruciate”
● The note below code 27407 reads “For
cruciate ligament reconstruction, use 27427”
● Coder would check this code, find it correct,
and use it instead of 27407
 CODE SYMBOLS

● Code symbols in the CPT codebook alert the

coder to new, revised, expanded codes
● Also inform the coder about special
circumstances with the procedure
● E.g. sedation, or whether a procedure is modifier
exempt
 CODE SYMBOLS CONT.

● New Codes: marked with a red dot

● Heavily revised codes: marked with a blue
triangle
● New and revised procedure descriptions:
marked with green triangles
● Modifier 51 exempt: marked with a circle
with a diagonal line through it
● Moderate sedation: a circle with a dot in the
center
 APPENDICES

● The CPT Manual comes with a number of

helpful appendices
● Included in these appendices is information
specific to certain codes, groups of similar
codes, clinical examples for complicated or
variously interpreted codes, and others
● Appendix A includes all of the CPT modifiers
approved for use with the code set
 INDEX

● Like the alphabetical index in the ICD code

sets
● Use this to locate codes by
● Where on the body the procedure is performed
● What type of procedure it is
● The colloquial name for a procedure

You NEVER code with the index. You simply

use it to help find the correct code.