CPT Coding for Beginners by AMCI Part 1

operatives, talking to family and other doctors or other qualified healthcare professionals, the cpt code in the surgery section also includes writing. orders, it also includes evaluation of the patient in the post-anesthesia recovery area and finally, that cpt code includes typical post-operative follow-up care, so one code, one cpt code in the surgical section includes a lot of things. Now let's move on, I think I'm ready to make an example. I have talked a lot. Now it's your turn and I want to demonstrate. Here's an example of bundling and that surgical bundle we just talked about. We have a 12 year old boy arriving. to the doctor's office, who performed a complete history and examination, the doctor decided that the child needed an emergency tonsillectomy, the patient was taken to the surgical center and then the doctor performed a tonsillectomy, so what happened?

That is what we must determine. Well, we know that a complete history and examination was performed, in other words, there was an office visit and you will learn about evaluation and management a little later when you get to advanced

coding

, but remember every time a patient you go to the doctor or the doctor sees you or or if the doctor visits the patient, the doctor can be billed for his visits, so you can code the visits. However, a procedure was performed on the same day as that visit and you might say, well, what are you talking about, Mrs.

J? I'm talking. cpt surgical package remember we just said that when a procedure is performed and you use a procedure code, there are some other things included in it and in this black box it says that evaluation and management services or subsequent e m services to the surgery decision the day before or the day of surgery, okay, so the coders pretty much if a patient has a doctor visit the day before or the day of surgery, it's grouped together, what does that mean? It means that it is not encoded separately. just use a code that is your procedure code and that's it, so the moral of the story is that the procedure code used for this tonsillectomy includes the office visit, so we would only code for the office visit and , if it is included, we call it included and there it is. okay so let's put our knowledge of cpt the symbols the guidelines let's put it all together and let's go ahead and code a little bit that's it, let's do it and don't forget our three steps step one let's look up to the main term or the procedure in the index, step two, we're going to check that code in the chapter, step three, we're going to confirm any applicable guidelines, let's get it right, so we have a 12 year old boy who had a tonsillectomy step one we're going to look up the procedure in the index our procedure is tonsillectomy boom tonsillectomy and it takes us to code the series four two eight two zero up to four two eight two six step two and here is our series of codes step two we Let's check these, the code or codes in the chapter, they gave us a whole series, so we're going to have to read them right, so if we look at four two eight two zero, this is the code for the tonsillectomy and adenoidectomy coders, there is no mention that the child's adenoids were removed, so that It is not the right step.

The next code in the series is four two eight two one. This is tonsillectomy and adenoidectomy and 2-1 is 12 years or older. That's also wrong because I'll tell you why it's wrong if you, if the parent is wrong, the child is wrong, okay, let's move on to four, two, eight, two, five primary or secondary tonsillectomy before the age of twelve, like this that I like the language of the common portion, but I don't like this, the um language that is specific. to this code I don't like the language behind the semicolon, so four two eight two five is wrong because this patient is not under twelve, the patient is twelve, so 42825 is wrong, but the language of the common

part

of this parent is correct Okay, let's go ahead and look at the indented code 42826 12 years or older and you know what encoders I like. 42826 primary or secondary tonsillectomy 12 years or older.

I like it, I hope you do too and look at my notation here in two. eight two five says 11 years or less, that's my chun, so if we went to this page and these notations were already here, we probably could have jumped straight to two 42826 and you would get to the fact that this is our answer, so the answer four two eight two six and what needs to be removed be careful that the patient is 12 years old and in this section or any section in cpt where you see that they are distinguishing that age, make it make sense in

amci

we make it make sense every time someone is under 12, we'll say 11 or less or we can say 11 or so, but not 12.

Okay.coders, so if you understand that great and for some of you it might have been too much, I know this is kind of basic and introductory level and I know the only goal I want them to achieve. I really want you to understand that there are guidelines. and I also want you to understand that there is a process to look for a cpt code and that's it, moving forward when you get to advanced cpt

coding

you will get all this that I have mentioned and more, all good and You will be ready, coders. This completes the first

part

of the introduction to CPT coding.

I want you to remember to practice, practice, practice. At this point, they should be able to put their knowledge of CPT symbols, guidelines, and coding into practice. Put it all together and really code. you are there, don't forget the three steps, the first step, find the main term in the index, the second step, check that code in the chapter, color pages, the third step, confirm the applicable guidelines, okay, so let's review what we've accomplished, let's review how. to find a cpt code basic cpt guidelines and scenarios to test your knowledge now congratulations you are ready for part 2 thanks for watching an exclusive presentation by

amci

in association with aapc until next time