Coding 101

ICD-10-CM

International Classification of Diseases-10th Revision-Clinical Modification. Codes for diseases, injuries, and statuses. Updated annually on Oct 1st.

CPT

Current Procedural Terminology. Codes for outpatient services and procedures. Medicare uses CPT and HCPCS

G codes - HCPCS

codes for annual wellness visits, screening mammograms, and colonoscopies

LOINC

Logical Observation Identifiers Names and Codes (LOINC). used for laboratory tests, measurements, and observations

NDC

National drug code. used for drugs.

CDC CVX

Centers for Disease Control and Prevention (CDC) Vaccines Administered (CVX) – used for vaccines

ICD-10-PCS

inpatient procedure codes - International Classification of Diseases, 10th Revision, Procedure Coding System; maintained by CMS & updated annually on Oct. 1st.

HCPCS

Healthcare Common Procedure Coding System - for services not included in CPT. Must use for preventive services for Medicare pts.

CDT

Current Dental Terminology for dental procedures

RBRVS

resource-based relative value scale. This scale is used to calculate payment for professional services. RBRVS assigns value to CPT and HCPCS Level II codes based on three components: the time or amount of work performed by the provider, the overhead cost of the practice to provide the service, and the expense of medical malpractice or professional liability coverage. This method reflects the traditional fee-for-service model.

SNOMED-CT

Systematized Nomenclature of Medicine-Clinical Terms. allows data to be abstracted regardless of different terms or phrases used by mapping sets of clinical phrases together by like terms. Basically sets of clinical phrases grouped together by like terms.

HCPCS Level II

Identify products, supplies, and services

CPT Category I

separated into 6 sections; surgery section separated into subsections depending on body systems; Everything before semicolon of cpt code description is kept and after the semicolon look below code and choose most specific option; EX:

25100 - arthrotomy, wrist joint; with biopsy

25101 with synovectomy

CPT description for 25105: Arthrotomy, wrist joint; with synovectomy

CPT category II

supplemental tracking codes used to collect data for reporting performance measurement. Don’t have reimbursement value.

CPT Category III

temporary codes used to report emerging technology and experimental medical procedures and services. After 5 yrs, codes are retired.

CPT Category I Section 1

99202-99499 E/M

CPT Category I section 2

00100-01999: Anesthesia

CPT Category I section 3

For surgery

• 10004-19499: Integumentary

• 20100-29999: Musculoskeletal

• 30000-32999: respiratory

• 33016-39599: Cardiovascular

• 40490-49999: Digestive

• 50010-60699: urinary, male, female genital

• 61000-64999: nervous

• 65091-69990: eye, auditory, operating microscope

In my red car dangerous unicorns never eat

CPT Category I Section 4

70010-79999: radiology

CPT Category I, section 5

80047-89398, 0001U-0520U: pathology & laboratory

CPT Category , section 6

90281-99607: medicine

CPT Category II

0001F – 9007F

CPT Category III

0042T - 0947T

CPT Appendix A Modifiers

-22 through -99

CPT Symbol: Red circle

new code

CPT Symbol: blue triangle

revised code

CPT Symbol: 2 green meeting triangles horizontally

contains new or revised text

CPT Symbol: black plus

add-on code

CPT Symbol: empty set or prohibition sign (circle with dash through middle)

modifier 51 exempt

CPT Symbol: lightning symbol

FDA approval pending

CPT Symbol: pound

resequenced code

CPT Symbol: star

telemedicine

CPT Symbol: reversed parentheses

duplicate PLA (proprietary laboratory analyses) test

New patient vs. established patient

new patient is one that hasn’t been seen face-to-face within 3 yrs

ICD-10-CM Ranges

1	A00-B99	Certain infectious and parasitic diseases
2	C00-D49	Neoplasms
3	D50-D89	Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
4	E00-E89	Endocrine, nutritional, and metabolic diseases
5	F01-F99	Mental, behavioral, and neurodevelopmental disorders
6	G00-G99	Diseases of the nervous system
7	H00-H59	Diseases of the eye and adnexa
8	H60-H95	Diseases of the ear and mastoid process
9	I00-I99	Diseases of the circulatory system
10	J00-J99	Diseases of the respiratory system
11	K00-K95	Diseases of the digestive system
12	L00-L99	Diseases of the skin and subcutaneous tissue
13	M00-M99	Diseases of the musculoskeletal system and connective tissue
14	N00-N99	Diseases of the genitourinary system
15	O00-O9A	Pregnancy, childbirth, and the puerperium
16	P00-P96	Certain conditions originating in the perinatal period
17	Q00-Q99	Congenital malformations, deformations, and chromosomal abnormalities
18	R00-R99	Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
19	S00-T88	Injury, poisoning, and certain other consequences of external causes
20	V00-Y99	External causes of morbidity
21	Z00-Z99	Factors influencing health status and contact with health services
22	U00-U85	Codes for special purposes

Acronym: I noticed big elephants marching nearby, eager cats racing dogs, small mice grabbing purple paper, and calm snakes imagining every happy scene.

ICD-10-CM Guideline Sections

• Section I: Conventions, General Coding Guidelines, and Chapter Specific Guidelines

• Section II: Selection of Principal Diagnosis

• Section III: Reporting Additional Diagnoses

• Section IV: Diagnostic Coding and Reporting Guidelines for Outpatient Services

NOS

not otherwise specified (aka unspecified)

NEC

not elsewhere classifiable (aka other specified)

CPT parentheses meaning

enclose nonessential modifiers or supplementary words

CPT brackets meaning

enclose a code assignment for a manifestation; identify need for additional code

Number 1 Rule for using ICD-10-CM coding manual

• find main term in alphabetical index first

• locate referred code in tabular section to confirm correct code

• 3-7 characters in length

7th ICD-10-CM value

• X - reports code to full extent (placeholder)

• S - sequela

• A - initial encounter

• D - subsequent encounter

HCPCS Level II Medicare Annual wellness visit Codes

G0438-G0429

HCPCS Level II Commercial Payers preventive medicine service codes

99381-99397

HCPCS Level II Categories of Codes

A-codes	transport services; medical and surgical supplies and administrative, miscellaneous, and investigational
B-codes	enteral and parenteral therapy
C-codes	CMS hospital outpatient payment system
D codes	dental procedures
E-codes	durable medical equipment
G-codes	temporary procedures and professional services
H-codes	behavioral health and/or substance abuse treatment services
J-codes	drugs
K-codes	temporary codes assigned to DME regional carriers
L-codes	orthotics and prosthetic
M-codes	other medical services
P-codes	laboratory services
Q-codes	temporary codes assigned by CMS
R-codes	diagnostic radiology services
S-codes	temporary national codes established by private payers
T-codes	temporary national codes established by Medicaid
U codes	coronavirus diagnostic panel
V-codes	vision and hearing services

acronym: smart engineers organized dull equipment, packed big delivery doors over little counters, rested more containers voluntarily.

fracture guidelines

if fracture is not reported as open/closed, assume closed when reporting code per ICD-10-CM guidelines