Medicine List Book I – Flashcards
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Analyze the format of the Medicine section
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Medicine Chapter Topics Format Introduction to Immunizations Psychiatry Biofeedback Dialysis Gastroenterology Ophthalmology Special Otorhinolaryngologic Services Cardiovascular Pulmonary Allergy and Clinical Immunology Endocrinology Neurology and Neuromuscular Procedures Central Nervous System Assessments/Tests Health and Behavior Assessment/Intervention Hydration Chemotherapy Administration Photodynamic Therapy Learning Objectives After completing this chapter you should be able to 1
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Report psychiatric services
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Identify biofeedback services
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List components of dialysis reporting
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Demonstrate ability to report gastrointestinal services
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Understand ophthalmology and otorhinolaryngologic reporting
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Report cardiovascular services
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Identify services reported with pulmonary codes
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List the important elements of coding allergy and clinical immunology services
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Report endocrine services
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Define neurology and neuromuscular services
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Demonstrate an understanding of central nervous system assessment and intervention
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Analyze chemotherapy services
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13
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Report special services and dermatologic procedures
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14
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Code physical medicine and rehabilitation services
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15
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Report active wound management
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Define osteopathic and chiropractic services
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Understand non-face-to-face services
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Code special services, procedures, and reports
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Report medical services using Medicine section codes
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Special Dermatological Procedures Physical Medicine and Rehabilitation Medical Nutrition Therapy Osteopathic Manipulative Treatment (OMT) Chiropractic Manipulative Treatment (CMT) Non-Face-to-Face Nonphysician Services Special Services, Procedures, and Reports Other Services and Procedures Home Health Procedures/ Services Medication Therapy Management Services Chapter Review Quick Check Answers The Medicine section (90281-99607) reports diagnostic and therapeutic services that are generally noninvasive (not entering a body cavity), but there are also invasive (entering a body cavity) procedures in the section, such as cardiac catheterization
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The section begins with Subsection Information and Guidelines applicable to all of the Medicine section codes, such as Add-on Codes, Separate Procedures, Unlisted Service/Procedure, Special Report, and Supplied Materials
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The various subsections of Medicine contain many specific notes to be applied with a certain group of codes, so be certain to read all notes that pertain to the group of codes with which you are working
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FORMAT Take a moment now to review the Medicine section in the CPT manual to have an overview of the subsections
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Many specialized types of tests are located in the Medicine section (e
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, biofeedback, audiologic function tests, electrocardiograms)
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Codes in this section do not usually include the supplies used in the testing, therapy, or diagnostic treatments unless specifically stated in the code description or guidelines
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You report supplies, including drugs, separately unless otherwise instructed in the code information
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CPT code 99070 is the supplies and materials code used to identify the supplying of drugs, trays, supplies, or materials needed to provide the service or the specific HCPCS supply code, which is usually what the payer will require
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For example, Fig
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30-1 illustrates the code for the service of a prescription for corneal contact lenses (also known as contacts, see Fig
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30-2) for both eyes (92310)
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When the lenses and the prescription services are provided, both the lenses and the prescription service are reported
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The supply of contact lenses may be reported as part of the service of fitting or reported separately using the appropriate HCPCS Level II supply code (V2500-V2599)
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Reporting the supply of the lens depends on the third-party payer guidelines
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INTRODUCTION TO IMMUNIZATIONS There are two types of immunization—active and passive
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Active immunization is the type given when it is anticipated that the person will be in contact with the disease
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Active immunization agents can be toxoids or vaccines
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Toxoids are bacteria that have been made nontoxic and when injected, produce an immune response that builds protection against a disease
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Vaccines are viruses that are given in small doses and cause an immune response
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Passive immunization does not cause an immune response
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rather, the injected material contains a high level of antibodies against a disease (e
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, rabies, hepatitis B, tetanus), called immune globulins
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The first three subsections in the Medicine section are: Immune Globulins, Serum or Recombinant Products Immunization Administration for Vaccines/Toxoids Vaccines, Toxoids The immune globulins (90281-90399) are passive immunization agents obtained from pooled human plasma that is immune to a particular disease
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The codes in this subsection identify only the immune globulin product and must be reported with the appropriate administration code (96365-96368, 96372, 96374, or 96375 as appropriate)
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Type of immune globulin (rabies, hepatitis B, etc
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Codes in the Immune Globulins subsection are categorized according to the: n
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Method of injection (IM, IV, SC, etc
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) n
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Type of dose (full dose, mini-dose, etc
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) n
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) The Immunization Administration subsection codes (90460-90474) are reported in conjunction with the Vaccines, Toxoids subsection codes (90476-90749)
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Immunization reporting requires two codes: one to report the administration and one to report the substance administered
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A variety of administration methods are utilized to deliver the vaccine/ toxoid: percutaneous, intradermal, subcutaneous, intramuscular, intranasal, or oral
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The administration codes are divided based on the method of administration and in some codes, the patient age, when administered with physician counseling
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Report each dose administered—single or combination with the appropriate administration code
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Codes 90460-90461 report immunization administration for patients through age 18 and for which counseling has been provided to the patient's family regarding the vaccine/toxoid
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Report 90460 for each vaccine administered
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For vaccines with multiple components (combined vaccines), report 90460 in conjunction with 90461 for each additional component in the vaccine
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Codes 90471-90474 report immunizations at which the physician did NOT provide counseling for patients of any age, including patients through age 18
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For example, you can report multiple administrations by reporting 90471 for the first administration and then reporting 90472 for each administration after the first
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Or you can report the first administration with 90471, as you would usually do, and then report 90472 times the number of injections after the first one
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CMS RULES Medicare reimburses for tetanus injections (90703 [tetanus, age 7>, IM]) when given for an acute injury to a person who is incompletely immunized
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When a tetanus booster is given to a patient in the absence of an injury, the injection (90703) is not covered by Medicare
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Vaccines, Toxoids The Vaccines, Toxoids subsection codes (90476-90749) report vaccine products for immunizations
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The subsection contains many codes for a single disease (e
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, 90703 for tetanus toxoid) as well as codes for a combination of diseases (e
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, 90700 for diphtheria, tetanus, and acellular pertussis [DTaP])
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In many of the code descriptions, specific ages are identified
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For example, 90658, trivalent (3 viruses) influenza virus vaccine, specifies age 3 and above, whereas code 90657, trivalent influenza virus vaccine, specifies ages 6 to 35 months
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Vaccines have pediatric or adult listed on the label of the vial
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You must carefully review the description of the vaccine product to determine which disease is specified in the code you are assigning
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When one code is available to describe multiple products given, the combination code must be assigned
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If each vaccine were to be listed separately when a combination vaccine was administered, it would be considered unbundling
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CMS RULES When reporting an adult dose of a pneumococcal vaccine (90732) to Medicare, the pneumococcal administration code is G0009 with a diagnosis code of Z23/V03
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82 (prophylactic vaccination, streptococcus pneumoniae)
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Once Medicare has assigned a HCPCS Level II administration code for a vaccine, the CPT administration code is not accepted
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There are often multiple codes available for variations of the product
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CAUTION
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For example, there are eight codes with combinations of diphtheria
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Read all descriptions carefully before assigning a code
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There are codes with schedules for a vaccine, such as a three-dose or four-dose schedule
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For example, 90634 is a two-dose hepatitis A vaccine that is intended to be administered on a two-dose schedule
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Each time the vaccine is administered, 90634 is reported along with the date of the injection
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The term "schedule" refers to the number of doses provided and the timing of the administration
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The doses and timing must be exactly as specified in the code
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The CPT Guidelines state that modifier -51 (multiple procedures) should not be reported for the vaccines/toxoids when performed with administration procedures
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Most payers want you to report the administration codes multiple times or use the "times" symbol (3) to indicate the number of injections given
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If a patient is given a vaccine in the course of an E/M service, the administration and Vaccines/Toxoids codes are assigned in addition to the E/M code
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Some third-party payers require a -25 modifier on the E/M code, so be certain to check with your local payer on how to submit the E/M code
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CODING SHOT If the only service is administration of a vaccine and no other service was provided, do not report an E/M service
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90657 Influenza virus vaccine, trivalent, split virus, when administered to children 6-35 months of age, for intramuscular use 90658 Influenza virus vaccine, trivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use REPORT ADMINISTRATION OF INFLUENZA VACCINE: HCPCS G0008 Administration of influenza vaccine (Medicare only) CPT 90471 Immunization administration, one vaccine 90472 Immunization administration, each additional vaccine CPT PNEUMOCOCCAL VACCINE CODE: 90732 Pneumococcal polysaccharide vaccine, 23-valent, 2 years of age and older, for subcutaneous or intramuscular use REPORT ADMINISTRATION OF PNEUMOCOCCAL VACCINE: HCPCS G0009 Administration of pneumococcal vaccine (Medicare only) CPT 90471 Immunization administration, one vaccine 90472 Immunization administration, each additional vaccine CMS RULES If a Medicare patient receives reasonable and necessary services constituting an office visit level of service, the physician may bill for the office visit, the vaccine and the administration of the vaccine
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CPT INFLUENZA VACCINE CODES: CPT
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Do not report 99211 instead of the administration service when only the administration is performed
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Hepatitis B vaccines and the administration are available to Medicare beneficiaries who are at high or intermediate risk of contracting hepatitis B
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Diagnosis code Z23/V05
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3 (prophylactic vaccination against viral hepatitis) must be submitted to demonstrate the medical necessity
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The administration code for Medicare is G0010 (administration of hepatitis B vaccine) and for other payers the administration is 90471
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CODING SHOT The diagnosis codes Z23/V03-V06 report the need for a prophylactic (preventative) vaccination or inoculation
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These codes can be located in the Index of the ICD-10-CM/ICD-9-CM manual under the main term "Vaccination
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" PSYCHIATRY The Psychiatry subsection (90785-90899) has a lengthy note under the heading detailing the use of psychiatric codes
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If psychiatric treatments are rendered on the same day as E/M services, both the E/M service and the psychiatric treatment are reported with one code from the Psychiatry subsection
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For example, if a patient is admitted to the hospital with a drug overdose secondary to depression, and the physician spends 60 minutes in crisis psychotherapy with the patient several hours after he was admitted to the hospital, services are reported with 90839 (Other Psychotherapy) for the psychiatric treatment and medical evaluation/management on the same day
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Code 90839 includes the development of orders, the review and interpretation of laboratory work or other diagnostic studies, and the review of therapy reports and other information from the medical record
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If the psychiatric treatment is provided on a different day than the E/M service, a code from the E/M section would be reported in addition to the psychiatry code
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You will work closely with third-party payers to determine any specific regional instructions for coding psychiatric services
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Partial hospitalization refers to a hospital setting in which the patients are in the hospital during the day and return to their homes in the evenings and on weekends
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The facilities may be open only during the day, 5 days a week, although there are also facilities that are open 7 days a week
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When a physician admits a patient to a partial hospital facility, the physician is responsible for preparing all of the admission paperwork that is prepared for admission to an acute care hospital
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E/M Initial Hospital Care and Subsequent Hospital Care codes (99221-99233) report inpatient stays
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The psychiatric services the physician provides to the patient are listed separately unless the E/M service and psychiatric service are provided on the same day
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These same-day services are reported with codes from the Psychiatry subsection
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Specific descriptions of services included in each of the codes appear in the Psychiatry subsection
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Some codes reflect evaluation or diagnostic services, such as CPT code 90791 (diagnostic evaluation)
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some reflect therapeutic procedures, such as 90832 (psychotherapy)
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and still others, located in the Central Nervous System Assessments/Tests, report psychological testing, such as code 96101 (psychological testing, per hour)
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A psychiatrist is a physician who specializes in psychiatry
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A psychologist is not a physician but is a qualified specialist in psychiatry
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States have varying regulations about how a psychologist reports services provided, and some states require a psychologist to provide and report services only under the supervision of a psychiatrist
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Third-party payers may also restrict the types of service a psychologist may report for reimbursement
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Time is the major billing factor in the Psychiatry subsection
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Diagnostic and therapeutic time must be documented in the patient's record to provide accurate billing
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Codes 90791 and 90792, psychiatric diagnostic evaluation and comprehensive psychiatric service, are described as the elicitation (gathering) of a complete medical (including past, family, social) and psychiatric history, establishment of a tentative diagnosis, and an evaluation of the patient's ability and willingness to work to solve the mental problem
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This service includes a complete mental status exam
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Information may be obtained from the patient, other physicians, and/or family
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There may be overlapping of the medical and psychiatric history depending on the problem
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An E/M service may be substituted for the initial interview procedure, including consultation codes (99241-99245), provided the required elements of the E/M service are provided
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Consultation services require, in addition to the history and examination, a written report of the consultation's opinion or advice
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Consultation does not include psychiatric treatment
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Psychotherapy is the therapeutic treatment of a psychological disorder or behavior and is reported with codes 90832-90838
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The codes are time- based (30, 45, or 60 minutes) and subdivided based on if the psychotherapy was provided in addition to another primary procedure
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The medical record must identify the time spent providing the psychotherapy service
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If the time spent providing the service is not recorded on the medical record, the physician should be queried
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If no time can be identified, report the service with an E/M code, not a Psychotherapy code
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The psychotherapy service may be provided to a patient and/or the patient's family member
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Crisis psychotherapy (90839, 90840) provides treatment to a patient experiencing a reaction to a more specific event or situation
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For example, a drug overdose, attempted suicide, or an episode of severe depression
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Crisis psychotherapy focuses on the immediate assessment and treatment of the patient in a crisis and is not intended to treat chronic psychological conditions
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Some patients receive psychotherapy only and others receive psychotherapy and medical E/M services
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E/M services involve a variety of responsibilities unique to the medical management of psychiatric patients, such as medical diagnostic evaluation, drug management when indicated, physician orders, interpretation of laboratory or other medical diagnostic studies and observations, review of activity therapy reports, the supervision of nursing and ancillary personnel, and scheduling of hospital resources for diagnosis and treatment, and leadership or direction of a treatment team
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The medical record must indicate the time spent in the psychotherapy encounter and the therapeutic maneuvers, such as behavior modification, supportive interactions, and interpretation of unconscious motivation, that were applied to produce the therapeutic change
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The medical record should document the symptoms, the goals of therapy, and the methods of monitoring the outcome
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It should also document why the chosen therapy is the appropriate treatment modality either instead of or in addition to another form of psychiatric treatment
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Biofeedback is the process of giving a person self-information
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BIOFEEDBACK
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The information can be used by patients to gain control over physiologic processes, such as blood pressure, heart rate, or pain
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Patients are trained to use biofeedback by a professional and then continue the use of the therapy on their own
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Biofeedback training is often incorporated in individual psychophysiologic therapy
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When biofeedback is part of the individual psychophysiologic therapy, one code is reported for both the biofeedback training and the individual psychophysiologic therapy (90875-90876)
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Biofeedback codes (90901, 90911) are located in the CPT manual index under the main terms "Training" and "Biofeedback
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" DIALYSIS Dialysis is the cleansing of the blood of waste products when it is not possible for the body to perform the cleansing function adequately on its own
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Dialysis may be temporary, as in the case of a patient who has acute renal failure from which he or she recovers, or permanent, as in the case of a patient with end- stage renal disease (ESRD) who will not recover without a kidney transplant
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The Dialysis subsection of the Medicine section (90935-90999) is divided into types of dialysis (see Table 30-1)
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Hemodialysis Hemodialysis is the routing of blood and its waste products to the outside of the body where it is filtered
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After the blood is cleansed, it is returned to the body
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Hemodialysis codes (90935 and 90937) are reported for each day the service is provided
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The codes in the hemodialysis category are based on the number of times the physician evaluates the patient during the procedure
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Peritoneal Dialysis Peritoneal dialysis (90945, 90947) involves using the peritoneal cavity as a filter
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Dialysis fluid is introduced into the cavity and left there for several hours so cleansing can take place (Fig
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30-3)
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The dialysis fluid is then drained from the peritoneal cavity
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Peritoneal dialysis is reported on the basis of each day the service is provided
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Some patients learn how to perform dialysis for themselves
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Dialysis teaching codes are located under Other Dialysis Procedures
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End Stage Renal Disease The subheading (End Stage Renal Disease Services) deals with dialysis of an ongoing nature
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The 90951-90966 codes reflect all services included in treating a patient with ESRD and are listed according to patient age (e
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, younger than 2 years of age, 2-11 years of age) and number of visits (1, 2-3, 41) per month
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Dialysis services are reported as a monthly fee
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For those cases in which a patient may be, for example, visiting the area and will not require a full month of dialysis, daily fees may be reported using codes 90967-90970 in the ESRD category
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Few third-party payers allow E/M codes to be reported in addition to dialysis service codes
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Most payers consider the dialysis codes to be bundled to include all the treatment necessary for a patient with renal disease, including the E/M services
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To report a separate E/M service, the condition would have to be unrelated to the renal condition, and modifier -25 must be added to the E/M code
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The diagnosis code reported would also indicate that the E/M service was unrelated to the ESRD service
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Dialysis is usually performed in an outpatient setting at a hospital or other outpatient dialysis facility (Fig
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30-4)
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The physician services are reported based on the type of dialysis the patient is receiving, the complexity of the service, and the number of visits the physician provides to the patient
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The reporting of just one code covers all physician visits to the dialysis laboratory during that month
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During a physician's visit to the dialysis laboratory, the physician assesses the patient while the patient is receiving dialysis
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The monthly services also include nutrition assessment and telephone calls
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Dialysis patients must sometimes be admitted to the hospital and while in the hospital must continue to receive dialysis treatments
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When the physician assesses the inpatient while the patient is undergoing dialysis, report 90935 (single visit) or 90937 (multiple visits)
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Code 90937 may include a significant revision of the dialysis prescription
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If a hospitalized patient receiving peritoneal dialysis is assessed by the physician, the physician services are reported with 90945 (single visit) and 90947 (multiple visits)
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Code 90947 may also include a significant revision of the dialysis prescription
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Modifier -26 is not used on these codes, as the code descriptions describe only the physician service to the dialysis patient
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TYPES OF DIALYSIS The codes to report physician services for patients with end-stage renal disease are located in the 90951-90970 range
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Codes 90951-90962 report a full month of physician service that includes monitoring the nutritional needs of the patient, assessing the status of the patient, and counseling
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The monthly services are reported based on the age of the patient and number of face-to-face visits that occurred during the month
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Visits per Month Code 2 4+ 90951 2-3 90952 1 90953 2-11 4+ 90954 2-3 90955 1 90956 12-19 4+ 90957 2-3 90958 1 90959 20+ 4+ 90960 2-3 90961 1 90962 If the physician provides the same evaluation and management to a patient receiving home dialysis, the monthly service is reported based on the age of the patient
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Age
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Code 2 90963 2-11 90964 12-19 90965 20+ 90966 If the physician provides these same services for less than a total month, the services are also reported based on the age of the patient
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Age
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Code 2 90967 2-11 90968 12-19 90969 20+ 90970 Dialysis solution Solution flowing in Catheter Peritoneal cavity Solution draining out Drained solution When a patient does not receive a full month of dialysis in the outpatient setting because of a kidney transplant, relocation, or death, report the number of days the patient had dialysis
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Age
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For example, a 50-year-old patient receives peritoneal dialysis from March 1 through 10
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On March 11, the patient receives a kidney transplant
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The 10 days of service are reported with 90970 x 10
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"Dialysis" is the main term to be referenced in the CPT manual index
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The Gastroenterology subsection (91013-91299) contains many types of tests and treatments that are performed on the esophagus, stomach, and intestine
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GASTROENTEROLOGY
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Several intubation codes are listed in the Gastroenterology subsection
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You must carefully review the code descriptions to determine which services are bundled into the code
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The notes located at the beginning of the Ophthalmology subsection (92002-92499) describe the services included in the various types of ophthalmologic services
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OPHTHALMOLOGY
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Ophthalmology is a very specialized field and ophthalmologists treat patients for a variety of diseases and injuries
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Often the services provided and documented do not adequately fall into an E/M definition
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Therefore, the AMA developed specialized codes that deal specifically with ophthalmology services
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There are extensive subsection notes that are required reading before you code in the subsection
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The notes explain the levels of service and present excellent examples to clarify the assignment of the codes
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The general ophthalmologic services (e
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, routine yearly eye examinations) are located in the subheading General Ophthalmological Services
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The codes in this subsection are based on whether the patient is a new or an established patient and on the complexity of service provided
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There are two levels of service (intermediate and comprehensive)
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Of special note are the definitions of new and established patients
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The definitions of the terms "new" and "established" patient are the same as those used in the E/M section
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You will recall that those definitions are as follows: New patient: One who has not received professional service from the physician, or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past 3 years
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Established patient: One who has received professional services from the physician, or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past 3 years
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The subheading Special Ophthalmological Services contains bilateral codes
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Each service in this subheading is performed on both eyes, and the codes do not require a modifier to indicate that two eyes were examined or tested
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In fact, should you need to report only one eye from these codes, you add modifier -52 to indicate a reduced service
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It is a good idea to make a note next to the codes that are bilateral in the CPT manual and also to make a note of modifier -52, to reduce the service if it was performed for only one eye
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Special Ophthalmological Service codes are those services that are not normally performed in a general eye examination
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Services in this group are performed for medically indicated reasons
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For example, an ophthalmological examination under general anesthesia with manipulation of the globe of the eye to determine the range of motion (92018)
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The definitions of the codes are very comprehensive in detailing the services involved with each code
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Other codes that are located in the Ophthalmology subsection under the subheading Spectacle Services report the provision of materials to the patient (e
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, spectacles, contact lenses, or ocular prostheses)
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The refraction that is performed to determine the lens prescription may be reported separately, depending on the policies set by third-party payers
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The decision to assign an ophthalmology code or an E/M code is determined by the service provided
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The ophthalmology codes have specific notes prior to code 92002 that serve as a guideline for an intermediate or comprehensive service
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Documentation should include the chief complaint, history, and general medical examination
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External examination, ophthalmoscopy, and biomicroscopy n Visual acuity (clarity of vision) n Basic sensorimotor examination (tests sensory and motor coordination) n Confrontation visual fields (peripheral vision) n Tonometry (intraocular pressure) n Evaluation of complete visual system n May include mydriasis (excess dilation of pupil) for ophthalmoscopy n Initiation of diagnosis and treatment programs An intermediate ophthalmological service (92002, 92012) describes an evaluation of a new or existing condition complicated with a new diagnosis or management problem not necessarily relating to the primary diagnosis
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Testing may include the following types of measures: n
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A comprehensive service (92004, 92014) describes a general evaluation of the complete visual system (Fig
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30-5)
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The comprehensive services constitute a single service that may be performed at different sessions but is reported only once
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The initiation of a diagnostic and treatment program includes the prescription of medication and arranging for special ophthalmological diagnostic or treatment services, consultations, laboratory procedures, and radiological services
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the ears, nose, and larynx
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SPECIAL OTORHINOLARYN-GOLOGIC SERVICES The services in this subsection (92502-92700) are special tests or studies of
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Audiology (hearing) testing is also located in the Special Otorhinolaryngologic Services subsection
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An audiology test may be performed by a physician or an audiologist trained in this area
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Otorhinolaryngologic diagnostic and treatment services are usually reported using codes from the Surgery section
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Special services are reported using the otorhinolaryngologic codes from the Medicine section
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For example, a nasopharyngoscopy with endoscopy provided during an office visit would be reported with 92511 (nasopharyngoscopy with endoscopy, the procedure) and a code from the E/M section for the office visit (with modifier -25)
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The Cardiovascular subsection is discussed in Chapter 21, but there are also some services that are reported with Medicine codes that you have not reviewed yet
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CARDIOVASCULAR
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Let's take a closer look at these services
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Under this heading you will find invasive and noninvasive cardiovascular service codes (92920-92998), such as cardiopulmonary resuscitation (CPR) and cardioversion (changing [converting] an abnormal heart rhythm to a normal one)
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Therapeutic Services
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Percutaneous transluminal coronary angioplasty (PTCA) codes 92920 and 92921 are also located here
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The femoral or brachial artery is usually accessed and a catheter with a balloon tip is threaded up to the heart, into the coronary artery
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The balloon is inflated in the area of occlusion and the occlusive material is pressed back, thereby widening the vessel
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Cardiography (93000-93278), Implantable and Wearable Cardiac Device Evaluations (93279-93299), and Echocardiography (93303-93352) were reviewed in Chapter 21 of this text
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Cardiac Catheterization Codes 93451-93568 report cardiac catheterization, which is a diagnostic medical procedure performed on the heart
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Cardiac Catheterization codes were also reviewed in Chapter 21 of this text
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The right side of the heart may be accessed by entering the right femoral vein and advancing through the inferior vena cava or entering the basilic vein in the arm and advancing through the superior vena cava
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Right heart catheters are used to measure and record right atrial, right ventricular, pulmonary artery, and pulmonary capillary wedge pressures
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Right-sided pressure measurements help diagnose congestive heart failure and right-sided valve disease
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The left side of the heart is approached through the arterial system
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Access is commonly through the right femoral artery and advancing through the ascending aorta, the aortic valve, and into the left ventricle
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A left heart catheterization will help to diagnose coronary artery disease, left ventricular dysfunction, and valve disease
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Noninvasive Vascular Diagnostic Studies The codes in this subsection (93880-93990) report procedures that are conducted to study veins and arteries other than the heart and great vessels
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These studies use the same devices as are used in heart and great-vessel echocardiography, except that the divisions are based on the location of the vein or artery being studied
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Catheter entrance Superior vena cava Femoral artery Catheter entrance PULMONARY Codes in the Pulmonary subsection (94002-94799) report therapies, such as nebulizer treatments, incentive spirometry (illustrated in Fig
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30-7), and diagnostic tests, such as pulmonary function tests
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A nebulizer (Fig
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30-8) is a device that produces a spray, which is inhaled
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it is used to treat patients with, for example, asthma
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Pulmonary function tests monitor the function of the pulmonary system and examine the lung capacity of patients with, for example, emphysema
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In most cases, several pulmonary function tests are performed together
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The data are then compiled, and a diagnosis is made
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Several indicators must be present from a variety of tests, and those tests must be performed many times and produce the same result each time for the results to be considered conclusive
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In most cases, each type of test is reported separately, unless it is specifically stated otherwise in the code description
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CODING SHOT Add -26 to the code when reporting only the physician interpretation of the test if the physician does not own the testing equipment
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ALLERGY CLINICAL AND IMMUNOLOGY Read the notes that appear at the beginning of the Allergy and Clinical Immunology subsection (95004-95199)
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The subsection is divided into three parts
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The first is Allergy Testing, which describes allergy testing by various methods (percutaneous, intracutaneous, inhalation) and the type of tests (allergenic extracts, venoms, biologicals, food)
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The number of tests must always be specified for reporting purposes because for most of these codes, payment is made per test
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Allergy testing consists of the performance, evaluation, and interpretation of allergens placed under the skin
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The testing should be based on a complete history and physical examination of the patient and correlated with signs and symptoms related to the presence of possible allergy diagnoses during allergy testing (95004-95071)
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The second subheading is Ingestion Challenge Testing (95076-95079)
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Code 95076 reports the initial 120 minutes of testing time and 95079 reports each additional 60 minutes
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The third subheading is Allergen Immunotherapy and the codes specify three types of services: Injection only, prescription and injection, provision of antigen only
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All the codes in Allergen Immunotherapy have specific notes that you must read to know whether the code is for injection, prescription and injection, or antigen only
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For example, code 95115 reports the injection of antigen only and does not include the extract, but code 95120 reports the prescription, extract, and injection
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So careful reading of the descriptions is a necessity
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The professional service necessary to provide the immunotherapy is bundled into the code, so an office visit code would not usually be reported
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If the physician provided another identifiable service at the time of the immunotherapy, an office visit may be reported
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But for the patient who has only the injection, prescription, antigen, or any combination of these three, the codes already contain the professional service
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Allergen Immunotherapy is the repeated administration of allergens to patients for the purpose of providing protection against the allergic symptoms and reactions associated with exposure to these allergens
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Immunotherapy (hyposensitization) may extend over a period of months, usually on an increasing dosage scale
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This is followed by a build-up of tolerance to the antigen (as evidenced by the higher doses that can be administered) and a decline in the symptoms and medication requirements
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Indications for allergen immunotherapy are determined by diagnostic testing appropriate to the individual needs of each patient and his/her clinical history of allergic diseases
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ENDOCRINOLOGY This subsection contains only codes used to report glucose monitoring (95250, 95251)
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Continuous glucose monitoring is a procedure in which a probe is inserted subcutaneously and attached to a monitor that is worn by the patient
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The monitor records the glucose level for a 72-hour period at which time the probe is removed and the data are downloaded from the monitor
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The patient records his or her insulin administration, meals, exercise, and any hypoglycemic events during the monitoring period, in addition to performing the usual finger stick glucose four times a day during the 3-day period
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The service includes the initial hookup, calibration of the monitor, patient training, recording, and downloading of data with printout of results
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NEUROLOGY AND NEUROMUSCULAR PROCEDURES There are codes in the Neurology and Neuromuscular Procedures (95800- 96020) subsection for sleep testing, muscle testing (electromyography), range of motion measurements (Fig
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30-9), cerebral seizure monitoring, and a variety of neurologic function tests
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The codes in this subsection are usually reported by physicians who specialize in neurology (neurologists)
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Sleep studies in newborns are performed by pediatric pulmonologists
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A neurologist usually is a consultant to a physician who is seeking the advice and input of another physician concerning a patient with suspected neurologic problems
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One of the specialized tests conducted in the neurology specialty area is sleep studies (95800-95811)
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Sleep studies are the monitoring of a patient's sleep for 6 or more hours
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The studies include the tracing (technical component) and the physician's review, interpretation, and report (professional component)
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If a physician performs only the professional component, modifier -26 is reported
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Sleep studies diagnose various sleep disorders and measure a patient's response to therapy
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An electroencephalogram (EEG) is a procedure that records changes in brain waves
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Polysomnography (Fig
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30-10) is the measurement of the brain waves during sleep but with the added feature of recording the various stages of sleep (i
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e
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, excited, relaxed, drowsy, asleep, or deep sleep)
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During each of these stages, the rate and amplitude (height) of the brain waves are measured and compared with normal ranges
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Certain neurologic conditions may be identified by the degree to which brain waves vary from normal ranges
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Nerve conduction tests (95905-95913) are usually performed in conjunction with conventional motor nerve conduction studies of the same nerve and may include F-wave studies
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F-wave studies assess motor nerve function along the entire extent of that nerve
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An impulse generated at the stimulating electrode travels up the motor nerves to the motor neuron cell bodies in the spinal cord
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The impulse then travels down the same motor nerves to the neuromuscular junction, and then to the muscle
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Codes 95907-95913 are to be reported for each nerve tested, regardless of the number of stimulation sites along the sensory or motor nerve being tested
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For a given patient, multiple motor or sensory nerve conduction codes may be assigned if multiple motor or sensory nerves are tested
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Appendix J of the CPT manual lists the specific nerves tested for codes 95905-95913
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Codes 95905-95913 report both sensory and motor nerve conduction studies with or without F-wave study and includes the interpretation and report
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Code 95905 reports motor and/or sensory nerve conduction using preconfigured electrodes that have been customized to specific anatomic sites
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Parameters are what are being measured during a sleep test
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For example, parameters include the measurement of snoring or blood pressure
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The number of parameters measured is listed in the code description
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The patient's medical record will contain the parameters, or measurements, recorded during the test
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To report sleep tests accurately, you must know the parameters and stages of testing
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Additionally, many codes include a time component (such as 95803)
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so it is important to have the duration of the test stated in the medical record
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Electromyographic (EMG) studies use needles and electric current to stimulate nerves and record the results
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Assessments of dysphasia, developmental testing, neurobehavior status, and neuropsychological test codes are also located in this subsection
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CENTRAL NERVOUS SYSTEM ASSESSMENTS/TESTS The Central Nervous System Assessments/Tests codes (96101-96125) identify psychological testing, speech/language (aphasia) assessment, developmental progress assessments, and thinking/reasoning status examination (neurobehavioral)
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Except for the basic developmental testing, the codes are defined on a per-hour basis
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The results of all the tests are to be developed into a report that is included in the patient record
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HEALTH AND BEHAVIOR ASSESSMENT/ INTERVENTION The codes in this subsection (96150-96155) do not report preventive medicine services, nor do they report psychiatric treatments
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Instead, these codes report assessment and/or intervention for behavioral, emotional, social, psychological, or knowledge factors that are affecting the patient's health
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Examples of assessments are clinical interview, behavior observation, and questionnaires
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Examples of interventions are individual, group, or family sessions
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All services are based on 15-minute increments
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These services are not performed by a physician
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If these services are performed by a physician they are reported with E/M codes
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HYDRATION Codes 96360 and 96361 report hydration services
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The physician's work related to these services usually involves oversight of the treatment plan and staff supervision
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When the physician provides a significant separately identifiable E/M service, report the service with an appropriate E/M service reporting modifier -25
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Modifier -25 must be added to the E/M code or the service will be assumed to be related to the physician's service for the hydration, injection, or infusion service
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Bundled into the hydration services are local anesthesia, placing the intravenous line, accessing an indwelling access line/catheter/port, flushing at the end of the infusion, and all standard supplies
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Codes 96360 and 96361 report intravenous hydration infusions that include the prepackaged fluid and electrolytes
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If other than a prepackaged substance is used, that substance would be reported separately
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Saline is not reported separately unless given alone for hydration
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If the drugs are mixed into the saline, then only the drug is reported and the saline is bundled into the cost of the drug and not reported separately
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Included in these hydration codes are the physician supervision and oversight of the staff providing the service
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Code 96360 reports 31 minutes to 1 hour of intravenous infusion hydration service and 96361, the add-on code, reports each additional hour
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You can only report 96361 if the service is at least 31 minutes over the 1 hour that was reported with 96360
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Time under 31 minutes is not reported
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Therapeutic, Prophylactic, and Diagnostic Injections and Infusions Codes 96365-96379 report the administration of therapeutic, prophylactic, or diagnostic intravenous infusion or injection
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Intravenous infusions are reported with 96365-96368 and are divided based on the time and type of infusion
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The initial infusion is reported with 96365 (up to 1 hour), and each additional hour (over 30 minutes) is reported with 96366
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Sometimes one infusion is provided followed by another infusion with a different medication (sequential infusions), in which case the initial infusion is listed first and the sequential infusion (add-on code 96367) is listed second
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There are times when more than one infusion is provided at the same time, which is a concurrent infusion
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A concurrent infusion is when there is one site and two lines infusing at the same time
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Report the initial infusion first and then the concurrent infusion (96368)
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answer
Subcutaneous infusions are reported with codes 96369-96371
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Initial set up and first hour are reported with 96369
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Each additional hour is reported with 96370
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Additional set up for a new infusion site is reported with 96371
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To report therapeutic, prophylactic, and diagnostic injections (96372-96376), the physician must be present
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Note that add-on code 96376 can only be reported when the service is provided in a facility
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Therapeutic, prophylactic, and diagnostic injections are divided based on the method used for the administration (Fig
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30-11)
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Subcutaneous and intramuscular injections are reported with 96372 in addition to a code to report the substance injected
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answer
For example, if the injection was a subcutaneous human rabies immune globulin, report 90375 for the substance and 96372 for the administration
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answer
The administration codes for vaccines/toxoids are reported with 90460/90461 or 90471-90474
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answer
Code 96372 is not used to report chemotherapy administration (see 96401-96549)
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Injections for allergen immunotherapy are reported with 95115/95117, not with therapeutic, prophylactic, or diagnostic injection codes
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Intra-arterial (96373) and intravenous push (96374/96375/96376) are reported with therapeutic, prophylactic, and diagnostic injection codes
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CHEMOTHERAPY ADMINISTRATION Chemotherapy codes 96401-96549 report a variety of chemotherapy services
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answer
The Injection and Intravenous Infusion Chemotherapy codes (96401-96417) report subcutaneous/intramuscular, intralesional, and intravenous chemotherapy
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Intra-Arterial Chemotherapy codes (96420- 96425) report various forms of chemotherapy administered via the arteries
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answer
Other Injection and Infusion Services codes (96440-96549) report other types of chemotherapy, such as pleural (96440), peritoneal via an indwelling port (96446), and central nervous system (96450), in addition to refilling/ maintenance of portable or implantable pumps or reservoirs (96521, 96522)
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There are two other sets of codes used to report chemotherapy services: Hydration (96360-96361) and Therapeutic, Prophylactic, and Diagnostic Injections and Infusions (96365-96379), which you learned about earlier in this chapter
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In addition to these CPT codes, HCPCS "J" codes report the substances injected or infused
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Included (not reported separately) with chemotherapy infusion or injection codes 96401-96549 are the following: 1
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Use of local anesthesia 2
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IV start 3
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Access to indwelling intravenous, subcutaneous catheter, or port 4
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Flush at the conclusion of infusion 5
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Standard tubing, syringes, and supplies 6
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answer
Preparation of the chemotherapy agent(s) If other services are provided, they may be reported separately
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answer
The initial intravenous infusion (the treatment) is reported with 96365 and each additional hour of infusion, up to 8 hours, is reported with 96366
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answer
If a sequential (one after another) intravenous therapy is provided, the service is reported with 96367
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answer
When a concurrent (at the same time as another) intravenous therapy is provided the service is reported with 96368
question
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answer
A concurrent infusion is one in which multiple infusions are provided through the same intravenous line
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A concurrent infusion can be billed only once per patient encounter
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answer
If more than one substance is placed in the one bag, it is considered one infusate and one infusion
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You would report one administration code and a Level II HCPCS J code for each substance or drug
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answer
Any administration that is 15 minutes or less is considered a push, not an infusion
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answer
The administration of an initial or single intravenous push is reported with 96374 and each additional push is reported with 96375
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answer
Report only one push per drug
question
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answer
For example, if a patient is given a push of morphine 2 mg at the beginning of a service and morphine 2 mg later in the service, bill one administration code for the two IV pushes of morphine
question
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answer
The appropriate units of the J code (J2270—morphine up to 10 mg 3 1) would also be billed for the total dose
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answer
If two drugs are mixed in the same bag and administered for 15 minutes or less, the service is reported with the appropriate push CPT code (initial or subsequent) 3 1 unit
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answer
The drug(s) or substance would be separately reported with the appropriate J code based on the amount and type
question
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answer
A patient will often receive hydration and ancillary medications before or after chemotherapy
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answer
Only one initial administration code can be reported for each encounter
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answer
other services are reported with secondary or subsequent codes
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answer
Modifier -59 should be reported to indicate that hydration was provided prior to or following chemotherapy
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answer
Hydration provided at the same time as chemotherapy to facilitate drug delivery is not reported separately
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answer
All infusions must have a documented start and stop time
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answer
The patient may also receive medications before and/or after chemotherapy, such as anti-nausea medications
question
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answer
These medications are reported in addition to the chemotherapy because chemotherapy is always the primary service
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answer
When the patient receives multiple intravenous infusions of medications and these medications are administered individually, each is reported separately
question
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answer
but if the medications are mixed together and given in one infusion, they are reported as one infusion
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answer
Code 96375 is an add-on code and is only reported with another code, such as 96413, Chemotherapy administration
question
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answer
The charges for the patients in the examples that follow would list the chemotherapy administration first, followed by the other service codes since the chemotherapy is the primary service
question
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answer
If the medications are all mixed together and administered in one infusion of less than 15 minutes, the J codes are reported along with 96375 3 1
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answer
Example A patient presents for a chemotherapy session and is given a 40-minute hydration prior to chemotherapy reported with 96361
question
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answer
If the patient receives hydration before and after chemotherapy, calculate the entire time of hydration infusion and code the appropriate number of units for 96361
question
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answer
For example, a patient received 1 hour of hydration before chemotherapy and 40 minutes of hydration after chemotherapy
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The total hydration time is 100 minutes
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answer
Code 96361 3 2 units
question
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answer
Example After chemotherapy, a patient received Aloxi (J2469), Benadryl (J1200), and Decadron (J1100) in three separate infusions of less than 15 minutes (pushes)
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answer
The J codes are reported along with 96375 3 3
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answer
Example A patient presents for chemotherapy and receives two pushes, one of Aloxi, 0
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answer
25 mg, and one of Benadryl, 50 mg
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answer
Chemotherapy with Rituximab, 100 mg, is administered for 3 hours by means of an intravenous infusion
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answer
After therapy, the patient is administered Decadron, 1 mg, by intravenous push
question
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answer
The services are reported as follows: Pre- and post-medications: 96375 3 3 (three total IV pushes)
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answer
J2469 (Aloxi) 3 10 units
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answer
J1200 (Benadryl) 3 1 unit
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answer
and J1100 (Decadron) 3 1 unit
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answer
NOTE: 1 unit of Aloxi 5 25 mcg
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answer
therefore, 0
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answer
25 mg 5 250 mcg 5 10 units
question
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answer
Chemotherapy: 96413 (initial hour)
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answer
96415 3 2 (2 additional hours)
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answer
J9310 3 1 (Rituximab)
question
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answer
Chemotherapy is the initial infusion and the hydration and pushes are secondary/subsequent
question
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answer
If a significant identifiable office visit service was provided in addition to the chemotherapy administration, report that service with an E/M code, adding -25 to indicate the service was separate and significant
question
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answer
CODING SHOT Chemotherapy administration codes (96401-96459) include the use of local anesthesia, initiating the intravenous therapy, access to an indwelling port, flush at conclusion, tubing/supplies/ syringes, and preparation of the chemotherapy agent(s)
question
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answer
These services are not reported separately
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answer
PHOTODYNAMIC THERAPY The photodynamic therapy services (96570-96571) are add-on codes reported in conjunction with the bronchoscopy or endoscopy services
question
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answer
An agent is injected into the patient that remains in cancerous cells longer than in the normal cells
question
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answer
After the agent has dissipated from the normal cells, the patient is exposed to laser light
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answer
The agent absorbs the light and the light produces oxygen, destroying the cancerous cells
question
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answer
Codes for endoscopic application are divided on the basis of time—the first 30 minutes and each additional 15 minutes
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answer
External application of light (96567) is based on each exposure session
question
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answer
SPECIAL DERMATOLOGICAL PROCEDURES The dermatology codes (96900-96999) are usually reported by a dermatologist who provides services to a patient in an office on a consultation basis
question
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answer
The dermatology codes for special procedures would typically be reported in addition to an E/M code, for example, if a patient is referred by his family physician to a dermatologist for treatment of acne
question
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answer
The dermatologist conducts a history and examination and treats the patient with ultraviolet light (actinotherapy)
question
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answer
The reporting would be an Office or Other Outpatient code, depending on the level of service provided, and 96900 to report the actinotherapy
question
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answer
PHYSICAL MEDICINE AND REHABILITATION The codes in the Physical Medicine and Rehabilitation subsection (97001- 97799) are reported by a physician or therapist
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answer
The subsection includes codes for different modalities of treatments (e
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answer
g
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answer
, traction, whirlpool, electrical stimulation) as well as various types of patient training (e
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answer
g
question
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answer
, functional activities, gait training, massage)
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answer
The codes are reported on the basis of time or treatment area, as stated in the description of the code
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answer
Codes are divided by supervision or constant attendance
question
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answer
Unit coding (i
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answer
e
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answer
, 32, 33) is necessary if the time spent administering the treatment exceeds the time listed in the code
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Prosthetic training, each 15 minutes CODING SHOT An orthotic is a support, splint, or brace used to align a body part, such as an elbow brace (L3700-L3766)
answer
Example Reporting for patient's prosthetic training of 60 minutes would be: 97761 x 4
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answer
A prosthetic is a replacement, such as a breast prosthesis (L8000-L8039)
question
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answer
All services provided by independent physical therapists and occupational therapists require a written referral from a physician that includes documentation of the disease or injury being treated and the diagnosis
question
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The services are rendered according to a written treatment plan determined by the provider after an appropriate assessment of the illness or injury
question
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answer
All providers rendering therapy must document the appropriate history, examination, diagnosis, related physician orders, therapy goals and potential for achievement, any contraindications, functional assessment, type of treatment, the body areas to be treated, the date that therapy initiated, and expected frequency and duration of treatments
question
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answer
This documentation must be maintained in the patient's medical record
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answer
Documentation should indicate the prognosis for restoration of function and the medical necessity of the treatment
question
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answer
Physical therapy test and measurement codes are listed by the type of testing and the time the testing requires
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answer
The type of test would be such as functional capacity
question
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answer
Note the use of type and time in the following CPT code
question
Physical performance test or measurement (e
answer
Example 97750
question
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answer
g
question
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answer
, musculoskeletal, functional capacity, with written report, each 15 minutes) CODING SHOT For all codes that are time based, the time must be documented in the patient's medical record
question
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answer
The codes in Physical Medicine and Rehabilitation are reported for physical medicine and therapy as well as for other rehabilitation, for example, community/work reintegration (97537)
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answer
Active Wound Care Management Nonphysician personnel perform the procedures described in Active Wound Care Management codes (97597-97606)
question
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answer
Codes 97597 and 97598 report debridement services by means of high pressure waterjets, scissors, scalpels, or forceps based on the first 20 sq cm or less (97597) and each additional 20 sq cm or part thereof (97598)
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answer
The codes are not reported with or to replace the surgical debridement represented by 11042-11047
question
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answer
If a physician performed the procedures, the services would be reported with the 11042-11047 codes
question
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answer
Wound management codes are based on nonselective or negative pressure procedures
question
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answer
Nonselective debridement is that in which healthy tissue is removed along with necrotic tissue
question
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answer
The tissue is gradually loosened with water (hydrotherapy)
question
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answer
Loosened tissue may be cut away with sharp instruments
question
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answer
Nonselective debridement is usually done over the course of several visits
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Negative Pressure Wound Therapy (NPWT, 97605, 97606), as illustrated in Figs
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30-12 and 30-13, may include vacuuming the drainage and tissue from the wound area, application of topical medications or ointments, assessment of the wound, and directions to the patient for continued care of the wound
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Choice of codes is dependent on the square centimeters treated
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MEDICAL NUTRITION THERAPY These codes (97802-97804) are reported by non-physician personnel for medical nutritional therapy assessment (NTA) or intervention
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If a physician provides the service, the service is reported using E/M codes or Preventive Medicine codes
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The codes report face-to-face services with the patient based on time of 15 minutes for initial or re-assessments and 30 minutes for group assessments
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The provider would review the patient's medical record, including the history of present illness and past medical history, along with pertinent laboratory data
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The nutritional history would be obtained from the patient and an appropriate examination would be conducted
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Documentation would indicate the nutritional assessment and prescription recommended to the patient and this information would be communicated to the health care provider
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OSTEOPATHIC MANIPULATIVE TREATMENT (OMT) Osteopathic manipulative treatment (98925-98929) is a form of manual treatment applied by a physician to eliminate or alleviate somatic (body) dysfunction and related disorders
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The codes are listed according to body regions
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These body regions are the head
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cervical, thoracic, lumbar, sacral, and pelvic regions
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lower extremities
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upper extremities
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rib cage
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abdomen and viscera region
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Codes are separated on the basis of the number of body regions treated
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These codes are usually reported by osteopathic physicians (doctors of osteopathy, DO)
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CHIROPRACTIC MANIPULATIVE TREATMENT (CMT) The Chiropractic Manipulative Treatment subsection (98940-98943) is divided by the number of regions manipulated
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For this subsection, the spine is divided into five regions (cervical, thoracic, lumbar, sacral, and pelvic), and the extraspinal regions are divided into five regions (head, lower extremities, upper extremities, rib cage, and abdomen)
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Chiropractic manipulation is the manipulation of the spinal column and other structures
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Each of the codes in the Chiropractic Manipulative Treatment subsection has a professional assessment bundled into the code
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An office visit code is reported only if the patient had a significant separately identifiable service provided
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otherwise, the service of the office visit is bundled into the code
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NON-FACE-TO-FACE NON-PHYSICIAN SERVICES This subsection is divided into Telephone Services (98966-98968) and On-Line Medical Evaluation (98969) services provided by qualified health care professionals
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The notes and the code descriptions for these codes indicate that the telephone or online service cannot originate from a related assessment that was provided within the previous 7 days or result in an appointment within the next 24 hours or the soonest available appointment
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The telephone services are reported based on the documented time, and the online service is per incident
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SPECIAL SERVICES, PROCEDURES, AND REPORTS Special Services, Procedures, and Reports (99000-99091) is a miscellaneous subsection that includes codes for services that are not reported with codes from other sections
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The codes report services that are, for example, rendered at unusual hours of the day or on holidays
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These codes are considered adjunct codes and are to be reported in addition to the codes for the major service
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For example, if a physician goes to the office on a Sunday to meet an established patient and provide urgent, but not emergency, service, the E/M service code for the office visit would be reported in addition to 99050 to indicate the unusual time at which the service was provided
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An often reported code is 99024 for an office visit provided during a global period
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Third-party payers do not reimburse for the submission of this code
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however, it communicates that the service was provided to the patient during the follow-period of a previous surgical procedure
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You have assigned 99070, supplies, from this subsection before
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One of the big advantages of the HCPCS coding system is that you specifically identify the supply reported rather than the more general 99070
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For example, you may report 99070 for a body sock for a patient
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With the HCPCS coding system, you can specify the body sock with a code L0984
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It is best to use HCPCS codes when reporting supplies since most third-party payers will request additional information when 99070 is submitted
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The subsection also contains codes for medical testimony, the completion of complicated reports, education services, unusual travel, and supplies
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Although this subsection is small, it contains codes that are reported often
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Take a few minutes to become familiar with the codes listed within Special Services, Procedures, and Reports and mark the subsection for future use
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The codes for Special Services are located in the CPT manual index under the main term "Special Services
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" Qualifying Circumstances for Anesthesia
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Anesthesia is discussed in Chapter 16
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Moderate Sedation
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Sedation reported with 99143-99150 is discussed in Chapter 16
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OTHER SERVICES AND PROCEDURES A wide variety of codes (99170-99199) is located in this subsection of the Medicine section
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For example, you will find codes for anogenital examination with a colposcope of a child in a case of suspected trauma, visual function screenings, pumping poison from the stomach, and therapeutic phlebotomy treatments
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Because the codes are so varied, the way in which they are divided is also varied
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For example, the code range 99190-99192 is divided on the basis of time, whereas other codes are divided according to the extent of the service
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HOME HEALTH PROCEDURES/ SERVICES These codes (99500-99602) report non-physician services provided at the patient's residence
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The residence may be an assisted living apartment, custodial care facility, group home, or other nontraditional residence
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The codes are divided based on the reason for the service (e
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g
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, injection, hemodialysis)
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Home Infusion Procedures Services The codes 99601 and 99602 represent services of administration of a variety of therapies (e
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g
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, nutrition, chemotherapy, pain management)
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The services are provided by non-physician allied health professionals
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Codes are divided based on the time spent providing the infusion
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MEDICATION THERAPY MANAGEMENT SERVICES These codes (99605-99607) are for patient assessments and interventions by a pharmacist, upon request
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These codes do not describe the product- specific information that a pharmacist would ordinarily provide to a patient regarding a medication
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but rather to assist in the management of treatment- related medication complications or interactions
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The codes are reported by the pharmacist based on the patient status (new or established) and the time spent in assessment and intervention
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STEP BY STEP BOOK I COMPLETED
