Contents
MEDICAL CODING FUNDAMENTALSCHAPTER 1: MEDICAL TERMINOLOGY, ANATOMY, AND PHYSIOLOGYWord ElementsRoot WordsCombining Vowels and Combining FormsPrefixesSuffixesEponyms, Abbreviations, and AcronymsEponymsAbbreviations and AcronymsAnatomy and PhysiologyIntegumentary SystemMusculoskeletal SystemCardiovascular SystemLymphatic SystemRespiratory SystemDigestive System Urinary SystemReproductive SystemNervous SystemEndocrine SystemHemic SystemICD-10-CM and Medical TerminologyPART I: ICD-9-CM AND ICD-10-CMThe Structure of the ICD-9-CM ManualUsing Volumes 1 and 2 to Determine Diagnosis CodesVolume 2: Alphabetic Index of Diseases Volume 1: Tabular List of DiseasesVolume 3: Tabular List and Alphabetic List for Procedure CodesICD-9-CM ConventionsAbbreviationsPunctuationUse Additional Code InstructionCode First Underlying Disease InstructionUpdate NotationsAdditional Digit Specificity IndicatorDiagnosis Code-Specific Color HighlightsAge Conflict EditsSex Conflict EditsHospital Acquired Condition (HAC) IndicatorOther and Unspecified Codes"See" and "See Also" InstructionsSigns and SymptomsCombination CodesOutpatient Coding PrinciplesSpecific Guidelines for Coding Outpatient EncountersCHAPTER 3: ICD-9-CM CHAPTER-SPECIFIC GUIDELINES, PART I: CHAPTERS 1-10Coding Diseases and Disorders, Chapters 1-3Chapter 1: Infectious and Parasitic Diseases (001-139)Chapter 2: Neoplasm (140-239)Chapter 3: Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders (240-279)Coding Diseases and Disorders, Chapters 4-6Chapter 4: Diseases of Blood and Blood-forming Organs (280-289)Chapter 5: Mental Disorders (290-319)Chapter 6: Diseases of Nervous System and Sense Organs (320-389)Coding Diseases, Chapters 7-8Chapter 7: Diseases of the Circulatory System (390-459)Chapter 8: Diseases of the Respiratory System (460-519)Coding Diseases, Chapters 9-10Chapter 9: Diseases of the Digestive System (520-579)Chapter 10: Diseases of the Genitourinary System (580-629)CHAPTER 4: ICD-9-CM CHAPTER-SPECIFIC GUIDELINES, PART II: CHAPTERS 11-19Coding Conditions and Complications of Pregnancy, Chapter 11Chapter 11: Pregnancy, Childbirth and the Puerperium (630-679)Coding Diseases, Chapters 12-13Chapter 12: Diseases of Skin and Subcutaneous Tissue (680-709)Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (710-739)Coding Abnormalities and Unusual Conditions, Chapters 14-17Chapter 14: Congenital Anomalies (740-750)Chapter 15: Certain Conditions Originating in the Perinatal Period (760-779)Chapter 16: Symptoms, Signs, and Ill-Defined Conditions (780-799)Chapter 17: Injury and Poisoning (800-999)V-Codes and E-Codes, Chapters 18-19Chapter 18: Supplemental Classification of Factors Influencing Health Status and Contact With Health Services (V01-V91)Chapter 19: Supplemental Classification of External Causes of Injury and Poisoning (E000-E030, E800-E999)Transitioning to the ICD-10-CM Coding SystemGeneral Equivalence MappingDiagnosis Code StructureLateralityTrimestersInitial Treatment, Subsequent Encounter and SequelaeStructure of the ICD-10-CM ManualICD-10-CM Conventions and General GuidelinesConventionsGeneral GuidelinesIntroduction to ICD-10-PCSBreakdown of SectionsPART II: CPT AND HCPCSStructure of the CPT ManualCode SectionsCode Format and Additional InformationIndented Code StructureSymbolsParenthetical NotesModifiersSeparate ProcedureOther Information Included in the CPT ManualIndexAppendicesIntroductory PagesInformation Listed Inside Front and Back CoversReporting Category II Codes and Using Category II ModifiersFormat of Category II CodesTypes of Category II Performance Measurement CodesReporting Category III CodesCHAPTER 7: MODIFIERSThe Function and Use of ModifiersServices Provided During the Global PeriodModifier 24Modifier 25Modifier 57Modifier 58Modifier 76 and 77Modifier 78Modifier 79Reporting Portions of a Procedure or ServiceProfessional and Technical ComponentsSurgical Procedure ComponentsReporting Multiple Services on the Same DateModifier 50Modifier 51Modifier 59Modifier 91Identifying Additional Providers Involved in ProceduresModifiers 80, 81, and 82Modifier 62Modifier 66Reporting Procedures Involving Significantly More or Less Work Than Is TypicalReporting Procedures Involving More Work Than TypicalReporting Procedures Involving Less Work Than TypicalReporting Mandatory Services, Physical Status and Genetic TestsMandatory ServicesPhysical Status Modifiers P1 through P6Genetic ModifiersHCPCS ModifiersAnatomical ModifiersAmbulance ModifiersEquipment ModifiersCHAPTER 8: EVALUATION AND MANAGEMENT SERVICES, PART I: STRUCTURE AND GUIDANCECategories and Subcategories of E/M ServicesSubcategories of E/M ServicesDefining Key Terms in E/M CodingNew vs. Established PatientChief ComplaintConcurrent Care and Transfer of CareCounselingFamily HistoryHistory of Present Illness (HPI)Nature of the Presenting ProblemPast HistoryReview of SystemsPhysical ExaminationMedical Decision MakingSocial HistoryTimeUnlisted ServicesSpecial ReportSelecting the Level of E/M ServiceWorking with HistoriesElements of HistoryThe Physical ExaminationThe Complexity of Medical Decision MakingSelecting the Correct Level of E/M ServicesDetermining Coding RequirementsSpecial SituationsCHAPTER 9: EVALUATION AND MANAGEMENT SERVICES, PART II: CODE SELECTIONOutpatient Services Coding for New or Established PatientsNew Patient (99201-99205)Established Patient (99211-99215)Categories and Suncategories of Hospital ServicesHospital Observation ServicesHospital Inpatient ServicesObservation or Inpatient Care Services (IncludinSubcategoriesnd Discharge)Hospital Discharge ServicesConsultation ServicesOffice or Other Outpatient Consultations (99241-99245)Inpatient Consultations (99251-99255)Emergency Department ServicesE/M Services for New or Established Patients (99281-99285)Other Emergency Services (99288)Reporting Critical Care ServicesServices Included in Critical CareReporting E/M Codes in Other SettingsNursing Facility ServicesDomiciliary, Rest Home (e.g., Boarding Home), or Custodial Care ServicesHome ServicesNew Patient (99341-99345)Established Patient (99347-99350)Prolonged Services and the Time FactorProlonged Physician Service with Direct Patient Contact (99354-99357)Prolonged Physician Service Without Direct Patient Contact (99358-99359)Physician Standby Services (99360)Case Management and Care Plan Oversight ServicesCase Management ServicesCare Plan Oversight ServicesPreventative Medicine ServicesNew Patient (99381-99387)Established Patient (99391-99397)Counseling Risk Factor Reduction and Behavior Change Intervention (99401-99412)Special E/M ServicesTelephone Services (99441-99443)Online Medical Evaluation (99444)Other Special E/M ServicesCoding E/M Services for Pediatric PatientsNewborn ServicesInpatient Neonatal Intensive Care and Pediatric/Neonatal Critical CareCHAPTER 10: ANESTHESIA SERVICESSelecting Anesthesia CPT Codes Based on the Surgical ProcedureAnesthesia Time UnitsSecondary Aspects of Anesthesia CodingPhysical Status ModifiersModifiers Identifying Professional Credentials of Anesthesia ProvidersModifiers Describing Reasons for Monitored Anesthesia Care (MAC)Qualifying Circumstances Add-on CodesCalculating Total Anesthesia UnitsSelecting Anatomy-Based Anesthesia CPT CodesHead (00100-00218)Neck (00300-00352)Thorax (Chest Wall and Shoulder Girdle) (00400-00474)Intrathoracic Region (00500-00580)Spine and Spinal Cords (00600-00670)Upper Abdomen (00700-00797)Lower Abdomen (00800-00882)Perineum (00902-00952)Pelvis (Except Hip) (01112-01190)Upper Leg (Except Knee) (01200-01274)Knee and Popliteal Area (01320-01444)Lower Leg (Below Knee, Includes Ankle and Foot) (01462-01522)Shoulder and Axilla (01610-01682)Upper Arm and Elbow (01710-01782)Forearm, Wrist and Hand (01810-01860)Coding for Specific ProceduresRadiological Procedures (01916-01936)Burn Excisions or Debridement (01951-01953)Obstetric Anesthesia (01958-01969)Other Procedures (01990-01999)CHAPTER 11: RADIOLOGY SERVICESPositions, Projections and PlanesReporting Radiology ServicesUnlisted CodesModifiersRadiology CPT CodingDiagnostic Radiology (Diagnostic Imaging) (70010-76499)Diagnostic Ultrasound (76506-76999)Radiologic Guidance (77001-77032)Mammography Services (77051-77059)Bone/Joint Studies (77071-77084)Radiation Oncology (77261-77799)Nuclear Medicine (78000-79999)CHAPTER 12: SURGICAL PROCEDURESIntroductionFollow-up CareMultiple Procedures and "Separate Procedures"Structure of the Surgical Section of the CPTModule 12.1 General and Integumentary SystemReporting Procedures of the Skin and Subcutaneous TissuesWound Repair (Closure)Skin Repair ProceduresDestruction of LesionsProcedures on the BreastAnesthesia Associated with Procedures on the Integumentary SystemModule ReviewModule 12.2 Musculoskeletal SystemMusculoskeletal System TreatmentsGeneral Codes and Codes Describing Procedures on the Head, Neck, Thorax, Back and FlankCodes Describing Procedures on the Back and Flank, Spinal Column and AbdomenCodes Describing Procedures on the Extremeties and JointsCasting, Strapping, Endoscopy and ArthroscopyAnesthesia Associated with Procedures on the Musculoskeletal SystemModule ReviewModule 12.3 Respiratory System; Cardiovascular System; Hemic and Lymphatic Systems; Mediastinum and DiaphragmProcedures on the Respiratory System (30000-32999)Procedures on the Heart and Pericardium (33010-33999)Procedures on the Arteries and Veins (34001-37799)Procedures on the Hemic and Lymphatic System, Mediastinum, and DiaphragmAnesthesia for Procedures in the 30000 SeriesModule ReviewModule 12.4 Digestive SystemProcedures on the Mouth and ThroatProcedures on the Gastrointestinal Tract from the Esophagus to the AnusProcedures on Organs Connected to the Digestive TractAnesthesia for Procedures in the 40000 SeriesModule ReviewModule 12.5 Urinary System, Male and Female Genital Systems, and Maternity Care and DeliveryProcedures on the Urinary System (50010-53899)Procedures on the Male Genital System (54000-55899)Procedures on the Female Genital System (56405-58999)Maternal Care and Delivery (59000-59899)Anesthesia for Procedures in the 50000 SeriesModule ReviewModule 12.6 Endocrine, Nervous, Ocular, and Auditory SystemsEndocrine System (60000-60699)Procedures on the Skill, Meninges, and Brain (61000-62258)Procedures on the Spine and Spinal Cord (62263-63746)Procedures on Extracranial Nerves, Peripheral Nerves and the Autonomic Nervous System (64400-64999)Procedures on Ocular StructuresProcedures on the Auditory System (69000-69979)Anesthesia for Procedures in the 60000 SeriesModule ReviewCHAPTER 13: PATHOLOGY AND LABORATORY SERVICESOrgan or Disease-Oriented Panels (80047-80076)Lab Tests Involving Drugs or MedicinesDrug Testing (80100-80104)Therapeutic Drug Assay (80150-80299)Evocative/Suppression Testing (80400-80440)Reporting Other Lab TestsConsultation (Clinical Pathology) (80500-80502)Urinalysis (81000-81099)Chemistry (82000-84999) Hematology and Coagulation (85002-85999)Immunology (86000-86849)Transfusion Medicine (86850-86899)Microbiology (87001-87999)Pathology ServicesAnatomic Pathology (88000-88099)Cytopathology (88104-88199) and Cytogenetic Studies (88230-88299)Surgical Pathology (88300-88399)In Vivo Laboratory Procedures (88720-88741)Reproductive Medicine Procedures (89250-89398)CHAPTER 14: MEDICINE SERVICESMedicine Chapter Structure and General GuidelinesMultiple ProceduresAdd-on CodesSeparate ProceduresUnlisted Service or ProcedureMaterials Supplied by PhysicianImmune Globulins; Immunization Administration for Vaccines/Toxoids; Vaccines, ToxoidsImmune Globulins (90281-90399)Immunization Administration for Vaccines/Toxoids (90460-90474)Vaccines, Toxoids (90476-90479)Psychiatry, Biofeedback, Dialysis, Gastroenterology, Ophthalomology, and Otorhinolaryngological ServicesPsychiatry (90801-90899)Biofeedback (90901 and 90911)Dialysis (90935-90999)Gastroenterology (91010-91299)Ophthalmology (92002-92499)Special Otorhinolaryngologic Services (92502-92700)Cardiovascular, Immunological, and Neurological ServicesCardiovascular (92950-93799)Noninvasive Vascular Diagnostic Studies (93875-93990)Pulmonary (94002-94799)Allergy and Clinical Immunology (95004-95199)Endocrinology (95250-95251)Neurology and Neuromuscular Procedures (95800-96020)Medical Genetics and Genetic Counseling Services (96040)Central Nervous System Assessments/Tests (96101-96125)Health and Behavior Assessment/Intervention (96150-96155)Injections and Infusions; Therapeutic Services; Rehabilitation; Moderate Sedation; Home Health and Medication Therapeutic Management ServicesHydration, Therapeutic Injections and Infusions, and ChemotherapyPhotodynamic Therapy (96567-96571)Special Dermatological Procedures (96900-96999)Physical Medicine and Rehabilitation (97001-97799)Medical Nutrition Management (97802-97804)Acupuncture (97810-97814)Osteopathic Manipulative Treatment (98925-98929)Chiropractic Manipulative Treatment (98940-98943)Education and Training for Patient Self-Management (98960-98962)Non-Face-to-Face Non-Physician Services (98966-98969)Special Services, Procedures and Reports (99000-99091)Qualifying Circumstances for Anesthesia (99100, 99116, 99135, and 99140)Moderate Sedation (99143-99150)Home Health Procedures/Services (99500-99602)Medication Therapy Management Services (99605-99607)CHAPTER 15: HCPCSHCPCS CodesFunctions of HCPCS CodesUses of HCPCS CodesIndex and Tabular List of ServicesCalculating Multiple Units of ServiceIdentifying Services Described by Each Category of HCPCS CodesHCPCS A, B, C, D, and E CodesA Codes: Transportation Services Including Ambulance; Medical & Surgical Supplies; Administrative, Miscellaneous & InvestigationalB Codes: Enteral and Parenteral TherapyC Codes: Outpatient HCPCS CodesE Codes: Durable Medical EquipmentHCPCS G, H, J, K, L, and M CodesG Codes: Procedures/Professional Services (Temporary); Physician's Voluntary Reporting Program Codes; Last Minute AdditionsH Codes: Alcohol and Drug Abuse Treatment ServicesJ Codes: Drug Administered Other than Oral MethodK Codes: Temporary CodesL Codes: Orthotic and Prosthetic Procedures (L0112-L9900)Other Medical ServicesHCPCS P, Q, R, S, T, and V CodesP Codes: Pathology and Laboratory Services (P2028-P9615)Q Codes: Miscellaneous Services (Temporary)R Codes: Diagnostic Radiology ServicesS Codes: Temporary National Codes (Non-Medicare)T Codes: National T Codes Established for State Medicaid Agencies (T1000-T5999)V Codes: Vision Services, Hearing Services & Speech-Language Pathology ServicesHCPCS Modifiers and HCPCS Manual AppendicesAnatomic ModifiersDME and Other Equipment ModifiersRadiology ModifiersPlace of Service ModifierAppendicesPART III: PRACTICUMCoding Scenarios
