MEDICINE SYNOPSIS(9 series)
IMMUNO GLOBULINS
Immunoglobulins are used to increase the immunity of the patients
Coding rule:
Two sets of codes are always required
1. Administration codes(they explain the method of injection inside the body
like, IV,IM etc)
Immunoglobulin codes(they explain how much of immunoglobulin or what
immunoglobulin is injected inside the body)
2. Do not use mod 51 with these codes
3. EX: Patient is given tetanus immunoglobulin byIMinjection.
a. 96365,90389
b. 96372, 90389
c. 90389
d. 96369,90389
VACCINATION:
Vaccinations are given to increase the immunity of common people.
Three types of vaccinesare mentioned:
1.MultiValent vaccine(trivalent, pentavalent)
2.Component vaccine(MMR, MMRV, DTaP- multiply the code for every
component present in the same vaccine when provided with counseling. When
provided without counseling the vaccine is not multiplied for every component)
3.Combination vaccine (DTaP-IPV- this has 4 components- multiply the
components when given with counseling . Do not multiply the comopnents
when done without counseling)
Coding rule:
Two sets of codes are always required:
1. Administration codes(they explain the method of injection like IV,IM
and also indicate with counseling or without counseling)
Vaccine codes(they explain the name of the vaccine )
2. Do not use mod 51 with these codes
3. If a significant EM is done along with vaccination , use EM code with
modifier 25(to show it is significantly done from the vaccination service)
EX: EM-25, adminstration code, vaccine code
EX: The child is a 5 year old established patient (99393-Em code) coming
for a regular preventive services . The physician performs the history and
examination and counseling. During the same visit the child is given a
Typhoid vaccine by oral method( 90690 vaccine code and 90460 admin
code) .
1. EX. 1 If DTaP vaccineis given to 3 year old child with counseling by IM
method. Find the code
a. 90460,90700
b. 90460,90461x2, 90700
c. 90471,90678
d. 90460,90461,90700-51
2. Ex.2 If DTaPis given to 3 year old child without counseling by IM method
a. 90471, 90472x2, 90700
b. 90460,90461x2, 90700
c. 90471,90700
d. 90473, 90700-51
3. EX: A child is presenting for polio vaccine, DTap- vaccine by IM method.
Counseling is provided to mother. Find the code
a. 90460,90675,90713-51
b. 90460x2,90461x2, 90675,90713
c. 90471, 90472, 90675,90713
d. 90471, 90675, 90713
4. EX: 5 year child is presenting for polio vaccine and rabies vaccine by IM
method. Find the code
a. 90460,90461, 90675,90713
b. 90471,90472,90675,90713
c. 90471,90675,90713-51
d. 90675,90713
5. EX: Child of 6 yrs is coming for a MMR vaccine by SC and DT vaccine by
IM method. Counseling is given to the parents.
a. 90471,90472x3, 90707, 90702
b. 90471x90707,90702
c. 90460x2, 90461x3,90707,90702
d. 90460, 90461x4,90707,90702
6. EX:AChild is coming for a regular check up at age 4. The child is new to the
hospital . The physician collects history and performs an examination
withcounseling. The child is also given influenza trivalent vaccine live by
intra nasal method.
a. 99382-25(EM) , 90460, 90660-51
b. 99382-25(EM), 90473, 90660
c. 99382-25(EM),90471,90660
d. 90460, 90660
7. EX:A Child is coming for a regular check up at age 4. The child is new to the
hospital . The physician checks the child and counseling provided to
parents. The child is also given influenza trivalent vaccine live by intra
nasal method.
e. 99382-25(EM) , 90460, 90660
f. 99382-25(EM), 90473, 90660
g. 99382-25(EM),90460,90660
h. 90460, 90660
PSYCHIATRY CODES
Diagnostic codes:
1. These codes are used for finding the problem of the patient
2. Code them once per day
3. Do not report diagnostic codes with EM codes on the same day
Psychotherapy codes :
1. These are treatment codes for mental illness, based on
timing. Refer the time range from the paragraph.
2. All the main codes are given for psychotherapyservice only.
3. All the add on codes are given for psychotherapy service done along with Em
service. So EM will be the primary code and medicine psychotherapy codes are
add on codes.
4. Example: 45 mins of psychotherapy is given to the patient
(90837/90834/90836)
5.Example: patient is given an Em with problem focused history, problem focused
exam,straight forward decision making in the OP along with 24 mins of
psychotherapy.
a. 90832
b. 99201(EM code),90833
c. 90833
d. 99201(EM code),90832
Interactive complexity codes
This is anadd on code. They are used additionally with diagnosticcodes or
psychotherapy codes, when there is a problem in interacting with the patient.
Example: patient is given diagnostic evaluation and doctor is finding
diffficulty to interact with the patient because of the repeated questions, so
spends additional time. Find the code
a. 90791
b. 90792
c. 90791, 90785
d. 90792,90785
Psychotherapy crisis
1. These codes are used when patient is assesed on urgent basis
2. The minimum timing to use crisis code is 30mins
3. If crisis procedure is done less than 30 minsuse only normal psychotherapy
codes and not the crisis codes.
4. use the main code 90839 for 74 mins
5. use the add on code 90840 for additional mins after 74 mins
6. Ex. Patient is given 65 mins of psychotherapy crisis treatment
a. 90839,90840
b.90839
c.90832
d.90837
7. Ex. Patient is given 20 mins of psychotherapy crisis treatment
a.90839
b.90832
c.90834
d.90833
Dialysis:
1. Hemodialysis: This service is given to patient in IP withESRD and NESRD
conditions or in OP with only NESRD conditions.
All EM related to dialysis is included .If EM is donesignificantly for another
condition use EM codewith modifier 25.
The codes are based on evaluation and re-evaluation services
2. Peritoneal dialysis/hemofiltration /continuous renal replacement
therapy:
All related EM included. If separate significantly of another condition use
with modifier 25.
The codes are based on evaluation and re-evaluation.
ESRD:
1. 90951-90962 for OP ESRD services on monthly basis(complete
assessment).
This has a complete assessment done.
2. 90963-90966 for home ESRD monthly service basis(complete assessment).
3. 90967-90970 forESRD per day service(multiply the codes according to the
number of days)
Per day codes are chosen for the following reason:
The patients without complete assessment
dialysis stopped due to death / recover / transplant
4. EX: Patient is 45 year old and taking OP ESRD service with complete
assessment for a month with 3 face to facevisit(90960/90966/90961)
5. EX: Patient is 30 year old ,taking home monthly ESRD service with
complete assessment (90962/90966/90970)
6. EX: Patient is 50 year oldtaking 4 days of ESRD services in the OP. There is
no complete assessment done for the patient
(90962x4/90966x4/90970x4)
OPTHALMOLOGY:
1. Patient can either come for :
General service orSpecial service
Routine opthalmoscope is always a part of general or special service
General service is further divided into intermediate service and
comprehensive service.
2. Intermediate service means
Patient is evaluated for new or existing problem with complication or
management of problem unrelated to primary diagnosis
Other terms, refer to the paragraph
3. Comprehensive service means
General evaluation of complete visual system. For detail definition refer
the paragraph
4. Special service means:Special evaluation of the part of the visual system is
done. These codes can be used in addition to General and EM service.
5. Artificial eye prescription, fitting and adaptation is given by Em
6. Contact lens service:It includes power,size,curvature,flexibility,gas
permeability,training, incidental revision. But follow up of the contact
service is coded from general services.
7. Spectacles: These codes include anatomy measurement of face,lab
specification,final adjustment of spectacles.These services do not require a
physician or qualified health care professional.
Percutaneous coronary artery Intervention(PCI)
1. Choose codes according to the number of arteries .
2. If multiple procedures are done in the same artery choose a singlecode,
which includes all the procedures( combined code).
3. Check the paragraph for major artery and branch artery list
4. Modifiers like RT-right side, LT-left side, RC-right coronary, LD- left
descending artery will be used to indicate the artery name and side
5. Base codes : main artery
6. Base codes and add on codes: main artery , branch
7. Example: Patient is having an angioplasty, stent and arthrectomyin the left
anterior descending artery
a. 92920,92921
b. 92928
c. 92928,92929
d. 92933
8. Example: Patient is having angioplasty in the left anterior descending(LD)
and stent in right coronary artery (RC) (both are major)artery
a. 92920,92921
b. 92920
c. 92928
d. 92920-LD, 92928-RC
9. Example: Patient undergoes stent in the left coronary artery
a. 92933
b. 92928, 92921
c. 92928
d. 92941
10.Example: Patient has angioplasty in left anterior descending and first
diagnonalartery .
a. 92928,92929
b. 92920,92921
c. 92933,92934
d. 92924,92929
ECG:
1. Global codes :
93000 , 93015 ,93040 areglobal codes(tracing, supervision ,interpretation
and report included in a single code )
These codes should be used only in the office /clinic of the doctor.
2. Independent codes :
The subcategory codes are for independent services provided by the
doctor in the hospital.
The subcategory codes can be combined if the doctor provides two
services to the patient in the hospital.
3. Global codes and independent codes do not require modifier 26
But SAECG code(93278) needs modifier 26 for supervision and
interpretation
4. Example1 : patient is seen in the office , where the doctor does tracing,
supervision and interpretation of the ECG(93000/93000-26/93010)
Example2 : patient is seen in the hospital, where the cardiologist supervises
and interprets an stress test ( 93015/93016/ 93016,93018)
Cardiovascular monitoring codes
93224 -93227 codes are used upto 48 hrs
If less than 12 hrs, then we use modifier 52 with the codes
If more than 48 hrs use 3rd category codes
Implantable and wearable devices
1. All 90 days codes need minimum of 30 days.
2. All 30 days codes need minimum of 10 days
ECHO:
1. The Echo codes are of two types Transthoracic andTransesophageal
2. Use modifier 26 for supervision and interpretation services.
Cardiac catherisation:
1. There are two families of catherisation
congenital(injection service excluded)
non congenital(injection service included)
2. They are further divided into Right, left and combined heart catherisation.
Follow the table of catherisationfor easy coding
3. Example: Patient is 45 year old undergoes both right and left of
catherisation with injection to left ventriculography and aortography. The
physician also performs supervision, interpretation and report.
93455/93457/93453
Transcatheter closureof paravalvular leak(PVL):
1. Paravalvular leak happens in patients with implanted mechanical valve. Blood
flows between the valve and the cardiac tissue because lack of sealing.
2. The codes include :fluoroscopy,Transeptal puncture, supravalvular
aortography and left heartcath and ventriculograpy
3. The codes exclude: transapical and Diagnostic cardiac catherisation codes.
The diagnostic cardiac cath can be separately reported with modifier 59.
Electrophysiological procedure(EPS):
1. EPS service is given for arrhythmia(irregular rhythm) patients
2. Few codes are meant for recording of the heart and next few for pacing of
the heart
3. Codes 93619 and 63620 is used for bundled services of recording and
pacing of the heart
4. use the bundle code if only all the services listed in the bundle code is done
on the patient.
5. If only few components done use individual recording and pacing codes.
6. Modifier 51 is not used with codes which has a symbol of a circle with a bar.
Home and outpatient INR service
1. Warfarinaanticoagulant is given as a management to the patient.
2. 93792 can be coded with EM with modifier 25
3. 93793 cannot be coded with EM.
.Extremity arterial study:
1. 93922(1-2 levels) is limited bilateral upper or lower extremity study
Use 93922 with modifier 52 for unilateral service of upper or lower
extremity study
Use 93922, 93922-59 for bilateral upper and lower extremity study
2. 93923(3 or more levels) is for complete upper or lower extremity study.
Use 93922(1-2 levels) for complete unilateral study of upper or lower
extremity even though 3 or more levels are studied.( no modifier 52 used
here)
Use 93923, 93923-59 is for both complete upper and lower extremity study
3. Example: Patient undergoes limited unilateral upper extremity
study-----------------------
4. Example: Patient undergoes limited bilateral upper and lower extremity
study in the same session----------------------------------
5. Example: Patient undergoes complete unilateral study in one lower
extremity-------------------------
Pulmonary:
1.94640: pressurized inhalation for less then 1 hour. The service can be repeated
on the same day Using the modifier 76.
EX: 30 mins of inhalation to the patient . The same service is repeated again in
the evening
94640,94640-76
2.94644,94645: continuous inhalation for one hour and more.
EX: 2 hrs of inhalation therapy to the patient .
94644,94645
3.Example: A child given 20 mins of inhalation in the morning and 30 mins
in the evening
a. 94644
b.94640
c.94644,94645
d.94640,94640-76
4.Example: A child is given 3 hrs of inhalation with aerosol
a.94640
b.94644,94645
c.94640,94640-76
d.94644,94645x2
Allergy testing:
1.Allergy testing codes are based on the method like percutaneous, intacutanoes,
inhalation etc
2.Multiply the codes according to the number of test done on the patient
3.Example: The child is tested for dog and cat fur bypercutaneous method
a.95017
b.95024
c.95004
d.95004x2
Ingestion challenge testing
1.for 60 mins and less use Em code
2.61 mins and more use medicine code
3.Example: In the OP patient is taking a ingestion challenge test and the results
are positive by 50 mins. Find the code?
4. Example: In the OP the patient is taking a challenge test which last for 70 mins .
Find the code?
Sleep medicine:
a. All sleep medicine codes are time based. Use the codes with modifier 52 if
performed with lesser timing.
EEG:
Routine EEG: 20 t0 40 mins
Extended EEG: longer than 40 mins
Longterm EEG: find the code from the table based on timing
EMG:
1. EMG codes are based on the number of extremities studied.
2. The add on code when done bilaterally is used two time( modifier 50 is not
used here)
Nerve study:
1. The codes are based on the number of studies on the nerves.
2. To know the nerve names (motor,sensory and mixed)included within the
codes refer the appendix J
Neurostimulaor analysis and programming:
1. Implantation and removal of neurostimulator is a surgical code.
2. Analysis and programming are medicine codes.
3. Programming means adjusting the parameters.
4. The examples of parameters are: contact groups, interleaving, amplitude,
pulse width, frequency, cycling, magnet mode, dose lockout, patient
selectable parameter, responsive, detection, close loop, passive
parameters.
Hydration(only saline is given to the patient)
1. 0-30 mins of service is not coded
2. 31 mins to 1 hr use the code 96930
3. The add on code 96361 is reported for service beyond 31 mins
4. Example: 20 mins of hydration----------------------
5. Example: 1 hour ---------------------------
6. Example: 1 hour and 30mins--------------------------------------------
7. Example :1 hr and 45 mins of hydration-----------------------------
8. Example :3 hrs of hydration---------------------------------
Therapeutic hydration(drugs are given as hydration)
1. Sequential hydration l: the drugs are given one after the other
2. Concurrent hydration : the drugs are given simultaneously to the patient
Chemotherapy
1. This is divided into IA(intra arterial) and IV(intra venous) push
2. Push means the service is 15 mins are less and a health care professionalis
always present throughout the service.
Photodynamic Therapy:
1. These services includes debridement.(skin chapter codes)
2. The addon code 96570 and 96571 are coded with surgical bronchoscopy
codes
3. Less then 23 mins of service use 96570 with 52
4. For first 23-37 mins of service use 96570
5. 38-52 mins of service use 96570, 96571
6. Example: patient is given bronchoscopicphotodynamic treatment of
45mins for the treatment of tumor.
a.97567
a.31641,96570,96571
b.43299,96570
c.96570,96571
7. Example: Patient is taking external photodynamic treatment by physician for a
day
a. 96570
b.96571
c.96567
d.96573
Rehabilitation codes
1. This topic includes PT(physical therapy)/OT(occupational therapy)/Athletic
training
2. The therapist will do History, exam and decision making within their levels
3. The codes are based on the level of evaluations done by the therapist
4. Do not use modifier 51 with these codes.
5. Example: An occupational therapist visit the patients home and performs a
moderate evaluation(97166/97162)
6. Example: patient has severe pain on right knee. He receives 15mins of
contrast treatment and 15 mins of ultrasound on the same day
a. 97034,97035-51
b. 97035
c. 97034,97035
d. 97036
Active Wound care management:
1. These codes include chemical cauterization. (skin chapter codes)
2. Skin level debridement are coded from medicine, where as deeper
levels(subcutaneous, muscle and bone) are coded from surgery skin
chapter.
3. Do not report medicine and skin chapter codes of debridement for the
same wound.
4. Example: The patient has skin level debridemnt in the forearm of 5 cm
andand a muscle level debridement in the leg of 7 cm.
a. 97597
b. 97597, 11043
c. 97602, 11043
d. 97602
5. Example : The patient has a wound in the left thigh. The physician makes a
incison on the thigh cleans the skin and the subcutaneous area of 4 cm
a. 97602
b. 97597
c. 11042
d. 97597,11042
OMT-osteopathic manipulative:
1. These codes are used for somatic dysfunction.
2. The body region are divided into head,cervical,thoracic, lumbar, sacral,
pelvic, lower extremity,upper extremity, rib, abdomen and viscera.
3. If EM is done significantly report EM with modifier 25
4. Example: patient is treated for head , lumbar and sacral region.
a.98925
b.98925
c.98941
d.98940
CMT: Chriopractic Manipulative
1. These codes are used for joint and neurophysiologic function
2. The body regions are divided into spinal and extra spinal regions
3. Spinal Region: cervical, thoracic, lumbar, sacral, pelvic
4. Extraspinal Region : head, lower extremity, upper extremity, rib and
abdomen
5. If EM is done significantly use EM codes with modifier 25
6. Ex: patient is treated for cervical and thoracic region
a.98925
b.98940
c.98943
7. Ex: patient treated for upper and lower extremity region
a.98940
b.98925
c.98943
Miscellaneous:
1. Post op Follow-up code: 99024
2. This code is a part of surgical package(used when patient comes for a follow
up during surgical days)
Moderate sedation:
1. Also called as conscious sedation
2. It includes, intra-service pre-service and post- service
3. Follow the table on page 737 for easy coding
4. Code 99151 is used if the sedation is given by a doctor and the same
doctor provides the surgery also. There will be a trained observer to take
care of the patient.
5. Code 99155 is used whentwo doctors are present during sedation. one
doctor provides sedation another doctor provides the surgery.
6. EX:35 year patient undergoing sedation for 60 mins given by a doctor and
taken care by a observer. Find the code?
7. 40 year patient undergoing sedation for 40 mins by a general surgeon and
a plastic surgeon performs the surgery. Find the code?
Some example for physician and non physician service:
1. A nutritionist is providing 30 mins of initial assessment to a patient
a. 97804
b. 97802x2
c. 99402
d. 99407
2. A physician is providing 30 mins of counseling for patient with dieting
problem
a. 99802
b. 99804
c. 99402
d. 99407
3. A non -physician is providing telephone service to a established patient on
the 3rd day of his Em service for 10 mins.
a. 99441
b. 98966
c. 98967
d. This service is not coded
4. Home visit of haemodialysis service to a established patient of 45 years by
a non -physician
a. 99601
b. 99512
c. 99347
d. 99341
Final summary of the chapter
EM VS Medicine codes:
1.Em codes can be additionally reported with medicine codes only when Em is
significantly and separately done. In that case report medicine codes, Em codes
with 25.
Ex: Em-25, vaccine admins, vaccine
Em-25, INR management 93792
Em-25, Acupuncture
Em-25, CMT
EM-25, OMT
EM-25, dialysis
2.But sometimes Em is strictly not to be reported with some medicine codes.
EX: Diagnostic PSychiatriccodes(90791,90792) not reported with EM
INR management 93973 not reported with EM
functional brain mapping code 96020 not reported with EM
92228 opthalmoscopy should not be reported with Em codes
3.Em codes substituting medicine codes
Genetic counseling, medical nutritional therapy, home visit for dialysis done by
physician useEm code
Genetic counseling, medical nutritional therapy, home visit for dialysis done by
non physician use medicine codes
Modifier 52 Rule
1.92537 vestibular test for 4 irrigation, less than 4 use 52
92538 for 2 irrigation, less than 2 use 52
2. 91110 is imaging till ileum. If ileum is not viewed, Report with 52 as 91110-52
2. All audiology( 92950-92596) codes are bilateral. So use 52 to make unilateral
service.
3. 92625 tinnitus .use 52 for unilateral service
4.Sleep medicine: These codes are time based. Mark then on page 795 second
para under sleep medicine. When the test are done lesser than the timing use
mod 52.
6. functional cortical codes 95961 is for 1 hour, when it is done 30 mins and less
use modifier 52
Modifier: 26
1. Used with SAECG codes and ECHO codes
2. But not used with ECG and cardiac stress codes
Modifier 51
1. Do not use modifier 51 with vaccination and immunoglobulin codes
2. Do not use modifier 51 with Rehabilitation codes(PT,PT,Atheletic training)
3. Do not use modifier 51 with Add on codes
4. Do not use modifier 51 with codes having a symbol of Circle with a
bar(modifier 51 exempt codes)
