CPT specialty coding sections

Musculoskeletal system

When determining codes for fractures in the surgery/musculoskeletal system section of the CPT manual there a several terms that you should be aware of:

• Closed fracture: The fractured bone does not protrude through the dermis or epidermis.
• Open fracture: The fractured bone cuts through the skin layers and can be directly visualized.
• Closed treatment: The fracture site is not surgically opened. There are three methods of closed treatment of fractures:
• Without manipulation
• With manipulation
• With or without traction
• Manipulation: Attempted reduction or restoration of a fracture or dislocated joint into its normal anatomic alignment by manually applied forces.
• Open treatment: Used when (1) the fractured bone is surgically opened or (2) an opening is made remote from the fracture site to insert an intramedullary nail across the fracture site.
• Percutaneous skeletal fixation: Fracture treatment that is neither open nor closed. The fracture fragments are not visualized, but a fixation device (e.g., pins) is placed across the fracture site, usually under x-ray imaging.

After determining the type of fracture and treatment, you can determine the correct code for the services provided.

Maternity care and delivery

The services normally provided in uncomplicated maternity cases include antepartum care, delivery, and postpartum care.

• Antepartum care includes the following:
• Initial and subsequent history
• Physical examinations
• Recording of weight, blood pressure, and fetal heart tones
• Routine chemical urinalysis
• Monthly visits up to 28 weeks’ gestation
• Biweekly visits to 36 weeks’ gestation
• Weekly visits until delivery

Any other visits or services provided within this period should be coded separately, including any routine tests (e.g., sonography, routine laboratory tests).

Delivery includes the following:

• Admission to the hospital, the admission history, and the physical examination
• Management of uncomplicated labor
• Vaginal delivery (with or without forceps or episiotomy), or cesarean delivery

Medical problems complicating labor and delivery should be identified by using the codes in the Medicine and E/M sections in addition to codes for maternity care.

Postpartum care includes the following:

• Hospital and office visits after vaginal or cesarean section delivery

Radiology section

Assigning CPT codes for the Radiology section follows the same procedure as for the Surgery section. The Radiology section contains all diagnostic imaging codes, including x-ray studies, ultrasound, MRI, computer axial tomography (CAT) scans, and nuclear medicine procedures, in addition to radiation oncology and several other types of diagnostic imaging procedures, services, and therapies. The Radiology section is divided into subsections: head and neck; chest, spine, and pelvis; upper and lower extremities; abdomen, gastrointestinal and urinary tracts; and gynecologic, obstetric, heart, and vascular procedures. The next subdivision, categories, defines the types or functions of various procedures (e.g., diagnostic ultrasound, radiation oncology, and so on) unique to the anatomic site subsection. In addition to the radiology procedure codes, codes are included for physician supervision and interpretation of diagnostic imaging data and for clinical and radiation treatment planning and administration of contrast materials during radiologic procedures.

Pathology and laboratory section

Assigning CPT codes for the Pathology section also follows the same procedure as for the Surgery section. For purposes of coding from the Laboratory section, organ or disease panels are groupings of numerous tests performed to diagnose the health or disease status of specific organ systems. A panel code can be used only if all the tests listed under the code selected were performed. These are considered bundled codes and must be billed under the single CPT code. If they are not all present, the individual tests should be billed using a separate code for each. There are two types of drug testing, qualitative and quantitative. The codes for drug testing are qualitative—that is, they are based on the type of drug found. Quantitative assays, on the other hand, are performed to determine the amount of drug present.

CPT Tabular List Basic Metabolic Panel

80047 Basic metabolic panel (Calcium, ionized)

This panel must include the following:

• Calcium, ionized (82330)
• Carbon dioxide (bicarbonate) (82374)
• Chloride (82435)
• Creatinine (82565)
• Glucose (82947)
• Potassium (84132)

The codes in parentheses after the individual tests are CPT codes. Those CPT codes would be used if not all of these tests were ordered at the same time.

Other basic metabolic panel components:

• Sodium (84295)
• Urea nitrogen (BUN) (84520

Medicine section

The Medicine section of the CPT contains codes for a variety of therapeutic procedures and diagnostic testing. This section also contains codes for dialysis, ophthalmology, acupuncture, chiropractic manipulation, and conscious sedation. The steps for determining Medicine codes are similar to those for choosing Surgery codes.

Immune globulins

When you code administration of immune globulins, identify the immune globulin product administered (CPT codes 90281–90399) and the method of administration using the codes in the hydration, therapeutic, prophylactic, and diagnostic injections and infusions subsection.

Hydration codes are intended to report a hydration intravenous (IV) infusion consisting of prepackaged fluid and electrolytes; they are not used to report the infusion of drugs or other substances. When multiple drugs are administered, report the service or services and the specific materials or drugs for each.

Immunization for vaccines or toxoids

The immunization for vaccines or toxoids codes (CPT codes 90460, 90461, 90471–90474) are for the administration of vaccines and toxoids only and should be reported in conjunction with the appropriate codes in the immunization administration for vaccine/toxoids subsection.

Vaccines/toxoids codes

These codes identify the vaccine product only (CPT codes 90476–90749). Codes in the immunization administration for vaccines/toxoids subsection must be used in addition to the vaccine or toxoid product codes. For example, if an adult patient received an influenza virus vaccine code 90471 would be used for the immunization administration and 90654 for the actual vaccine. To meet the reporting requirements of immunization registries, vaccine distribution programs, and reporting systems, the exact vaccine product administered must be reported on the insurance claim.

Home health procedures and services

The home health procedures and services codes (CPT codes 99500–99602) are used by non physician healthcare professionals only. They are used to report services provided in a patient’s residence, including assisted-living apartments, group homes, nontraditional private homes, custodial care facilities, and schools.