Transcription
2019MEDICAL CODINGTRAININGCOCTMCERTIFIED OUTPATIENT CODERSTUDY GUIDE
2019COC Examination Study Guide
DisclaimerCoding decisions should not be made based solely upon information within this study guide. All judgments impacting career,and/or an employer must be based upon individual circumstances including legal and ethical considerations, local conditions,payer policies within the geographic area, and new or pending government regulations, etc.AAPC does not accept responsibility or liability for any adverse outcome from using this study program for any reason includingundetected inaccuracy, opinion, and analysis that might prove erroneous or amended, or the coder’s misunderstanding or misapplication of topics.Application of the information in this text does not imply or guarantee claims payment. Inquiries of your local carrier(s)’ bulletins, policy announcements, etc., should be made to resolve local billing requirements. Payers’ interpretations may vary fromthose in this program. Finally, the law, applicable regulations, payers’ instructions, interpretations, enforcement, etc., may changeat any time in any particular area. Information in this program is solely based on CPT , ICD-10-CM, and HCPCS Level II rulesand regulations.AAPC has obtained permission from various individuals and companies to include their material in this manual. These agreements do not extend beyond this program. It may not be copied, reproduced, dismantled, quoted, or presented without theexpressed written approval of AAPC and the sources contained within.No part of this publication covered by the copyright herein may be reproduced, stored in a retrieval system or transmitted in anyform or by any means (graphically, electronically, or mechanically, including photocopying, recording or taping) without theexpressed written permission from AAPC and the sources contained within.Clinical Examples Used in this Study GuideAAPC believes it is important in training and testing to reflect as accurate a coding setting as possible to students and examinees.All examples and case studies used in our study guides and exams are actual, redacted office visit and procedure notes donated byAAPC members.To preserve the real world quality of these notes for educational purposes, we have not re-written or edited the notes to the stringent grammatical or stylistic standards found in the text of our products. Some minor changes have been made for clarity or tocorrect spelling errors originally in the notes, but essentially, they are as one would find them in a coding setting.AMA DisclaimerCPT copyright 2018 American Medical Association (AMA). All rights reserved.Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part ofCPT , and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispensemedical services. The AMA assumes no liability for data contained or not contained herein.CPT is a registered trademark of the AMA. 2018 AAPC2233 South Presidential Drive, Suites F–C, Salt Lake City, Utah 84120800-626-2633, Fax 801-236-2258, www.aapc.comUpdated 12212018. All rights reserved.ISBN 978-1-626886-421CPC , CIC , COC , CPC-P , CPMA , CPCO , and CPPM are trademarks of AAPC.ii2019 COC Examination Study GuideCPT copyright 2018 American Medical Association. All rights reserved.
ContentsChapter 1—Medical Terminology . . . . . . . . . . . . . . . . . . 1Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Word Root . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Prefixes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Suffixes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5Chapter 2—ICD-10-CM . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Medical Necessity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9ICD-10-CM Conventions and Terms . . . . . . . . . . . . . . . . . 10Conventions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Table of Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Table of Drugs and Chemicals. . . . . . . . . . . . . . . . . . . . . . . . . . 16Adverse Effect . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Poisoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Underdosing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17External Cause Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Z Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Selecting the Correct ICD-10-CM Diagnosis . . . . . . . . . . 20Chapter 3—Payment Methodologies and theOutpatient Prospective Payment System . . . . . . . . . . . . 21Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Billing for Outpatient Facilities . . . . . . . . . . . . . . . . . . . . . . 21Medicare Program Instructions. . . . . . . . . . . . . . . . . . . . . . . . . 21Outpatient Hospital Departments. . . . . . . . . . . . . . . . . . . . . . . 22Hospital Emergency Department . . . . . . . . . . . . . . . . . . . . 22Outpatient Hospital Clinics . . . . . . . . . . . . . . . . . . . . . . . . . 22Outpatient Therapy Departments . . . . . . . . . . . . . . . . . . . . 22Outpatient Cancer Center . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Dialysis Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Outpatient Radiology Department . . . . . . . . . . . . . . . . . . . 23Hospital Ambulatory SurgeryCenter (ASC) (Outpatient Facility) . . . . . . . . . . . . . . . . . . . 23Administrative Departments. . . . . . . . . . . . . . . . . . . . . . . . . . . 23Admitting Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Health Information Management Department . . . . . . . . . 23Business Office . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Typical Outpatient Flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Other Types of Outpatient Facilities. . . . . . . . . . . . . . . . . . . . . 24Freestanding Ambulatory Surgical Centers . . . . . . . . . . . . 24Teaching Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Graduate Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Comprehensive OutpatientRehabilitation Facility (CORF). . . . . . . . . . . . . . . . . . . . . . . . . . 25Partial Hospitalization. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25CPT copyright 2018 American Medical Association. All rights reserved.Inpatient Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Compliance Plans for Hospitals . . . . . . . . . . . . . . . . . . . . . . 26Privacy and Confidentiality . . . . . . . . . . . . . . . . . . . . . . . . . 26The Outpatient Prospective Payment System . . . . . . . . . . . . . 27History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Status Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28ADDENDUM D1—FINAL OPPS PAYMENT STATUSINDICATORS FOR CY 2019 . . . . . . . . . . . . . . . . . . . . . . . . 30Ambulatory Payment Classification System . . . . . . . . . . . . . . 33Example of APC Assignment by Category/Grouping . . . 34APC Structure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Composite APCs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Comprehensive APC Payment Groups (C-APCs) . . . . . . . 37Packaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Revenue Codes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Revenue Codes and CPT . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Charge Description Master (CDM) . . . . . . . . . . . . . . . . . . . 41CDM Review Tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4210 Steps to a Successful Chargemaster Review . . . . . . . . . 42National Correct Coding Initiative . . . . . . . . . . . . . . . . . . . 44Transitional Pass-through Drugs and Devices . . . . . . . . . 45Transitional Pass-through Devices . . . . . . . . . . . . . . . . . . . 46New Technology APCs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Partial Hospitalization Services. . . . . . . . . . . . . . . . . . . . . . . . . 48Evaluation and ManagementCoding for Outpatient Facilities. . . . . . . . . . . . . . . . . . . . . . . . . 48Hospital Emergency Departments. . . . . . . . . . . . . . . . . . . . . . . 49Observation Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Outpatient Facility Reimbursement . . . . . . . . . . . . . . . . . . 52Inpatient Reimbursement-MedicareSeverity Diagnostic Related Groups (MS-DRG) . . . . . . . . . . . 53Diagnostic Related Groups . . . . . . . . . . . . . . . . . . . . . . . . . . 53Major Diagnostic Categories . . . . . . . . . . . . . . . . . . . . . . . . 54Inpatient Claim Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55Prior Authorization and Concurrent Review . . . . . . . . . . 55Advance Beneficiary Notice (ABN). . . . . . . . . . . . . . . . . . . . . . 57Proper Notice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57ABN Timeliness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57Preparation of ABN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58Beneficiary Changes His or Her Mind . . . . . . . . . . . . . . . . 58Patient Refusals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58Routine ABN Notice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58Period of Effectiveness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Emergency Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Standard ABN Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Categorical Denials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59HCPCS Modifiers with ABN . . . . . . . . . . . . . . . . . . . . . . . . 62Medicare—Appeals Process. . . . . . . . . . . . . . . . . . . . . . . . . . . . 62Quality Reporting (QR) Programs . . . . . . . . . . . . . . . . . . . . . . 64Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64www.aapc.comv
ContentsChapter 4—HCPCS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73Level I HCPCS Codes—CPT Codes . . . . . . . . . . . . . . . . . 73Procedure Code Assignment . . . . . . . . . . . . . . . . . . . . . . . . 73HCPCS Level II—National Codes . . . . . . . . . . . . . . . . . . . . 73HCPCS Modifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76Chapter 5—CPT Coding . . . . . . . . . . . . . . . . . . . . . . . . . 77Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77CPT Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Evaluation and Management . . . . . . . . . . . . . . . . . . . . . . . . 77Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Pathology and Laboratory . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Category II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Category III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79Subsection Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81Unlisted Procedure Codes . . . . . . . . . . . . . . . . . . . . . . . . . . 81CPT Coding Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . 82Coding Outpatient Hospital Claims . . . . . . . . . . . . . . . . . . 82Chapter 6—CPT Surgery . . . . . . . . . . . . . . . . . . . . . . . . 85Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85Definition of Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85CPT and Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85Unbundling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86Types of Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86Diagnostic Services vs. Therapeutic Services . . . . . . . . . . . 87Coding from an Operative Report . . . . . . . . . . . . . . . . . . . . 88Modifiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89APC Services and Procedures . . . . . . . . . . . . . . . . . . . . . . . 92Integumentary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92Coding Tips for the Integumentary System. . . . . . . . . . . . . . . 92Biopsies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92Lesion Excisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93Destructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94Repairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94Skin Tags . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Skin Replacement Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . 95Breast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95vi2019 COC Examination Study GuideMusculoskeletal System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Arthrocentesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96Trigger Point Injections (20552–20553) . . . . . . . . . . . . . . . 96Aspiration/Injection: Joint Size . . . . . . . . . . . . . . . . . . . . . . . . . 97Fracture Care: Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97Types of Fractures/Dislocations . . . . . . . . . . . . . . . . . . . . . . 98Endoscopy/Arthroscopy (29800–29999) . . . . . . . . . . . . . 100Summary: Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Respiratory System Checklist . . . . . . . . . . . . . . . . . . . . . . . 102Bronchoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103Cardiovascular System . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103Vascular System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104Embolectomy/Thrombectomy . . . . . . . . . . . . . . . . . . . . . . 104Sclerotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106Endovascular Revascularization . . . . . . . . . . . . . . . . . . . . 106Ligation and Other Procedures . . . . . . . . . . . . . . . . . . . . . 106Digestive System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106Endoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106Hernia Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107Urinary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Drainage of an Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Excision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Laparoscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Cystourethroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Genitourinary System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110Incision and Drainage of Abscess . . . . . . . . . . . . . . . . . . . 111Vaginal Delivery, Antepartum, and Postpartum Care . 113Endocrine System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113Endovascular Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Neurostimulators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Reservoir/Pump Implantation (62360–62370) . . . . . . . . 114Introduction/Injection of Anesthetic Agent (Nerve Block),Diagnostic or Therapeutic (64400–64530) . . . . . . . . . . . . 114Peripheral Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Destruction by Neurolytic Agent . . . . . . . . . . . . . . . . . . . 115Eye and Ocular Adnexa . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115Laceration Repairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115Ear. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118Excision (69100–69155) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118Foreign Body Removal (69200–69205) . . . . . . . . . . . . . . . 119Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119Myringotomy (69420–69424) . . . . . . . . . . . . . . . . . . . . . . . 119Tympanostomy (69433–69436) . . . . . . . . . . . . . . . . . . . . . 119Mastoidectomy (69501–69511) . . . . . . . . . . . . . . . . . . . . . . 119Operating Microscope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119CPT copyright 2018 American Medical Association. All rights reserved.
ContentsChapter 7—Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . 123Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123Composite APCs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123Sample of HCPCS Level I CodesAssigned to Composite APC 2016 . . . . . . . . . . . . . . . . . . . 124Positions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124Views . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124Technical vs. Professional Component. . . . . . . . . . . . . . . . . . 124Laterality. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125Contrast Material. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125General Diagnostic Radiology. . . . . . . . . . . . . . . . . . . . . . . . . 125Computerized Tomography (CT) . . . . . . . . . . . . . . . . . . . 125Magnetic Resonance Imaging (MRI) . . . . . . . . . . . . . . . . 125Magnetic Resonance Angiography (MRA) . . . . . . . . . . . 125PET Scans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125Chest (71045–71555). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126Gastrointestinal Tract (74210–74363). . . . . . . . . . . . . . . . . . . 126Urinary Tract (74400–74485). . . . . . . . . . . . . . . . . . . . . . . . . . 126Tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126Gynecological and Obstetrical (74710–74775). . . . . . . . . . . . 126Vascular Procedures (75600–75893). . . . . . . . . . . . . . . . . . . . 126Transcatheter Procedures (75894–75989). . . . . . . . . . . . . . . . 126Diagnostic Ultrasound Procedures (76506–76999). . . . . . . . 126Obstetrical Pelvis (76801–76828). . . . . . . . . . . . . . . . . . . . . . . 127Non Obstetrical Pelvis (76830–76857). . . . . . . . . . . . . . . . . . 127Radiologic Guidance (77001–77022). . . . . . . . . . . . . . . . . . . . 127Radiation Oncology (77261–77799). . . . . . . . . . . . . . . . . . . . . 127Hospitals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127Radiation Oncology Terminology . . . . . . . . . . . . . . . . . . . 127Initiation of Radiation Therapy . . . . . . . . . . . . . . . . . . . . . 129Therapeutic Radiology Simulation (77280–77299) . . . . . 129Medical Radiation Physics, Dosimetry, TreatmentDevices, and Special Services (77295–77370) . . . . . . . . . 129Isodose Plan (77306–77321) . . . . . . . . . . . . . . . . . . . . . . . . 129Brachytherapy Isodose Plan (77316–77318) . . . . . . . . . . . 130Treatment Devices (77332–77334) . . . . . . . . . . . . . . . . . . . 131Stereotactic RadiationTreatment Delivery (77371–77373) . . . . . . . . . . . . . . . . . . 131Radiation Treatment Delivery (77401–77425) . . . . . . . . . 132Neutron Beam Treatment Delivery (77423) . . . . . . . . . . . 133Radiation Treatment Management (77427–77499) . . . . . 133Proton Beam Treatment Delivery (77520–77525) . . . . . . 134Hyperthermia (77600–77615) . . . . . . . . . . . . . . . . . . . . . . . 134Clinical Brachytherapy (77750–77799) . . . . . . . . . . . . . . . 134Nuclear Medicine (78012–79999). . . . . . . . . . . . . . . . . . . . . . . 134Chapter 8—Pathology and Laboratory . . . . . . . . . . . . 137Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137Modifiers Used in Laboratory and Pathology Services . . . . 137Code Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137CPT copyright 2018 American Medical Association. All rights reserved.Organ or Disease Oriented Panels (80047–80081). . . . . . . . 138Drug Assay (80305–80377). . . . . . . . . . . . . . . . . . . . . . . . . . . . 138Therapeutic Drug Assays (80150–80377). . . . . . . . . . . . . . . . 138Evocative/Suppression Testing (80400–80439). . . . . . . . . . . 139Consultations (Clinical Pathology) (80500–80502). . . . . . . 139Urinalysis (81000–81099) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139Molecular Pathology (81170–81471) . . . . . . . . . . . . . . . . . . . . 139Tier 1 Molecular Pathology Procedures (81105–81383) . 139Tier 2 Molecular Pathology Procedures (81400–81408) 139Multianalyte Assays withAlgorithmic Analyses (81490–81599). . . . . . . . . . . . . . . . . . . 139Chemistry (82009–84999). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139Hemoccult Testing (82270–82274) . . . . . . . . . . . . . . . . . . 139Hematology and Coagulation (85002–85999). . . . . . . . . . . . 140Immunology (86000–86804) . . . . . . . . . . . . . . . . . . . . . . . . . . 140Transfusion Medicine (86850–86999). . . . . . . . . . . . . . . . . . . 141Microbiology (87003–87999) . . . . . . . . . . . . . . . . . . . . . . . . . . 141Streptococcal Testing Techniques (87650–87653) . . . . . . 141Anatomic Pathology (88000–88099). . . . . . . . . . . . . . . . . . . . 141Cytopathology (88104–88199) . . . . . . . . . . . . . . . . . . . . . . . . . 141Surgical Pathology (88300–88399). . . . . . . . . . . . . . . . . . . . . 142Frozen Sections (Rapid Examinations) (88331–88332) . 142Chapter 9—Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . 145Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145Immune Globulins (90281–90399). . . . . . . . . . . . . . . . . . . . . . 145Immunization Administrationfor Vaccines/Toxoids (90460–90474). . . . . . . . . . . . . . . . . . . . 145Vaccines, Toxoids (90476–90749). . . . . . . . . . . . . . . . . . . . . . . 145Psychiatry (90785–90899). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146Dialysis (90935–90999) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147Gastroenterology (91010–91299) . . . . . . . . . . . . . . . . . . . . . . . 147Ophthalmology (92002–92499). . . . . . . . . . . . . . . . . . . . . . . . 147Otorhinolaryngology Services (92502–92700). . . . . . . . . . . . 147Cardiovascular (92920–93799). . . . . . . . . . . . . . . . . . . . . . . . . 147Therapeutic Services (92920–92998) . . . . . . . . . . . . . . . . . 147Thrombolysis (92975–92977) . . . . . . . . . . . . . . . . . . . . . . . 148Cardiography (93000–93050) . . . . . . . . . . . . . . . . . . . . . . . 149Echocardiography (93303–93355) . . . . . . . . . . . . . . . . . . . 149Cardiac Catheterization (93451–93592) . . . . . . . . . . . . . . 149Intracardiac ElectrophysiologicalProcedures (93600–93662) . . . . . . . . . . . . . . . . . . . . . . . . . 150Pulmonary (94002–94799) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150Allergy and Clinical Immunology (95004–95199). . . . . . . . 151Allergen Immunotherapy (95115–95199) . . . . . . . . . . . . . 151Neurology and NeuromuscularProcedures (95782–96020) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151Hydration (96360–96361) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151Therapeutic, Prophylactic, and Diagnostic Injections andInfusions (96365–96379). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152www.aapc.comvii
ContentsChemotherapy Administration (96401–96549). . . . . . . . . . . 152Special Dermatological Procedures (96900–96999). . . . . . . 152Physical Medicine and Rehabilitation (97161–97799). . . . . 152Active Wound Care Management (97597–97610) . . . . . . 152Osteopathic Manipulative Treatment (98925–98929) . . . . . 153Chiropractic Manipulative Treatment (98940–98943). . . . . 153Moderate Conscious Sedation (99151-99157). . . . . . . . . . . . . 153Category III Codes (0042T–0542T). . . . . . . . . . . . . . . . . . . . . 154Answers for Section Reviews . . . . . . . . . . . . . . . . . . . . . 157Chapter 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157Chapter 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157Chapter 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158Chapter 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159Chapter 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159Chapter 6 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159Chapter 7 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160Chapter 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160Chapter 9 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160Answer Sheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179Practice Examination . . . . . . . . . . . . . . . . . . . . . . . . . . . 181Medical Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181ICD-10-CM Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182Payment Methodologies . . . . . . . . . . . . . . . . . . . . . . . . . . . 185General CPT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186Surgical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199Answers for Practice Examination . . . . . . . . . . . . . . . . . 201Medical Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201ICD-10-CM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201Payment Methodologies . . . . . . . . . . . . . . . . . . . . . . . . . . . 201General CPT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201Surgical Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201Miscellaneous . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161Operative Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165Answers for Case Studies and Operative Reports . . . . 175Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175Operative Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175Medical Terminology . . .
AAPC believes it is important in training and testing to reflect as accurate a coding setting as possible to students and examinees. All examples and case studies used in our study guides and exams are actual, redacted
