The ABC’s of CPT

“Spotlight on CPT” this month is going to focus on the ABC’s of CPT, that is the appendices in CPT. There are 20 appendices found in the back of the American Medical Association’s (AMA) CPT manual.
 

Here’s a quick run-down:
 

Appendix A – Modifiers
Appendix B – Summary of Additions, Deletions, and Revisions
Appendix C – Clinical Examples (deleted)
Appendix D – Summary of CPT Add-on Codes
Appendix E – Summary of CPT Codes Exempt from Modifier 51
Appendix F – Summary of CPT Codes Exempt from Modifier 63
Appendix G – Summary of CPT Codes That Include Moderate (Conscious) Sedation
Appendix H – Alphabetical Clinical Topics Listing (AKA-Alphabetical Listing)
Appendix I – Genetic Testing Code Modifiers
Appendix J – Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves
Appendix K – Product Pending FDA Approval
Appendix L – Vascular Families
Appendix M – Renumbered CPT Codes – Citations Crosswalk
Appendix N – Summary of Resequenced CPT Codes
Appendix O – Multianalyte Assays with Algorithmic Analyses and PLAs
Appendix P – CPT Codes That May Be Used for Synchronous Real-Time Interactive Audio-Video Telemedicine Services
Appendix Q – Severe Acute Respiratory Syndrome Coronavirus 2 (SARS CoV-2) (coronavirus disease [COVID-19]) Vaccines (deleted)
Appendix R – Digital Medicine-Service Taxonomy
Appendix S – Artificial Intelligence Taxonomy for Medical Services and Procedures
Appendix T – CPT Codes That May Be Used for Synchronous Real-Time Interactive Audio-Only Telemedicine Services
 

Some of these will be more familiar than others depending on the organization or provider type where a coding professional is employed. Many of us make frequent reference to Appendix A where the modifiers and their definitions are housed. (Quick note-in the AMA CPT manual, the modifiers are also found inside the front cover). In either location, it is important to remember that the modifiers do differ between those used by providers and those used for hospital outpatient services. For example, modifier 53 for discontinued procedure may be used by providers, but the hospital outpatient setting modifiers 73 or 74 would be used depending on if the patient received anesthesia or not.
 

Appendix B is a great resource to be used at the beginning of the year when the CPT codes are updated. This provides a comprehensive listing of all the changes that took place to codes for the upcoming year. If a code was revised, you can see exactly what was changed.
 

Appendix L addresses the first, second, and beyond second order determinations of vascular families. Interventional radiology coders will find this resource immensely helpful as not only is there a comprehensive listing of the vascular families but there are also many detailed illustrations.
 

Appendices P and T provide clarity on code that may be used to convey audio-video (P) or audio-only (T) CPT codes. In the CPT manual, the audio-video codes will be identified with a ★ symbol and indicate that modifier 95 must accompany the code. The audio-only codes are identified with and require modifier 93 be assigned.
 

As you can see, the appendices can provide a wealth of information. Don’t overlook them when assigning CPT codes. Many questions can be answered by just using these references.
 

Now, light has been shed on using the CPT appendices.

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.

 

Multiple Sclerosis

Multiple sclerosis (MS) is an autoimmune disease of the brain and spinal cord. This chronic disease occurs when the patient’s own immune system targets and attacks the protective covering of nerve fibers called the myelin sheath. The resulting damage leads to a disruption in the transmission of nerve signals throughout the body. “In the kNOW” is going to review the different types of MS and the new codes that became effective in October to capture that specificity.

MS types are predominately characterized by how often a relapse occurs and on the progression of symptoms. For most individuals with MS, the relapsing-remitting type is the most common. They will experience a recurrence of symptoms that can last days, weeks, or even months before improving either partially or fully. The time between relapses is the remission period when the disease is dormant. Those periods may last anywhere from months to years. The newly expanded G35 category code for relapsing-remitting multiple sclerosis is G35.A.

Secondary progressive MS is a progression of the relapsing-remitting MS. With the secondary progressive type, the MS symptoms gradually get worse due to the accumulated nerve damage that has taken place. Relapses may still happen, but remission periods are less apt to occur. The new ICD-10-CM codes for secondary progressive MS are:

G35.C0 Secondary progressive multiple sclerosis, unspecified

G35.C1 Active secondary progressive multiple sclerosis

Secondary progressive multiple sclerosis with evidence of inflammatory disease activity

G35.C2 Non-active secondary progressive multiple sclerosis

Secondary progressive multiple sclerosis without evidence of inflammatory disease activity

The next type of multiple sclerosis to be discussed is primary-progressive. This type of MS begins gradually and continues to worsen without any periods of remission. Primary progressive MS codes differentiate between the conditions that have evidence of inflammatory disease activity and those that do not. The codes are:

G35.B0 Primary progressive multiple sclerosis, unspecified

G35.B1 Active primary progressive multiple sclerosis

Primary progressive multiple sclerosis with evidence of inflammatory disease activity

G35.B2 Non-active primary progressive multiple sclerosis

Primary progressive multiple sclerosis without evidence of inflammatory disease activity

Still, we have an option to code multiple sclerosis that is unspecified by assigning G35.D.

While none of these codes carries a designation of CC or MCC, it is nonetheless, vitally important that coding professionals assign the specificity of MS when it is known. Our codes make it possible for research to identify effective treatment and outcomes. Clinical documentation integrity specialists can assist by educating providers of the need for specificity of the type of MS when known.

Now you are In the kNOW!!

 

About the Author

Dianna Foley, RHIA, CCS, CDIP, CHPS, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as a program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.