Surgical Cross Coder. Essential links from CPT codes to ICD-9-CM and HCPCS Codes

Transcription

1 Surgical Cross Coder Essential links from CPT codes to ICD-9-CM and HCPCS Codes 2011

2 Contents Introduction... iii Format...iii Icon Key...iv CPT Codes...v Code Links...vi ICD-9 Diagnostic Codes...vi ICD-9-CM Procedural Codes...vii HCPCS Level II Codes...vii Summary...viii General...1 Integumentary System...8 Skin, Subcutaneous and Accessory Structures...8 Nails...23 Pilonidal Cyst...26 Introduction...27 Repair (Closure)...31 Destruction Breast Musculoskeletal System General Head Neck (Soft Tissues) and Thorax Back and Flank Spine (Vertebral Column) Abdomen Shoulder Humerus (Upper Arm) and Elbow Forearm and Wrist Hand and Fingers Pelvis and Hip Joint Femur (Thigh Region) and Knee Joint Leg (Tibia and Fibula) and Ankle Joint Foot and Toes Application of Casts and Strapping Endoscopy/Arthroscopy Respiratory System Nose Accessory Sinuses Larynx Trachea and Bronchi Lungs and Pleura Cardiovascular System Heart and Pericardium Arteries and Veins Spleen General Lymph Nodes and Lymphatic Channels Mediastinum Diaphragm Digestive System Lips Vestibule of Mouth Tongue and Floor of Mouth Dentoalveolar Structures Palate and Uvula Salivary Gland and Ducts Pharynx, Adenoids, and Tonsils Esophagus Stomach Intestines (Except Rectum) Meckel s Diverticulum and the Messentery Appendix Rectum Anus Liver Biliary Tract Pancreas Abdomen, Peritoneum, and Omentum Urinary System Kidney Ureter Bladder Urethra Male Genital System Penis Testis Epididymis Tunica Vaginalis Scrotum Vas Deferens Spermatic Cord Seminal Vesicles Prostate Reproductive System Procedures Ingenix, Inc. CPT 2010 American Medical Association. All Rights Reserved. i

3 Introduction Ingenix is proud to present the 2011 Surgical Cross Coder. The popularity of Surgical Cross Coder in recent years indicates that it has become the quintessential one-stop reference for medical coders. Fully comprehensive and illustrated, Surgical Cross Coder links more than 4,000 CPT surgical codes to corresponding diagnosis and procedure codes. This reference is embraced by professional coders working in clinical outpatient, hospital, as well as payer settings. Surgical Cross Coder is a single repository where every surgical CPT code instantly reveals the most appropriate diagnosis code and, the corresponding inpatient procedure codes, as well as appropriate codes for ancillary supplies and pharmaceuticals. Surgical Cross Coder is based on the Surgery section of Current Procedural Terminology (CPT ). Up-to-date CPT surgery codes link to the following related medical coding systems: International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) Healthcare Common Procedural Coding System (HCPCS) Level II All coding relationships in Surgical Cross Coder start with the surgery section of the CPT book presenting a general clinical picture of each surgery code. Pertinent surgery-related coding relationships were carefully reviewed and screened for appropriate information. For example, it is clinically unusual for a closed fracture procedure to be performed when an open fracture diagnosis code is reported. This type of unusual association is not included. Perhaps more significantly, many acute and chronic medical conditions may eventually lead to surgical intervention. Clinical analysts point out that chronic and acute conditions are nearly always aggressively approached medically before surgery is even considered. For this reason, the number of cross-coded chronic and acute conditions are selectively culled in this reference book. In some instances the data is abridged simply due to the enormity of the listings. For example, diagnosis codes for infections call for additional codes to identify specific organisms. The possible associations are simply too numerous and, as a result, do not appear in Surgical Cross Coder. In a similar vein, Surgical Cross Coder features codes that require accompanying etiologies or manifestations (examples include Code first underlying disease... ). However, associated infectious and parasitic diseases are, once again, simply too numerous to list and do not appear in Surgical Cross Coder. For further discussion on secondary diagnosis codes, see the ICD-9-CM section later in this introduction. Some CPT codes are omitted from the listing because consistent and reliable cross links are almost impossible to establish. Unlisted procedure codes are an obvious example. Certain types of add-on codes are also treated somewhat differently in Surgical Cross Coder. These codes are discussed in greater detail under the CPT Codes section later in this introduction. Add-on and unlisted codes are listed with full descriptions in appendixes A and B. As a coding reference, Surgical Cross Coder presents most likely scenarios as derived from clinical review. However, Surgical Cross Coder is not a substitute for ICD-9-CM, or any other medical coding reference, and users are urged to regularly consult all available sources. The absence of any specific code does not necessarily indicate that its association to the base procedure code is inappropriate. Assuming all rules of medical coding are followed, excepted diagnosis codes may prove appropriate to a specific code scenario. Surgical Cross Coder does not include coding rules and guidelines. Once again, the user is urged to consult the original coding reference (e.g., current CPT, ICD-9-CM, HCPCS Level II, etc.) or one of several reputable medical coding instruction manuals. This advice may be more crucial when sorting through codes for wounds, burns, fractures, and complications. Format An understanding of the Surgical Cross Coder format allows users to easily navigate its content. Information within the main section ties back to the CPT book and codes are presented in the numeric order of the Surgery section. Sections Surgical Cross Coder provides linked information to the CPT code range to the surgical portion of the CPT book. The codes are divided into the same sections and subsections as the Surgery section of the CPT book. For example, the Respiratory System section is divided into anatomical subsections including nose, accessory sinuses, and larynx. Larynx is further divided into excision, introduction, endoscopy, repair, and destruction. Codes and Code Ranges The data within each CPT code set of Surgical Cross Coder is presented as follows: CPT code or code range CPT codes and descriptions ICD-9-CM diagnostic codes and descriptions ICD-9-CM procedural codes and descriptions HCPCS codes and descriptions 2010 Ingenix, Inc. CPT 2010 American Medical Association. All Rights Reserved. iii

4 22595 ICD-9-CM Procedural Atlas-axis spinal fusion Refusion of Atlas-axis spine Fusion or refusion of 2-3 vertebrae Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment thoracic (with or without lateral transverse technique) lumbar (with or without lateral transverse technique) each additional vertebral segment (List separately in addition to code for primary ICD-9-CM Diagnostic Malignant neoplasm of vertebral column, excluding sacrum and coccyx Secondary malignant neoplasm of bone and bone marrow Secondary neuroendocrine tumor of bone Benign neoplasm of vertebral column, excluding sacrum and coccyx Neoplasm of uncertain behavior of bone and articular cartilage Unspecified disease of spinal cord Cervical spondylosis without myelopathy Cervical spondylosis with myelopathy Thoracic spondylosis without myelopathy Lumbosacral spondylosis without myelopathy Spondylosis with myelopathy, thoracic region Spondylosis with myelopathy, lumbar region Other allied disorders of spine Displacement of cervical intervertebral disc without myelopathy Displacement of lumbar intervertebral disc without myelopathy Displacement of thoracic intervertebral disc without myelopathy Schmorl's nodes, thoracic region Degeneration of cervical intervertebral disc Degeneration of thoracic or thoracolumbar intervertebral disc Degeneration of lumbar or lumbosacral intervertebral disc Intervertebral cervical disc disorder with myelopathy, cervical region Intervertebral thoracic disc disorder with myelopathy, thoracic region Intervertebral lumbar disc disorder with myelopathy, lumbar region Postlaminectomy syndrome, cervical region Postlaminectomy syndrome, thoracic region Postlaminectomy syndrome, lumbar region Other and unspecified disc disorder of cervical region Other and unspecified disc disorder of thoracic region Other and unspecified disc disorder of lumbar region Spinal stenosis in cervical region Spinal stenosis of thoracic region Spinal stenosis of lumbar region, without neurogenic claudication Spinal stenosis of lumbar region, with neurogenic claudication Lumbago Sciatica Thoracic or lumbosacral neuritis or radiculitis, unspecified Other unspecified back disorder Osteitis deformans without mention of bone tumor Pathologic fracture of vertebrae Nonunion of fracture Stress fracture of other bone (Use additional external cause code(s) to identify the cause of the stress fracture) Acquired deformity of neck Other acquired deformity of back or spine Congenital spondylolysis, lumbosacral region Congenital spondylolisthesis Other congenital anomaly of spine Closed fracture of cervical vertebra, unspecified level without mention of spinal cord injury Closed fracture of third cervical vertebra without mention of spinal cord injury Closed fracture of fourth cervical vertebra without mention of spinal cord injury Surgical Cross Coder Closed fracture of fifth cervical vertebra without mention of spinal cord injury Closed fracture of sixth cervical vertebra without mention of spinal cord injury Closed fracture of seventh cervical vertebra without mention of spinal cord injury Closed fracture of multiple cervical vertebrae without mention of spinal cord injury Open fracture of cervical vertebra, unspecified level without mention of spinal cord injury 2 Open fracture of third cervical vertebra without mention of spinal cord injury Open fracture of fourth cervical vertebra without mention of spinal cord injury Open fracture of fifth cervical vertebra without mention of spinal cord injury Open fracture of sixth cervical vertebra without mention of spinal cord injury Open fracture of seventh cervical vertebra without mention of spinal cord injury Open fracture of multiple cervical vertebrae without mention of spinal cord injury Closed fracture of dorsal (thoracic) vertebra without mention of spinal cord injury Open fracture of dorsal (thoracic) vertebra without mention of spinal cord injury Closed fracture of lumbar vertebra without mention of spinal cord injury Open fracture of lumbar vertebra without mention of spinal cord injury Closed fracture of C1-C4 level with unspecified spinal cord injury 2 Closed fracture of C1-C4 level with complete lesion of cord Closed fracture of C1-C4 level with anterior cord syndrome Closed fracture of C1-C4 level with central cord syndrome Closed fracture of C1-C4 level with other specified spinal cord injury Closed fracture of C5-C7 level with unspecified spinal cord injury 2 Closed fracture of C5-C7 level with complete lesion of cord Closed fracture of C5-C7 level with anterior cord syndrome Closed fracture of C5-C7 level with central cord syndrome Closed fracture of C5-C7 level with other specified spinal cord injury Open fracture of C1-C4 level with unspecified spinal cord injury 2 Open fracture of C1-C4 level with complete lesion of cord Open fracture of C1-C4 level with anterior cord syndrome Open fracture of C1-C4 level with central cord syndrome Open fracture of C1-C4 level with other specified spinal cord injury Open fracture of C5-C7 level with unspecified spinal cord injury 2 Open fracture of C5-C7 level with complete lesion of cord Open fracture of C5-C7 level with anterior cord syndrome Open fracture of C5-C7 level with central cord syndrome Open fracture of C5-C7 level with other specified spinal cord injury Closed fracture of T1-T6 level with unspecified spinal cord injury 2 Closed fracture of T1-T6 level with complete lesion of cord Closed fracture of T1-T6 level with anterior cord syndrome Closed fracture of T1-T6 level with central cord syndrome Closed fracture of T1-T6 level with other specified spinal cord injury Closed fracture of T7-T12 level with unspecified spinal cord injury 2 Closed fracture of T7-T12 level with complete lesion of cord Closed fracture of T7-T12 level with anterior cord syndrome Closed fracture of T7-T12 level with central cord syndrome Closed fracture of T7-T12 level with other specified spinal cord injury Open fracture of T1-T6 level with unspecified spinal cord injury 2 Open fracture of T1-T6 level with complete lesion of cord Open fracture of T1-T6 level with anterior cord syndrome Open fracture of T1-T6 level with central cord syndrome Open fracture of T1-T6 level with other specified spinal cord injury Open fracture of T7-T12 level with unspecified spinal cord injury 2 Open fracture of T7-T12 level with complete lesion of cord Open fracture of T7-T12 level with anterior cord syndrome Open fracture of T7-T12 level with central cord syndrome Open fracture of T7-T12 level with other specified spinal cord injury Closed fracture of lumbar spine with spinal cord injury Open fracture of lumbar spine with spinal cord injury Closed dislocation, third cervical vertebra Closed dislocation, fourth cervical vertebra Closed dislocation, fifth cervical vertebra Closed dislocation, sixth cervical vertebra Closed dislocation, seventh cervical vertebra Unspecified code ; Female diagnosis E Manifestation code : Male diagnosis [Resequenced code] 2010 Ingenix, Inc. CPT only 2010 American Medical Association. All Rights Reserved.

5 Appendix A Add-On Codes 0054T 0055T 0076T 0079T 0081T 0092T 0095T 0098T 0159T 0163T 0164T 0165T 0172T 0173T 0174T 0189T 0190T 0196T 0205T 0214T Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on fluoroscopic images (List separately in addition to code for primary Computer-assisted musculoskeletal surgical navigational orthopedic procedure, with image-guidance based on CT/MRI images (List separately in addition to code for primary Transcatheter placement of extracranial vertebral or intrathoracic carotid artery stent(s), including radiologic supervision and interpretation, percutaneous; each additional vessel (List separately in addition to code for primary Placement of visceral extension prosthesis for endovascular repair of abdominal aortic aneurysm involving visceral vessels, each visceral branch (List separately in addition to code for primary Placement of visceral extension prosthesis for endovascular repair of abdominal aortic aneurysm involving visceral vessels, each visceral branch, radiological supervision and interpretation (List separately in addition to code for primary Total disc arthroplasty (artificial disc), anterior approach, including diskectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary Removal of total disc arthroplasty, anterior approach; each additional interspace (List separately in addition to code for primary Revision of total disc arthroplasty, anterior approach; each additional interspace (List separately in addition to code for primary Computer-aided detection, including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis, with further physician review for interpretation, breast MRI (List separately in addition to code for primary Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), lumbar, each additional interspace Removal of total disc arthroplasty, anterior approach, lumbar, each additional interspace Revision of total disc arthroplasty, anterior approach, lumbar, each additional interspace Insertion of posterior spinous process distraction device (including necessary removal of bone or ligament for insertion and imaging guidance), lumbar; each additional level (List separately in addition to code for primary Monitoring of intraocular pressure during vitrectomy surgery (List separately in addition to code for primary Computer aided detection (CAD) (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed concurrent with primary interpretation (List separately in addition to code for primary Remote real-time interactive videoconferenced critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service) Placement of intraocular radiation source applicator (List separately in addition to primary Arthrodesis, pre-sacral interbody technique, including instrumentation, imaging (when performed), and discectomy to prepare interspace, lumbar; each additional interspace (List separately in addition to code for primary Intravascular catheter-based coronary vessel or graft spectroscopy (eg, infrared) during diagnostic evaluation and/or therapeutic intervention including imaging supervision, interpretation, and report, each vessel (List separately in addition to code for primary Injection(s), diagnostic or therapeutic agent, paravertebral facet guidance, cervical or thoracic; second level (List separately in addition to code for primary 0215T Injection(s), diagnostic or therapeutic agent, paravertebral facet guidance, cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary 0217T Injection(s), diagnostic or therapeutic agent, paravertebral facet guidance, lumbar or sacral; second level (List separately in addition to code for primary 0218T Injection(s), diagnostic or therapeutic agent, paravertebral facet guidance, lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary 0222T Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; each additional vertebral segment (List separately in addition to code for primary 0229T Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; each additional level (List separately in addition to code for primary 0231T Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; each additional level (List separately in addition to code for primary 0241T Esophageal motility (manometric study of the esophagus and/or gastroesophageal junction) study with interpretation and report; with stimulation or perfusion during 3-dimensional high resolution esophageal pressure topography study (eg, stimulant, acid or alkali perfusion) (List separately in addition to code for primary 0250T Airway sizing and insertion of bronchial valve(s), each lobe (List separately in addition to code for primary 0252T Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of bronchial valve(s), each additional lobe (List separately in addition to code for primary Anesthesia for second and third degree burn excision or debridement with or without skin grafting, any site, for total body surface area (TBSA) treated during anesthesia and surgery; each additional nine percent total body surface area or part thereof (List separately in addition to code for primary Anesthesia for cesarean delivery following neuraxial labor analgesia/ anesthesia (List separately in addition to code for primary procedure performed) Anesthesia for cesarean hysterectomy following neuraxial labor analgesia/ anesthesia (List separately in addition to code for primary procedure performed) Debridement of extensive eczematous or infected skin; each additional 10% of the body surface (List separately in addition to code for primary Removal of prosthetic material or mesh, abdominal wall for necrotizing soft tissue infection for infection (eg, for chronic or recurrent mesh infection or necrotizing soft tissue infection) (List separately in addition to code for primary Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple closure), unless otherwise listed; each separate/additional lesion (List separately in addition to code for primary Removal of skin tags, multiple fibrocutaneous tags, any area; each additional ten lesions (List separately in addition to code for primary Avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary 2010 Ingenix, Inc. CPT 2010 American Medical Association. All Rights Reserved. 1239