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

2 Contents Introduction... iii Format...iii Icon Key...iv CPT Codes...v Code Links...vi ICD-9 Diagnostic Codes...vi 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...26 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 Vas Deferens Spermatic Cord Seminal Vesicles Prostate Reproductive System Procedures Ingenix, Inc. CPT 2009 American Medical Association. All Rights Reserved. i

3 Contents Intersex Surgery Female Genital System Vulva, Perineum and Introitus Vagina Cervix Uteri Corpus Uteri Oviduct/Ovary Ovary In Vitro Fertilization Maternity Care and Delivery Endocrine System Thyroid Gland Parathyroid, Thymus, Adrenal Glands, Pancreas, and Carotid Body Nervous System Skull, Meninges, and Brain Spine and Spinal Cord Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System Surgical Cross Coder Eye and Ocular Adnexa Eyeball Anterior Segment Posterior Segment Ocular Adnexa Conjunctiva Auditory System External Ear Middle Ear Inner Ear Temporal Bone, Middle Fossa Approach Operating Microscope Appendix A Add-On Codes B Modifier 51 Exempt, Modifier 63 Exempt, Moderate (Conscious) Sedation Codes C Unlisted Codes D CPT and HCPCS Modifiers ii CPT 2009 American Medical Association. All Rights Reserved Ingenix, Inc.

4 Introduction Ingenix is proud to present the 2010 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. Users will find pertinent procedural and anatomical illustrations within each section. 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 2009 Ingenix, Inc. CPT 2009 American Medical Association. All Rights Reserved. iii

5 Abdomen Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); less than 5 cm 5 cm or greater Excision, tumor, soft tissue of abdominal wall, subcutaneous; less than 3 cm Excision, tumor, soft tissue of abdominal wall, subcutaneous; 3 cm or greater Radical resection of tumor (eg, malignant neoplasm), soft tissue of abdominal wall; less than 5 cm Radical resection of tumor (eg, malignant neoplasm), soft tissue of abdominal wall; 5 cm or greater Malignant neoplasm of connective and other soft tissue of abdomen Secondary malignant neoplasm of other specified sites Merkel cell carcinoma of the trunk Secondary Merkel cell carcinoma Lipoma of other skin and subcutaneous tissue Other benign neoplasm of connective and other soft tissue of abdomen Neoplasm of uncertain behavior of connective and other soft tissue Neoplasms of unspecified nature of bone, soft tissue, and skin 54.3 Excision or destruction of lesion or tissue of abdominal wall or umbilicus Excision of lesion of other soft tissue Other excision of soft tissue 86.3 Other local excision or destruction of lesion or tissue of skin and subcutaneous tissue 86.4 Radical excision of skin lesion HCPCS Level II Supplies & Services A4305 Disposable drug delivery system, flow rate of 50 ml or greater per hour Shoulder Removal of subdeltoid calcareous deposits, open Calcifying tendinitis of shoulder Other specified disorders of rotator cuff syndrome of shoulder and allied disorders Other affections of shoulder region, not elsewhere classified Calcium deposits in tendon and bursa Other disorders of synovium, tendon, and bursa Progressive myositis ossificans Traumatic myositis ossificans Postoperative heterotopic calcification Other muscular calcification and ossification Excision of lesion of other soft tissue Capsular contracture release (eg, Sever type procedure) Contracture of shoulder joint Division of joint capsule, ligament, or cartilage of shoulder Other division of soft tissue Incision and drainage, shoulder area; deep abscess or hematoma Cellulitis and abscess of upper arm and forearm (Use additional code to identify organism, such as 041.1, etc.) Arthropathy associated with other bacterial diseases, shoulder region (Code first underlying disease, such as diseases classifiable to (except ), (except )) E Hemarthrosis, shoulder region Other disorders of synovium, tendon, and bursa Chronic osteomyelitis, shoulder region (Use additional code to identify organism: Unspecified osteomyelitis, shoulder region (Use additional code to identify organism: 2 Periostitis, without mention of osteomyelitis, shoulder region (Use additional code to identify organism: 041.1) Major osseous defects (Code first underlying disease: , , , , ) Postprocedural fever Contusion of shoulder region Hematoma complicating a procedure Infected postoperative seroma (Use additional code to identify organism) Other postoperative infection (Use additional code to identify infection) Myotomy HCPCS Level II Supplies & Services A4305 Disposable drug delivery system, flow rate of 50 ml or greater per hour Incision and drainage, shoulder area; infected bursa Unspecified disorders of bursae and tendons in shoulder region Other bursitis disorders Other disorders of synovium, tendon, and bursa Acute osteomyelitis, shoulder region (Use additional code to identify organism: Chronic osteomyelitis, shoulder region (Use additional code to identify organism: Unspecified osteomyelitis, shoulder region (Use additional code to identify organism: Major osseous defects (Code first underlying disease: , , , , ) Infected postoperative seroma (Use additional code to identify organism) Other postoperative infection (Use additional code to identify infection) Bursotomy HCPCS Level II Supplies & Services A4305 Disposable drug delivery system, flow rate of 50 ml or greater per hour Surgical Cross Coder Incision, bone cortex (eg, osteomyelitis or bone abscess), shoulder area Cellulitis and abscess of upper arm and forearm (Use additional code to identify organism, such as 041.1, etc.) Chronic osteomyelitis, shoulder region (Use additional code to identify organism: Unspecified osteomyelitis, shoulder region (Use additional code to identify organism: Other infections involving bone diseases classified elsewhere, shoulder region (Use additional code to identify organism: Code first underlying disease: 002.0, ) E Major osseous defects (Code first underlying disease: , , , , ) Infected postoperative seroma (Use additional code to identify organism) Other postoperative infection (Use additional code to identify infection) Other incision of scapula, clavicle, and thorax (ribs and sternum) without division Unspecified code ; Female diagnosis E Manifestation code : Male diagnosis [Resequenced code] 2009 Ingenix, Inc. CPT only 2009 American Medical Association. All Rights Reserved.

6 Appendix B Modifier 51 Exempt Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), all benign or premalignant lesions (eg, actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions, 15 or more lesions Application of multiplane (pins or wires in more than 1 plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; exchange (ie, removal and replacement) of strut, each Electrical stimulation to aid bone healing; noninvasive (nonoperative) Electrical stimulation to aid bone healing; invasive (operative) Intubation, endotracheal, emergency procedure Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous Introduction of long gastrointestinal tube (eg, Miller-Abbott) (separate procedure) Twist drill hole for subdural or ventricular puncture; for implanting ventricular catheter or pressure recording device Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes Injection procedure during cardiac catheterization; for selective opacification of arterial conduits (eg, internal mammary), whether native or used for bypass Injection procedure during cardiac catheterization; for selective opacification of aortocoronary venous bypass grafts, 1 or more coronary arteries Injection procedure during cardiac catheterization; for aortography Injection procedure during cardiac catheterization; for selective coronary angiography (injection of radiopaque material may be by hand) Imaging supervision, interpretation and report for injection procedure(s) during cardiac catheterization; ventricular and/or atrial angiography Imaging supervision, interpretation and report for injection procedure(s) during cardiac catheterization; pulmonary angiography, aortography, and/ or selective coronary angiography including venous bypass grafts and arterial conduits (whether native or used in bypass) Bundle of His recording Intra-atrial recording Right ventricular recording Intra-atrial pacing Intraventricular pacing Esophageal recording of atrial electrogram with or without ventricular electrogram(s); Esophageal recording of atrial electrogram with or without ventricular electrogram(s); with pacing Induction of arrhythmia by electrical pacing Intra-operative epicardial and endocardial pacing and mapping to localize the site of tachycardia or zone of slow conduction for surgical correction Intrapulmonary surfactant administration by a physician through endotracheal tube Nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with F-wave study Nerve conduction, amplitude and latency/velocity study, each nerve; sensory Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed, with interpretation and report Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day Moderate sedation services (other than those services described by codes ) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patients level of consciousness and physiological status; under 5 years of age, first 30 minutes intra-service time Moderate sedation services (other than those services described by codes ) provided by the same physician performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patients level of consciousness and physiological status; age 5 years or older, first 30 minutes intra-service time Modifier 63 Exempt Repair choanal atresia; intranasal Repair choanal atresia; transpalatine Laryngoscopy direct, with or without tracheoscopy; diagnostic, newborn Valvuloplasty, aortic valve; open, with inflow occlusion Valvuloplasty, aortic valve; using transventricular dilation, with cardiopulmonary bypass Valvotomy, pulmonary valve, closed heart; transventricular Valvotomy, pulmonary valve, open heart; with inflow occlusion Repair of anomalous coronary artery from pulmonary artery origin; by ligation Repair of anomalous coronary artery; by graft, without cardiopulmonary bypass Repair of anomalous coronary artery; with construction of intrapulmonary artery tunnel (Takeuchi procedure) Repair of anomalous coronary artery; by translocation from pulmonary artery to aorta Repair of complex cardiac anomalies (eg, single ventricle with subaortic obstruction) by surgical enlargement of ventricular septal defect Repair of double outlet right ventricle with intraventricular tunnel repair; Repair of single ventricle with aortic outflow obstruction and aortic arch hypoplasia (hypoplastic left heart syndrome) (eg, Norwood procedure) Repair of atrial septal defect and ventricular septal defect, with direct or patch closure Repair of complete atrioventricular canal, with or without prosthetic valve Banding of pulmonary artery Complete repair tetralogy of Fallot without pulmonary atresia; with transannular patch Complete repair of anomalous venous return (supracardiac, intracardiac, or infracardiac types) Repair of cor triatriatum or supravalvular mitral ring by resection of left atrial membrane Atrial septectomy or septostomy; closed heart (Blalock-Hanlon type operation) Atrial septectomy or septostomy; open heart with cardiopulmonary bypass Shunt; subclavian to pulmonary artery (Blalock-Taussig type operation) Shunt; ascending aorta to pulmonary artery (Waterston type operation) Shunt; descending aorta to pulmonary artery (Potts-Smith type operation) Repair of transposition of the great arteries, aortic pulmonary artery reconstruction (eg, Jatene type); Total repair, truncus arteriosus (Rastelli type operation) Transection of pulmonary artery with cardiopulmonary bypass Prolonged extracorporeal circulation for cardiopulmonary insufficiency; initial 24 hours Prolonged extracorporeal circulation for cardiopulmonary insufficiency; each additional 24 hours (List separately in addition to code for primary procedure) Collection of venous blood by venipuncture Venipuncture, cutdown; under age 1 year Exchange transfusion, blood; newborn Transfusion, intrauterine, fetal Catheterization of umbilical vein for diagnosis or therapy, newborn Catheterization, umbilical artery, newborn, for diagnosis or therapy Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia 2009 Ingenix, Inc. CPT 2009 American Medical Association. All Rights Reserved. 1227