Sample page. Surgical. Cross Coder. Essential links from CPT codes to ICD-10-CM and HCPCS

Transcription

1 Cross Coder 2018 Surgical Essential links from CPT codes to ICD-10-CM and HCPCS POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years. Visit optum360coding.com.

2 Contents Introduction... iii Format... iii Icon Key... iv CPT Codes... iv Code Links... v... v HCPCS Level II Codes... vi Summary... vi Integumentary System... 1 Skin, Subcutaneous and Accessory Structures... 1 Nails...25 Pilonidal Cyst...32 Introduction...32 Repair (Closure)...39 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 Female Genital System Vulva, Perineum and Introitus Vagina Cervix Uteri Corpus Uteri Optum360, LLC 2017 American Medical Association. All Rights Reserved. i

3 Surgical Cross Coder Contents 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 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 ii 2017 American Medical Association. All Rights Reserved Optum360, LLC

4 Introduction Optum360 is proud to present the 2017 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 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 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, 10th Revision, Clinical Modification (ICD-10-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 is 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. For further discussion on secondary diagnosis codes, see the ICD-10-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. These codes are discussed in greater detail under the CPT Codes section later in this introduction. 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-10-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-10-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-10-CM diagnostic codes and descriptions HCPCS codes and descriptions For example: Removal of foreign body, pelvis or hip; subcutaneous tissue deep (subfascial or intramuscular) L92.3 Foreign body granuloma of the skin and subcutaneous tissue M79.5 Residual foreign body in soft tissue S31.020A Laceration with foreign body of lower back and pelvis without penetration into retroperitoneum, initial S31.040A Puncture wound with foreign body of lower back and pelvis without penetration into retroperitoneum, initial S70.251A Superficial foreign body, right hip, initial S70.252A Superficial foreign body, left hip, initial S71.021A Laceration with foreign body, right hip, initial S71.022A Laceration with foreign body, left hip, initial S71.041A Puncture wound with foreign body, right hip, initial S71.042A Puncture wound with foreign body, left hip, initial HCPCS Level II Supplies & Services A4305 Disposable drug delivery system, flow rate of 50 ml or greater per hour Each CPT code or code range is followed by its specific ICD-10-CM and HCPCS codes. Surgical Cross Coder presents full descriptions for all CPT codes and their links Optum360, LLC 2017 American Medical Association. All Rights Reserved. iii

5 Musculoskeletal System General Incision and drainage of soft tissue abscess, subfascial (ie, involves the soft tissue below the deep fascia) K61.0 K61.1 K61.2 K61.3 K65.1 K68.12 M M M M M M M M M M M M M M M71.08 M71.09 M72.2 M72.6 M72.8 N61.0 N61.1 Anal abscess Rectal abscess Anorectal abscess Ischiorectal abscess Peritoneal abscess Psoas muscle abscess Abscess of bursa, right shoulder Abscess of bursa, left shoulder Abscess of bursa, right elbow Abscess of bursa, left elbow Abscess of bursa, right wrist Abscess of bursa, left wrist Abscess of bursa, right hand Abscess of bursa, left hand Abscess of bursa, right hip Abscess of bursa, left hip Abscess of bursa, right knee Abscess of bursa, left knee Abscess of bursa, right ankle and foot Abscess of bursa, left ankle and foot Abscess of bursa, other site Abscess of bursa, multiple sites Plantar fascial fibromatosis Necrotizing fasciitis Other fibroblastic disorders Mastitis without abscess Abscess of the breast and nipple Exploration of penetrating wound (separate procedure); neck S11.011A Laceration without foreign body of larynx, initial S11.012A Laceration with foreign body of larynx, initial S11.013A Puncture wound without foreign body of larynx, initial S11.014A Puncture wound with foreign body of larynx, initial S11.015A Open bite of larynx, initial S11.021A Laceration without foreign body of trachea, initial S11.022A Laceration with foreign body of trachea, initial S11.023A Puncture wound without foreign body of trachea, initial S11.024A Puncture wound with foreign body of trachea, initial S11.025A Open bite of trachea, initial S11.031A Laceration without foreign body of vocal cord, initial S11.032A Laceration with foreign body of vocal cord, initial S11.033A Puncture wound without foreign body of vocal cord, initial S11.034A Puncture wound with foreign body of vocal cord, initial S11.035A Open bite of vocal cord, initial S11.11XA Laceration without foreign body of thyroid gland, initial S11.12XA Laceration with foreign body of thyroid gland, initial S11.13XA Puncture wound without foreign body of thyroid gland, initial S11.14XA Puncture wound with foreign body of thyroid gland, initial S11.15XA Open bite of thyroid gland, initial S11.21XA Laceration without foreign body of pharynx and cervical esophagus, initial S11.22XA Laceration with foreign body of pharynx and cervical esophagus, initial S11.23XA Puncture wound without foreign body of pharynx and cervical esophagus, initial S11.24XA Puncture wound with foreign body of pharynx and cervical esophagus, initial S11.25XA Open bite of pharynx and cervical esophagus, initial S11.81XA Laceration without foreign body of other specified part of neck, initial S11.82XA Laceration with foreign body of other specified part of neck, initial S11.83XA Puncture wound without foreign body of other specified part of neck, initial S11.84XA Puncture wound with foreign body of other specified part of neck, initial S11.85XA Open bite of other specified part of neck, initial S11.89XA Other open wound of other specified part of neck, initial S16.2XXA Laceration of muscle, fascia and tendon at neck level, initial S16.8XXA Other specified injury of muscle, fascia and tendon at neck level, initial S19.81XA Other specified injuries of larynx, initial S19.82XA Other specified injuries of cervical trachea, initial S19.83XA Other specified injuries of vocal cord, initial S19.84XA Other specified injuries of thyroid gland, initial S19.85XA Other specified injuries of pharynx and cervical esophagus, initial S19.89XA Other specified injuries of other specified part of neck, initial HCPCS Level II Supplies & Services A4305 Disposable drug delivery system, flow rate of 50 ml or greater per hour Exploration of penetrating wound (separate procedure); chest S21.111A Laceration without foreign body of right front wall of thorax without penetration into thoracic cavity, initial S21.112A Laceration without foreign body of left front wall of thorax without penetration into thoracic cavity, initial S21.121A Laceration with foreign body of right front wall of thorax without penetration into thoracic cavity, initial S21.122A Laceration with foreign body of left front wall of thorax without penetration into thoracic cavity, initial S21.131A Puncture wound without foreign body of right front wall of thorax without penetration into thoracic cavity, initial S21.132A Puncture wound without foreign body of left front wall of thorax without penetration into thoracic cavity, initial S21.141A Puncture wound with foreign body of right front wall of thorax without penetration into thoracic cavity, initial S21.142A Puncture wound with foreign body of left front wall of thorax without penetration into thoracic cavity, initial S21.151A Open bite of right front wall of thorax without penetration into thoracic cavity, initial S21.152A Open bite of left front wall of thorax without penetration into thoracic cavity, initial S21.211A Laceration without foreign body of right back wall of thorax without penetration into thoracic cavity, initial S21.212A Laceration without foreign body of left back wall of thorax without penetration into thoracic cavity, initial S21.221A Laceration with foreign body of right back wall of thorax without penetration into thoracic cavity, initial 174 ; Female diagnosis : Male diagnosis [Resequenced code] 2017 Optum360, LLC CPT 2017 American Medical Association. All Rights Reserved.

6 Eye and Ocular Adnexa Eyeball Evisceration of ocular contents; without implant with implant H Panophthalmitis (acute), right eye H Panophthalmitis (acute), left eye H Panophthalmitis (acute), bilateral H Absolute glaucoma, right eye H Absolute glaucoma, left eye H Absolute glaucoma, bilateral H Atrophy of globe, right eye H Atrophy of globe, left eye H Atrophy of globe, bilateral S05.21XA Ocular laceration and rupture with prolapse or loss of intraocular tissue, right eye, initial S05.22XA Ocular laceration and rupture with prolapse or loss of intraocular tissue, left eye, initial S05.41XA Penetrating wound of orbit with or without foreign body, right eye, initial S05.42XA Penetrating wound of orbit with or without foreign body, left eye, initial S05.51XA Penetrating wound with foreign body of right eyeball, initial S05.52XA Penetrating wound with foreign body of left eyeball, initial HCPCS Level II Supplies & Services V2623 Prosthetic eye, plastic, custom Enucleation of eye; without implant with implant, muscles not attached to implant with implant, muscles attached to implant C69.01 C69.02 C69.11 C69.12 C69.21 C69.22 C69.31 C69.32 C69.41 C69.42 C69.61 C69.62 C69.81 C69.82 H40.31X3 H40.32X3 H40.33X3 H40.41X3 H40.42X3 H40.43X3 H40.51X3 H40.52X3 H40.53X3 Malignant neoplasm of right conjunctiva Malignant neoplasm of left conjunctiva Malignant neoplasm of right cornea Malignant neoplasm of left cornea Malignant neoplasm of right retina Malignant neoplasm of left retina Malignant neoplasm of right choroid Malignant neoplasm of left choroid Malignant neoplasm of right ciliary body Malignant neoplasm of left ciliary body Malignant neoplasm of right orbit Malignant neoplasm of left orbit Malignant neoplasm of overlapping sites of right eye and adnexa Malignant neoplasm of overlapping sites of left eye and adnexa Glaucoma secondary to eye trauma, right eye, severe stage Glaucoma secondary to eye trauma, left eye, severe stage Glaucoma secondary to eye trauma, bilateral, severe stage Glaucoma secondary to eye inflammation, right eye, severe stage Glaucoma secondary to eye inflammation, left eye, severe stage Glaucoma secondary to eye inflammation, bilateral, severe stage Glaucoma secondary to other eye disorders, right eye, severe stage Glaucoma secondary to other eye disorders, left eye, severe stage Glaucoma secondary to other eye disorders, bilateral, severe stage H Absolute glaucoma, right eye H Absolute glaucoma, left eye H Absolute glaucoma, bilateral H Atrophy of globe, right eye H Atrophy of globe, left eye H Atrophy of globe, bilateral Q11.0 Cystic eyeball S05.21XA Ocular laceration and rupture with prolapse or loss of intraocular tissue, right eye, initial S05.21XD Ocular laceration and rupture with prolapse or loss of intraocular tissue, right eye, subsequent S05.22XA Ocular laceration and rupture with prolapse or loss of intraocular tissue, left eye, initial S05.22XD Ocular laceration and rupture with prolapse or loss of intraocular tissue, left eye, subsequent S05.51XA Penetrating wound with foreign body of right eyeball, initial S05.51XD Penetrating wound with foreign body of right eyeball, subsequent S05.52XA Penetrating wound with foreign body of left eyeball, initial S05.52XD Penetrating wound with foreign body of left eyeball, subsequent Exenteration of orbit (does not include skin graft), removal of orbital contents; only with therapeutic removal of bone with muscle or myocutaneous flap C41.0 C43.11 C43.12 C C C C C C C69.01 C69.02 C69.11 C69.12 C69.21 C69.22 C69.31 C69.32 C69.41 C69.42 C69.61 C69.62 C69.81 C Malignant neoplasm of bones of skull and face Malignant melanoma of right eyelid, including canthus Malignant melanoma of left eyelid, including canthus Basal cell carcinoma of skin of right eyelid, including canthus Basal cell carcinoma of skin of left eyelid, including canthus Squamous cell carcinoma of skin of right eyelid, including canthus Squamous cell carcinoma of skin of left eyelid, including canthus Other specified malignant neoplasm of skin of right eyelid, including canthus Other specified malignant neoplasm of skin of left eyelid, including canthus Malignant neoplasm of right conjunctiva Malignant neoplasm of left conjunctiva Malignant neoplasm of right cornea Malignant neoplasm of left cornea Malignant neoplasm of right retina Malignant neoplasm of left retina Malignant neoplasm of right choroid Malignant neoplasm of left choroid Malignant neoplasm of right ciliary body Malignant neoplasm of left ciliary body Malignant neoplasm of right orbit Malignant neoplasm of left orbit Malignant neoplasm of overlapping sites of right eye and adnexa Malignant neoplasm of overlapping sites of left eye and adnexa Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure) T85.318A Breakdown (mechanical) of other ocular prosthetic devices, implants and grafts, initial T85.328A Displacement of other ocular prosthetic devices, implants and grafts, initial 1726 ; Female diagnosis : Male diagnosis [Resequenced code] 2017 Optum360, LLC CPT 2017 American Medical Association. All Rights Reserved.