Cross Coder 2018 Medical 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.
Contents Introduction...i Immune Globulins...1 Immunization Adminstration for Vaccines/Toxoids...8 Vaccines, Toxoids...9 Psychiatry...17 Biofeedback...71 Dialysis...74 Gastroenerology...77 Ophthalmology...82 Special Otorhinolaryngologic Services...164 Cardiovascular...198 Non-Invasive Vascular Diagnostic Studies...247 Pulmonary...271 Allergy and Clinical Immunology...278 Endocrinology...296 Neurology and Neuromuscular Procedures...300 Health and Behavior Assessment/Intervention...357 Therapeutic, Prophylactic, and Diagnostic Injections and Infusions... 358 Chemotherapy Adminstration... 359 Photodynamic Therapy... 361 Special Dermatological Procedures... 363 Physical Medicine and Rehabilitation... 367 Medical Nutrition Therapy... 371 Osteopathic Manipulative Treatment... 384 Chiropractic Manipulative Treatment... 393 Nonphysician Services... 400 Special Services, Procedures, and Reports... 401 Qualifying Circumstances for Anesthesia... 402 Moderate (Conscious) Sedation... 403 Other Services and Procedures... 404 Home Health Procedures/Services... 435 Medication Therapy Management... 438 2017 Optum360, LLC 2017 American Medical Association. All Rights Reserved. i
Introduction Optum360 is proud to present the 2017 Medical Services Cross Coder. The popularity of Medical Services Cross Coder in recent years indicates that it has become the quintessential one-stop reference for medical coders. Fully comprehensive and illustrated, Medical Services Cross Coder links more than 900 CPT medical services codes to corresponding diagnosis and procedure codes. This reference is embraced by professional coders working in clinical outpatient, hospital, as well as payer settings. Medical Services Cross Coder is a single repository where every medical services CPT code instantly reveals the most appropriate diagnosis code as well as appropriate codes for ancillary supplies and pharmaceuticals. Medical Services Cross Coder is based on the medicine 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 Medical Services Cross Coder start with the medicine section of the CPT book presenting a general clinical picture of each medical services code. Pertinent related coding relationships were carefully reviewed and screened for appropriate information. Unusual associations not commonly found are not included. Perhaps more significantly, many acute and chronic medical conditions may eventually lead to medical 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 Medical Services Cross Coder. In a similar vein, Medical Services 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 Medical Services 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. Certain types of add-on codes are also treated somewhat differently in Medical Services Cross Coder. These codes are discussed in greater detail under the CPT Codes section later in this introduction. Listings for codes that are modifier 51 exempt or modifier 63 exempt can be found in CPT 2017. As a coding reference, Medical Services Cross Coder presents most likely scenarios as derived from clinical review. However, Medical Services 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. Medical Services 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. Format An understanding of the Medical Services 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 Medical Services Cross Coder provides linked information to the CPT code range 90281 99607 the medicine portion of the CPT book. The codes are divided into the same sections and subsections as the medicine section of the CPT book. For example, the cardiovascular section is divided into subsections including therapeutic services, cardiography, cardiovascular monitoring, device monitoring, echocardiography, cardiac catheterization, electrophysiological procedures, peripheral arterial disease rehabilitation, noninvasive physiologic studies, and other procedures. Codes and Code Ranges The data within each CPT code set of Medical Services Cross Coder is presented as follows: CPT code or code range CPT codes and descriptions Associated CPT codes and descriptions ICD-10-CM diagnostic codes and descriptions HCPCS codes and descriptions For example: 92551 92551 Screening test, pure tone, air only Z00.00 Encounter for general adult medical examination without Z00.01 Encounter for general adult medical examination with abnormal findings Z01.10 Encounter for examination of ears and hearing without Z01.110 Encounter for hearing examination following failed hearing screening Z01.118 Encounter for examination of ears and hearing with other Z01.12 Encounter for hearing conservation and treatment Z97.4 Presence of external hearing-aid HCPCS Level II Supplies & Services V5008 Hearing screening 2017 Optum360, LLC 2017 American Medical Association. All Rights Reserved. i
Vaccines, Toxoids 90476-90477 90476 90477 Adenovirus vaccine, type 4, live, for oral use Adenovirus vaccine, type 7, live, for oral use 90473 90474 Immunization administration by intranasal or oral route; 1 vaccine (single or combination Immunization administration by intranasal or oral route; each additional vaccine (single or combination (List separately in addition to code for 90581 90581 Anthrax vaccine, for subcutaneous or intramuscular use Z03.810 Z20.810 90585 90585 Encounter for observation for suspected exposure to anthrax ruled out Contact with and (suspected) exposure to anthrax Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis, live, for percutaneous use 90586 90586 Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use 51720 Bladder instillation of anticarcinogenic agent (including retention time) [90620] 90620 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB), 2 dose schedule, for intramuscular use [90621] 90621 Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB), 3 dose schedule, for intramuscular use [90625] 90625 Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use 90632-90636 90632 90633 90634 90636 Hepatitis A vaccine (HepA), adult dosage, for intramuscular use Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use Hepatitis A vaccine (HepA), pediatric/adolescent dosage-3 dose schedule, for intramuscular use Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use 90460 90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for Z20.5 Contact with and (suspected) exposure to viral hepatitis Crosswalks 2017 Optum360, LLC CPT only 2017 American Medical Association. All Rights Reserved. ; Female diagnosis : Male diagnosis 9
93015-93018 T82.528A Displacement of other cardiac and vascular devices and implants, initial T82.530A Leakage of surgically created arteriovenous fistula, initial T82.531A Leakage of surgically created arteriovenous shunt, initial T82.533A Leakage of balloon (counterpulsation) device, initial T82.534A Leakage of infusion catheter, initial T82.535A Leakage of umbrella device, initial T82.538A Leakage of other cardiac and vascular devices and implants, initial T82.590A Other mechanical complication of surgically created arteriovenous fistula, initial T82.591A Other mechanical complication of surgically created arteriovenous shunt, initial T82.593A Other mechanical complication of balloon (counterpulsation) device, initial T82.594A Other mechanical complication of infusion catheter, initial T82.595A Other mechanical complication of umbrella device, initial T82.598A Other mechanical complication of other cardiac and vascular devices and implants, initial T82.6XXA Infection and inflammatory reaction due to cardiac valve prosthesis, initial T82.7XXA Infection and inflammatory reaction due to other cardiac and vascular devices, implants and grafts, initial T82.817A Embolism due to cardiac prosthetic devices, implants and grafts, initial T82.827A Fibrosis due to cardiac prosthetic devices, implants and grafts, initial T82.837A Hemorrhage due to cardiac prosthetic devices, implants and grafts, initial T82.847A Pain due to cardiac prosthetic devices, implants and grafts, initial T82.855A Stenosis of coronary artery stent, initial T82.857A Stenosis of other cardiac prosthetic devices, implants and grafts, initial T82.867A Thrombosis due to cardiac prosthetic devices, implants and grafts, initial T82.897A Other specified complication of cardiac prosthetic devices, implants and grafts, initial T82.898A Other specified complication of vascular prosthetic devices, implants and grafts, initial T86.21 Heart transplant rejection T86.22 Heart transplant failure T86.23 Heart transplant infection 93024 93024 Ergonovine provocation test I20.1 I25.110 I25.710 I25.720 I25.730 I25.750 I25.760 I25.790 Z01.810 Angina pectoris with documented spasm Atherosclerotic heart disease of native coronary artery with unstable angina pectoris Atherosclerosis of autologous vein coronary artery bypass graft(s) with unstable angina pectoris unstable angina pectoris with unstable angina pectoris Atherosclerosis of native coronary artery of transplanted heart with unstable angina unstable angina Atherosclerosis of other coronary artery bypass graft(s) with unstable angina pectoris Encounter for preprocedural cardiovascular examination HCPCS Level II Supplies & Services J1330 Injection, ergonovine maleate, up to 0.2 mg 93025 93025 Microvolt T-wave alternans for assessment of ventricular arrhythmias I25.111 I25.118 I25.5 I25.711 I25.718 I25.721 I25.728 I25.731 I25.738 I25.751 I25.758 I25.761 I25.768 I25.791 I25.798 I25.89 I42.1 I42.2 I42.5 I42.8 I47.0 I47.1 I47.2 I49.01 I49.02 R55 Atherosclerotic heart disease of native coronary artery with angina pectoris with documented spasm Atherosclerotic heart disease of native coronary artery with other forms of angina pectoris Ischemic cardiomyopathy Atherosclerosis of autologous vein coronary artery bypass graft(s) with Atherosclerosis of autologous vein coronary artery bypass graft(s) with other forms of angina pectoris other forms of angina pectoris with with other forms of angina pectoris Atherosclerosis of native coronary artery of transplanted heart with angina pectoris with documented spasm Atherosclerosis of native coronary artery of transplanted heart with other forms of angina pectoris other forms of angina pectoris Atherosclerosis of other coronary artery bypass graft(s) with angina pectoris with documented spasm Atherosclerosis of other coronary artery bypass graft(s) with other forms of angina pectoris Other forms of chronic ischemic heart disease Obstructive hypertrophic cardiomyopathy Other hypertrophic cardiomyopathy Other restrictive cardiomyopathy Other cardiomyopathies Re-entry ventricular arrhythmia Supraventricular tachycardia Ventricular tachycardia Ventricular fibrillation Ventricular flutter Syncope and collapse 93040-93042 93040 93041 93042 Rhythm ECG, 1-3 leads; with interpretation and report tracing only without interpretation and report interpretation and report only I44.0 I44.1 I44.2 I44.39 I45.2 I45.3 I45.4 I45.5 I45.6 I45.81 I45.89 I46.2 I46.8 I47.0 Medical Services Cross Coder Atrioventricular block, first degree Atrioventricular block, second degree Atrioventricular block, complete Other atrioventricular block Bifascicular block Trifascicular block Nonspecific intraventricular block Other specified heart block Pre-excitation syndrome Long QT syndrome Other specified conduction disorders Cardiac arrest due to underlying cardiac condition Cardiac arrest due to other underlying condition Re-entry ventricular arrhythmia 208 ; Female diagnosis : Male diagnosis Crosswalks 2017 Optum360, LLC CPT only 2017 American Medical Association. All Rights Reserved.