Anesthesia Cross Coder Essential links from CPT codes to ICD-9-CM and HCPCS codes 2015
Contents Introduction... i CPT Anesthesia to Procedure Crosswalk...i Format...i Icon Key...ii CPT Codes...ii Resequenced Codes...iii Physicians and Other Qualified Health Care Professional...iii Code Links...iii ICD-9-CM Diagnostic Codes...iv ICD-9-CM to ICD-10 Transition...v ICD-9-CM Procedure Codes...v ICD-9-CM Volume 3 to ICD-10-PCS Transition..vi HCPCS Level II Codes...vi Modifiers...vi Summary...vi CPT Procedure to Anesthesia Code... 1 Head... 37 Neck... 116 Thorax (Chest Wall and Shoulder Girdle)... 138 Intrathoracic... 157 Spine and Spinal Cord... 196 Upper Abdomen... 216 Lower Abdomen...242 Perineum...290 Pelvis (Except Hip)...325 Upper Leg (Except Knee)...334 Knee and Popliteal Area...352 Lower Leg (Below Knee, Includes Ankle and Foot)...372 Shoulder and Axilla...391 Upper Arm and Elbow...404 Forearm, Wrist, and Hand...418 Radiological Procedures...441 Burn Excisions or Debridement...461 Obstetric...466 Other Procedures...478 Introduction/Injection of Anesthetic Agent (Nerve Block), Diagnostic or Therapeutic...479 Moderate (Conscious) Sedation...486 Appendixes Modifiers... 487 Glossary... 489 Crosswalks 2014 OptumInsight, Inc. CPT 2013 American Medical Association. All Rights Reserved.
Introduction Optum is pleased to present the 2013 Anesthesia Cross Coder. Fully comprehensive, the Anesthesia Cross Coder links more than 300 CPT codes commonly used by anesthesiologists to corresponding surgical CPT and ICD-9-CM diagnosis codes, and as appropriate, ICD-9-CM procedure and HCPCS Level II codes. Optum believes that professional coders working in physician offices, clinical outpatient areas, hospitals, as well as payer settings will find this reference a useful tool. Anesthesia Cross Coder is based on the Anesthesia section of Physicians Current Procedural Terminology (CPT ), but includes CPT codes commonly used by practicing anesthesiologists from other sections of the CPT system as well. Up-to-date CPT codes link to the following related medical coding systems: International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) Healthcare Common Procedure Coding System (HCPCS) Level II All coding relationships in Anesthesia Cross Coder start with the Anesthesia section of the CPT book presenting a general clinical picture of each anesthesia code. Pertinent surgical related coding relationships were carefully reviewed and screened for appropriate information. 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 too numerous and do not appear in Anesthesia Cross Coder. In a similar vein, Anesthesia Cross Coder features codes that require accompanying etiologies or manifestations (e.g., Code first underlying disease ). However, associated infectious and parasitic diseases are, once again, simply too numerous to list and do not appear in Anesthesia 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. As a coding reference, Anesthesia Cross Coder presents most likely scenarios as derived from clinical information and official sources. Anesthesia 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 anesthesia coding are followed, excepted diagnosis codes may prove appropriate to a specific code scenario. Anesthesia Cross Coder does not include coding rules or guidelines. Once again, the user is urged to consult the original coding reference (e.g., CPT, ICD-9-CM, HCPCS Level II, etc.) or one of several reputable medical coding instruction manuals. CPT Anesthesia to Procedure Code Crosswalk The surgical CPT codes are listed with the corresponding anesthesia CPT codes. The relationships were developed by comparing each individual surgical CPT code, current practice patterns, and techniques to determine the appropriate relationship of the surgical code to the anesthesia CPT code assignment. Using this methodology, the surgical codes and anesthesia codes are assigned the most appropriate coding relationships. Optum does not rely on the combinations suggested by other organizations or groups with the exception of CMS. Reimbursement data was not used to suggest one code combination over another. Format An understanding of the Anesthesia Cross Coder format allows users to easily navigate its content. Information within the main section ties to the CPT book and the codes are presented in the same numeric order as the anesthesia and other appropriate CPT sections. Sections Anesthesia Cross Coder provides linked information to the CPT code range 00100 to 01999, as well as several other code ranges typically used by anesthesiologists. The codes are divided into the same sections as found in the CPT book. Codes and Code Ranges The data within each CPT code set of Anesthesia Cross Coder is presented as follows: Anesthesia CPT code Corresponding surgical CPT codes and descriptions ICD-9-CM diagnostic codes and descriptions ICD-9-CM procedural codes and descriptions, where applicable HCPCS Level II codes and descriptions, where applicable Crosswalks 201 OptumInsight, Inc. CPT 201 American Medical Association. All Rights Reserved. i
CPT Procedure to Anesthesia Code 0051T 0052T 0053T 0071T 0072T 0073T 0075T 01925 0078T 01926 0080T 01925 0099T 0100T 00145 0102T 01730 0123T 00147 0124T 0169T 00214 0171T 0182T 0184T 0191T 0192T 0195T 0200T 0201T 0202T 0219T 00600 0220T 00620 0221T 0226T 0227T 0234T 0235T 0236T 0237T 01650 01770 0238T 01270 0245T 0246T 0247T 0248T 0249T 0253T 0254T 0255T 0262T 00560 00561 00562 0263T 01112 0265T 01112 0266T 0267T 0268T 0269T 0270T 0271T 0274T 0275T 0281T 0282T 0283T 0284T 0288T 0293T 0294T 0299T 01200 0302T 0303T 0304T 0307T 0308T 00142 0312T 00790 0313T 00790 0314T 00792 0315T 0316T 0318T 00561 00562 00563 0319T 0320T 0321T 0322T 0323T 0324T 0325T 0326T 00537 10060 10061 10080 10081 10120 10121 10140 10160 10180 11000 11004 11005 00700 00800 11006 11010 11011 00402 00700 00730 01250 01320 01470 01710 01810 11012 00190 00450 01120 01230 01360 01392 01400 01480 01630 01740 01830 11042 11043 00402 01250 01320 01470 01710 01810 11044 00160 00190 00450 01120 01230 01360 01392 01400 01480 01630 01740 01742 01830 11055 11056 11057 11100 11200 11300 11301 11302 11303 11305 11306 11307 11308 11310 11311 11312 11313 11400 11401 1 201 OptumInsight, Inc. CPT 2013 American Medical Association. All Rights Reserved. 4
Lower Leg (Below Knee, Includes Ankle and Foot) Anesthesia for all closed procedures on lower leg, ankle, and foot Associated CPT Codes 0299T Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial wound 20220 Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs) 20615 Aspiration and injection for treatment of bone cyst 20694 Removal, under anesthesia, of external fixation system 20982 Ablation, bone tumor(s) (eg, osteoid osteoma, metastasis) radiofrequency, percutaneous, including computed tomographic guidance 27648 Injection procedure for ankle arthrography 27745 Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, tibia 27750 Closed treatment of tibial shaft fracture (with or without fibular fracture); without 27752 Closed treatment of tibial shaft fracture (with or without fibular fracture); with, with or without skeletal traction 27756 Percutaneous skeletal fixation of tibial shaft fracture (with or without fibular fracture) (eg, pins or screws) 27760 Closed treatment of medial malleolus fracture; without 27762 Closed treatment of medial malleolus fracture; with, with or without skin or skeletal traction 27767 Closed treatment of posterior malleolus fracture; without 27768 Closed treatment of posterior malleolus fracture; with 27780 Closed treatment of proximal fibula or shaft fracture; without 27781 Closed treatment of proximal fibula or shaft fracture; with 27786 Closed treatment of distal fibular fracture (lateral malleolus); without 27788 Closed treatment of distal fibular fracture (lateral malleolus); with 27808 Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without 27810 Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with 27816 Closed treatment of trimalleolar ankle fracture; without 27818 Closed treatment of trimalleolar ankle fracture; with 27824 Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; without 27825 Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; with skeletal traction and/or requiring 27831 Closed treatment of proximal tibiofibular joint dislocation; requiring anesthesia 27842 Closed treatment of ankle dislocation; requiring anesthesia, with or without percutaneous skeletal fixation 27860 Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus) 28400 Closed treatment of calcaneal fracture; without 28405 Closed treatment of calcaneal fracture; with 28406 Percutaneous skeletal fixation of calcaneal fracture, with 28430 Closed treatment of talus fracture; without 28435 Closed treatment of talus fracture; with 28436 Percutaneous skeletal fixation of talus fracture, with 28450 Treatment of tarsal bone fracture (except talus and calcaneus); without, each 28455 Treatment of tarsal bone fracture (except talus and calcaneus); with, each 28456 28470 28475 28476 28490 28495 28496 28510 28515 28530 28545 28546 28575 28576 28605 28606 28635 28636 28665 28666 28890 29540 29550 29580 29581 29582 Percutaneous skeletal fixation of tarsal bone fracture (except talus and calcaneus), with, each Closed treatment of metatarsal fracture; without, each Closed treatment of metatarsal fracture; with, each Percutaneous skeletal fixation of metatarsal fracture, with, each Closed treatment of fracture great toe, phalanx or phalanges; without Closed treatment of fracture great toe, phalanx or phalanges; with Percutaneous skeletal fixation of fracture great toe, phalanx or phalanges, with Closed treatment of fracture, phalanx or phalanges, other than great toe; without, each Closed treatment of fracture, phalanx or phalanges, other than great toe; with, each Closed treatment of sesamoid fracture Closed treatment of tarsal bone dislocation, other than talotarsal; requiring anesthesia Percutaneous skeletal fixation of tarsal bone dislocation, other than talotarsal, with Closed treatment of talotarsal joint dislocation; requiring anesthesia Percutaneous skeletal fixation of talotarsal joint dislocation, with Closed treatment of tarsometatarsal joint dislocation; requiring anesthesia Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with Closed treatment of metatarsophalangeal joint dislocation; requiring anesthesia Percutaneous skeletal fixation of metatarsophalangeal joint dislocation, with Closed treatment of interphalangeal joint dislocation; requiring anesthesia Percutaneous skeletal fixation of interphalangeal joint dislocation, with Extracorporeal shock wave, high energy, performed by a physician or other qualified health care professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia Strapping; ankle and/or foot Strapping; toes Strapping; Unna boot Application of multi-layer compression system; leg (below knee), including ankle and foot Application of multi-layer compression system; thigh and leg, including ankle and foot, when performed ICD-9-CM Diagnostic 170.7 Malignant neoplasm of long bones of lower limb 170.8 Malignant neoplasm of short bones of lower limb 198.5 Secondary malignant neoplasm of bone and bone marrow 213.7 Benign neoplasm of long bones of lower limb 213.8 Benign neoplasm of short bones of lower limb 238.0 Neoplasm of uncertain behavior of bone and articular cartilage 239.2 Neoplasms of unspecified nature of bone, soft tissue, and skin 275.40 Unspecified disorder of calcium metabolism (Use additional code to identify any associated intellectual disabilities) 2 275.42 Hypercalcemia (Use additional code to identify any associated intellectual disabilities) 275.49 Other disorders of calcium metabolism (Use additional code to identify any associated intellectual disabilities) 715.97 Osteoarthrosis, unspecified whether generalized or localized, ankle and foot 2 718.17 Loose body in ankle and foot joint 718.57 Ankylosis of ankle and foot joint 718.76 Developmental dislocation of joint, lower leg 718.77 Developmental dislocation of joint, ankle and foot 719.07 Effusion of ankle and foot joint 2 Unspecified code E Manifestation code 2014 OptumInsight, Inc. 372 ; Female diagnosis : Male diagnosis CPT 2013 American Medical Association. 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