PCC.book Page 1 W ednesday, N ovem ber 23, 2011 10:17 AM Procedural Cross Coder Essential links from ICD-9-CM volume 3 procedure codes to CPT® and HCPCS Level II codes 2013 PCC.book Page i W ednesday, N ovem ber 23, 2011 10:17 AM Contents Introduction.............................................................. i Operations on the Hemic and Lymphatic History..........................................................................i System (40–41) ................................................ 121 Format..........................................................................i Operations on the Digestive System (42–54) ....... 127 Organization.................................................................i Operations on the Urinary System (55–59) ......... 170 Crosswalking the Codes...............................................ii Operations on the Male Genital Organs Procedures and Interventions NEC (00) .................. 1 (60–64) ............................................................. 184 Operations on the Nervous System (01–05) ............ 8 Operations on the Female Genital Organs Operations on the Endocrine System (06–07) ....... 26 (65–71) ............................................................. 193 Operations on the Eye (08–16) .............................. 31 Obstetrical Procedures (72–75) ........................... 211 Other Miscellaneous Diagnositic and Operations on the Musculoskeletal Therapeutic Procedures (17.1–17.71) ................ 52 System (76–84) ................................................. 217 Operations on the Ear (18–20) .............................. 55 Operations on the Integumentary Operations on the Nose Mouth, and System (85–86) ................................................. 288 Pharynx (21–29) ................................................. 61 Miscellaneous Diagnostic and Therapeutic Operations on the Respiratory System (30–34)..... 77 Procedures (87–99)........................................... 305 Operations on the Cardiovascular Glossary ............................................................... 387 System (35–39)................................................... 87 © 2011 Optum CPT © 2011 American Medical Association. All Rights Reserved. i PCC.book Page i W ednesday, N ovem ber 23, 2011 10:17 AM Introduction Parallel procedural coding systems have been in place in U.S. • Each ICD-9-CM volume 3 code is linked to all applicable CPT medical reimbursement circles for decades. ICD-9-CM volume 3, codes, which are printed with their official, complete AMA established in 1975 by the federal Centers for Medicare and descriptions. Medicaid Services (CMS), is now in its fifth edition. ICD-9-CM, • Each ICD-9-CM volume 3 code is linked to all applicable volume 3 is the coding system used by hospitals to report inpatient surgical HCPCS codes. care. The American Medical Association’s (AMA) Current Procedural Terminology (CPT®), first published in 1966, is now in its fourth • All ICD-9-CM volume 3 codes are valid and of the highest edition. This coding system covers outpatient (office) services, and level of specificity. inpatient (hospital) services performed specifically by the • The ICD-9-CM volume 3, CPT, and HCPCS code sets have physician. Each system has strengths within the market it serves. been updated to include 2011 changes. Until recently, each was autonomous. Organization Today’s consolidated health care environment is creating conflicts Prior to using the OptumInsight 2012 Procedural Cross Coder, take between the two systems. Many hospitals operate outpatient the time to study the format and to understand the conventions of facilities in which CPT coding is used instead of ICD-9-CM ICD-9-CM and CPT coding. The crosswalk is organized similar to procedural coding. With the advent of ambulatory surgical centers ICD-9-CM volume 3. These codes are presented in numeric order, and physician office surgical suites, many procedures that were and the section title from ICD-9-CM appears at the top of each once performed exclusively for inpatient services now can be page. The sections are organized by anatomy, rather than surgical performed as either inpatient or outpatient services. Consequently, specialty: two coding systems are in use for the same procedures. Procedures and Interventions, NEC (00) Managers have difficulty tracking frequencies or costs when the Operations on the Nervous System (01-05) facility data contains both ICD-9-CM and CPT codes. Payers and government statisticians become mired in tracking trends when Operations on the Endocrine System (06-07) their statistics contain both code sets. The OptumInsight 2012 Operations on the Eye (08-16) Procedural Cross Coder is designed to act as a bridge to connect Other Miscellaneous Diagnostic and Therapeutic ICD-9-CM procedural codes and CPT codes. It gives coders an Procedures (17) easy-to-use reference when selecting the correct CPT procedural Operations on the Ear (18-20) code from ICD-9-CM volume 3 codes. The crosswalk translates the Operations on the Nose, Mouth, and Pharynx (21-29) selected procedural codes for services provided by the physician in either the inpatient or outpatient setting. Operations on the Respiratory System (30-34) History Operations on the Cardiovascular System (35-39) Operations on the Hemic and Lymphatic Systems (40-41) ICD-9-CM volume 3 draws heavily from procedural classifications developed in the early 1970s by an international committee Operations on the Digestive System (42-54) sponsored by the World Health Organization (WHO). Significant Operations on the Urinary System (55-59) work on surgical procedures for this project came from the United Operations on the Male Genital Organs (60-64) States, and that original work is the basis for today’s ICD-9-CM, Operations on the Female Genital Organs (65-71) volume 3. Current procedural coding evolved from a three- to Obstetrical Procedures (72-75) four-digit system necessitated by the demand for more specific clinical detail. Operations on the Musculoskeletal System (76-84) Operations on the Integumentary System (85-86) CMS maintains the volume 3 codes, which include operative, diagnostic, and therapeutic procedures. Annual code revisions Miscellaneous Diagnostic and Therapeutic Procedures (87-99) reflect the goal of a procedure coding system that can be used with The most important factor in ICD-9-CM procedure coding is equal efficiency both in hospitals and other primary care settings. understanding the rules. Format Only valid codes—those that are coded to their highest level of OptumInsight 2012 Procedural Cross Coder offers these features: specificity—are included in the crosswalk. If you are seeking information about a code that is not at its highest level of specificity, • Numeric listing of all valid ICD-9-CM volume 3 codes and you should seek your answer among all the valid codes within that their official, complete government descriptions. rubric. For instance, if you are working with the invalid code 24.3, review 24.31, 24.32, and 24.39 for the best CPT crosswalk. © 2011 Optum CPT © 2011 American Medical Association. All Rights Reserved. i Procedural Cross Coder 45.62 45.41 45383 Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or Excision of lesion or tissue of large intestine snare technique CPT Codes 45384 Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), 44110 Excision of 1 or more lesions of small or large intestine not requiring anastomosis, or other lesion(s) by hot biopsy forceps or bipolar cautery exteriorization, or fistulization; single enterotomy 45385 Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s), polyp(s), 44111 Excision of 1 or more lesions of small or large intestine not requiring anastomosis, or other lesion(s) by snare technique exteriorization, or fistulization; multiple enterotomies 45.49 45.42 Other destruction of lesion of large intestine Endoscopic polypectomy of large intestine CPT Codes CPT Codes 44799 Unlisted procedure, intestine 44392 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery 45.50 44393 Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s) not Isolation of intestinal segment, not otherwise specified amenable to removal by hot biopsy forceps, bipolar cautery or snare technique 44394 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by CPT Codes snare technique See code for primary procedure. 45320 Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique (eg, 45.51 laser) Isolation of segment of small intestine 45333 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery CPT Codes 45338 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare See code for primary procedure. technique 45339 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) not 45.52 amenable to removal by hot biopsy forceps, bipolar cautery or snare technique Isolation of segment of large intestine 45383 Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar