CODING COMPANION Ophthalmology A comprehensive illustrated guide to coding and reimbursement SAMPLE 2022 optum360coding.com ATEY_ATEY21_CVR_Final.indd 1 5/7/2020 10:54:15 AM Contents Getting Started with Coding Companion..................................i Pelvis/Hip.......................................................................................... 106 CPT Codes ...............................................................................................i Femur/Knee ..................................................................................... 200 ICD-10-CM...............................................................................................i Leg/Ankle ......................................................................................... 289 Detailed Code Information.................................................................i Foot/Toes.......................................................................................... 361 Appendix Codes and Descriptions....................................................i Casts/Strapping............................................................................... 469 CCI Edit Updates....................................................................................i Arthroscopy ..................................................................................... 482 Index.........................................................................................................i Arteries/Veins .................................................................................. 512 General Guidelines ...............................................................................i Extracranial Nerves ........................................................................ 520 Medical Services ............................................................................. 560 Orthopaedics: Hips & Below Procedures and Services.............1 HCPCS................................................................................................ 561 E/M Services ......................................................................................... 1 Appendix .......................................................................................... 569 Skin.......................................................................................................22 Nails......................................................................................................29 Correct Coding Initiative Update ....................................... 603 Repair...................................................................................................33 General Musculoskeletal .................................................................70 Index..................................................................................... 715 Spine ..................................................................................................105 SAMPLE CPT © 2021 American Medical Association. All Rights Reserved. © 2021 Optum360, LLC Coding Companion for Orthopaedics - Lower: Hips and Below Contents — i Getting Started with Coding Companion Coding Companion for Orthopaedics — Lower: Hips and Below is Category II codes are not published in this book. Refer to the CPT designed to be a guide to the specialty procedures classified in the book for code descriptions. CPT® book. It is structured to help coders understand procedures and translate physician narrative into correct CPT codes by CCI Edit Updates The Coding Companion series includes the list of codes from the combining many clinical resources into one, easy-to-use source official Centers for Medicare and Medicaid Services’ National Correct book. Coding Policy Manual for Part B Medicare Contractors that are The book also allows coders to validate the intended code selection considered to be an integral part of the comprehensive code or by providing an easy-to-understand explanation of the procedure mutually exclusive of it and should not be reported separately. The and associated conditions or indications for performing the various codes in the Correct Coding Initiative (CCI) section are from version procedures. As a result, data quality and reimbursement will be XX.X, the most current version available at press time. The CCI edits improved by providing code-specific clinical information and are located in a section at the back of the book. Optum360 helpful tips regarding the coding of procedures. maintains a website to accompany the Coding Companions series CPT Codes and posts updated CCI edits on this website so that current For ease of use, evaluation and management codes related to information is available before the next edition. The website address Orthopaedics are listed first in the Coding Companion. All other CPT is http://www.optum360coding.com/ProductUpdates/. The 2022 2 codes in Coding Companion are listed in ascending numeric order. edition password is: XXXXXXX 2. Log in each quarter to ensure Included in the code set are all surgery, radiology, laboratory, and you receive the most current updates. An email reminder will also medicine codes pertinent to the specialty. Each CPT code is followed be sent to you to let you know when the updates are available. by its official CPT code description. Index Resequencing of CPT Codes A comprehensive index is provided for easy access to the codes. The The American Medical Association (AMA) employs a resequenced index entries have several axes. A code can be looked up by its numbering methodology. According to the AMA, there are instances procedural name or by the diagnoses commonly associated with it. where a new code is needed within an existing grouping of codes, Codes are also indexed anatomically. For example: but an unused code number is not available to keep the range 69501 Transmastoid antrotomy (simple mastoidectomy) sequential. In the instance where the existing codes were not could be found in the index under the following main terms: changed or had only minimal changes, the AMA assigned a code out of numeric sequence with the other related codes being grouped Antrotomy together. The resequenced codes and their descriptions have been Transmastoid, 69501 placed with their related codes, out of numeric sequence. Excision CPT codes within the Optum360 Coding Companion series display in Mastoid their resequenced order. Resequenced codes are enclosed in Simple, 69501 brackets for easy identification. General Guidelines ICD-10-CM Providers Overall, the 10th revision goes into greater clinical detail than did The AMA advises coders that while a particular service or procedure ICD-9-CM and addresses information about previously classified may be assigned to a specific section, it is not limited to use only by diseases, as well as those diseases discovered since the last revision. that specialty group (see paragraphs two and three under Conditions are grouped with general epidemiological purposes and “Instructions for Use of the CPT Codebook” on page xiv of the CPT the evaluation of health care in mind. New features have been Book). Additionally, the procedures and services listed throughout added, and conditions have been reorganized, although the format the book are for use by any qualified physician or other qualified and conventions of the classification remain unchanged for the health care professional or entity (e.g., hospitals, laboratories, or most part. home health agencies). Keep in mind that there may be other Detailed Code Information policies or guidance that can affect who may report a specific One or more columns are dedicated to each procedure or service or service. to a series of similar procedures/services. Following the specific CPT Supplies code and its narrative, is a combination of features. A sample is Some payers may allow physicians to separately report drugs and shown on page ii. The black boxes with numbers in them other supplies when reporting the place of service as office or other correspond to the information on the page following the sample. nonfacility setting. Drugs and supplies are to be reported by the Appendix Codes and DescriptionsSAMPLEfacility only when performed in a facility setting. Some CPT codes are presented in a less comprehensive format in the Professional and Technical Component appendix. The CPT codes appropriate to the specialty are included in Radiology and some pathology codes often have a technical and a the appendix with the official CPT code description. The codes are professional component. When physicians do not own their own presented in numeric order, and each code is followed by an equipment and send their patients to outside testing facilities, they easy-to-understand lay description of the procedure. should append modifier 26 to the procedural code to indicate they The codes in the appendix are presented in the following order: performed only the professional component. • HCPCS • Pathology and Laboratory • Surgery • Medicine Services •Radiology •Category III CPT © 2021 American Medical Association. All Rights Reserved. © 2021 Optum360, LLC Coding Companion for Orthopaedics - Lower: Hips and Below Getting Started with Coding Companion — i 99211 does not require the presence of a physician or other qualified health 99211-99215 care professional. For office or other outpatient services for a new patient, see 99202-99205. For observation care services, see 99217-99226. For patients s 99211 Office or other outpatient visit for the evaluation and admitted and discharged from observation or inpatient status