Medicare Correct Coding Guide - OptumCoding.com

Medicare Correct Coding Guide

Contents
Getting Started with Medicare Correct Coding Guide ................................................................................Introduction–1
Introduction .............................................................................................................................................Introduction–3
Resource-Based Relative Value Scale (RBRVS) ..................................................................................................Introduction–3
Correct Coding Initiative (CCI) ........................................................................................................................Introduction–3
Medically Unlikely Edits............................................................................................................................Introduction–4
Manual Organization .......................................................................................................................................Introduction–4
How to Use This Book .....................................................................................................................................Introduction–5
Resource-Based Relative Value Scale (RBRVS) Payment Computation .......................................................Introduction–5
Modifiers ..........................................................................................................................................................Introduction–6
Surgery Modifiers .....................................................................................................................................Introduction–6
Modifiers Affecting Correct Coding Edits .................................................................................................Introduction–6
Other Payment Indicators ................................................................................................................................Introduction–7
Status Indicator ........................................................................................................................................Introduction–7
Global Period ...........................................................................................................................................Introduction–7
Physician Supervision Level ......................................................................................................................Introduction–7
Definitions ...............................................................................................................................................Introduction–7
Levels of Physician Supervision of Diagnostic Tests...................................................................................Introduction–7
Correct Coding Initiative (CCI) ........................................................................................................................Introduction–8
Step-by-Step Instructions .................................................................................................................................Introduction–9
Code Pair Additions ................................................................................................................... Summary of Changes–1
Code Pair Deletions .................................................................................................................. Summary of Changes–26
Modifier Revisions .................................................................................................................... Summary of Changes–36
Edit Revisions ............................................................................................................................ Summary of Changes–37
General Correct Coding Policies .......................................................................................................................General–1
A. Introduction ............................................................................................................................................... General–1
B. Coding Based on Standard of Medical/Surgical Practice ............................................................................... General–2
C. Medical/Surgical Package ............................................................................................................................ General–3
D. Evaluation and Management Services ......................................................................................................... General–4
E. Modifiers and Modifier Indicators ............................................................................................................... General–5
F. Standard Preparation/Monitoring Services for Anesthesia ............................................................................ General–7
G. Anesthesia Service Included in the Surgical Procedure ................................................................................ General–7
H. HCPCS/CPT Procedure Code Definition ..................................................................................................... General–7
I. CPT Manual and CMS Coding Manual Instructions ..................................................................................... General–8
J. CPT “Separate Procedure” Definition ........................................................................................................... General–8
K. Family of Codes .......................................................................................................................................... General–8
L. More Extensive Procedure ........................................................................................................................... General–8
M. Sequential Procedure .................................................................................................................................. General–9
N. Laboratory Panel ......................................................................................................................................... General–9
O. Misuse of Column 2 Code with Column 1 Code ......................................................................................... General–9
P. Mutually Exclusive Procedures .................................................................................................................... General–9
Q. Gender-Specific Procedure (formerly Designation of Sex) ........................................................................... General–9
R. Add-on Codes ............................................................................................................................................. General–9
S. Excluded Service ....................................................................................................................................... General–10
T. Unlisted Service or Procedure ................................................................................................................... General–10
U. Modified, Deleted, and Added Code Pairs/Edits ........................................................................................ General–10
V. Medically Unlikely Edits ........................................................................................................................... General–10
Surgery: Integumentary System (CPT Codes 10000–19999) ..................................................................Integumentary–i
Correct Coding Policies ..................................................................................................................................Integumentary–i
A. Introduction ......................................................................................................................................Integumentary–i
B. Evaluation and Management (E/M) Services ........................................................................................Integumentary–i
C. Anesthesia ..........................................................................................................................................Integumentary–i
D. Incision and Drainage .......................................................................................................................Integumentary–ii
E. Lesion Removal .................................................................................................................................Integumentary–ii
F. Mohs Micrographic Surgery .............................................................................................................Integumentary–iii
© 2012 OptumInsight January 2012 Contents–1
CPT only © 2011 American Medical Association. All Rights Reserved.

Getting Started with Medicare Correct Coding Guide
Welcome to Medicare Correct Coding Guide! This page will help you navigate the data within. For more detailed information about this data, or
how to use the Medicare Correct Coding Guide, please refer to the appropriate pages in the Introduction and General Correct Coding Policies
chapters. Within each section of the book, you will also find detailed information for correct coding within specific sections of CPT® codes.
If you have additional questions, please contact Customer Service at 800.464.3649.
CPT or HCPCS code.
This code represents the column 1 code within the column 1/
column 2 correct coding edits table, (formerly called the
“comprehensive” code), which indicates the major service or
procedure. Only codes with Correct Coding Initiative (CCI) edits
and/or Medicare physician fee schedule (MPFS) relative values are
included in this book.
Full CPT or HCPCS Level II description.
RBRVS relative value units (RVUs) from the MPFS.
• When billing multiple procedures, the code with the highest
RVU is generally considered the primary procedure.
• For more information about RBRVS, see pages
Introduction-3 and 4.
• For information about calculating fees, see page Introduction-5.
Global period as listed in the MPFS.
• This indicator is sometimes referred to as follow-up days.
• For a complete description of this field, see page Introduction-7.
MPFS modifiers.
• Medicare coverage for bilateral procedures (50), multiple
procedures (51), cosurgeons (62), team surgery (66), and assistant
surgeon (80 and 82).
• For a complete description of MPFS modifiers and indicators, see
page Introduction-6.
• For a complete list of CPT modifiers, see Appendix B.
• For information about the use of modifiers with CCI, see page
General-5.
Medicare physician fee schedule status indicator.
• Indicates codes that are included, excluded, bundled, or not
valid for Medicare payment purposes.
• For a complete list of status indicators, see page Introduction-7.
Physician supervision level indicator.
• Applies to every diagnostic test paid under the MPFS.
• Many codes have 9 to indicate that this concept does not apply.
• For a full description of each indicator, see page Introduction-7.
Medically Unlikely Edits
• These indicate the maximum units of service (UOS) for a CPT/
HCPCS code for the service provided to the same patient on the
same date of service.
Correct Coding Initiative (CCI) edits.
• Includes column 2 of the correct coding (column 1/
column 2) edits (previously called “component” codes) as well
as the mutually exclusive edits.
• A shaded gray box over an edit code indicates a modifier may be
used to bypass a CCI edit, when appropriate.
• A symbol key appears on each page of data in the book.
• For a full description of each symbol, see the section “General
Correct Coding Policies.”
© 2012 OptumInsight January 2012 Introduction–1
CPT only © 2011 American Medical Association. All Rights Reserved.

Medicare Correct Coding Guide (CCI Version18.0)
26445
Tenolysis, extensor tendon, hand OR finger, each tendon
RELATIVE VALUE UNITS
OTHER
Work MP PE-nf PE-f Total-nf Total-f Global P MUE
4.45 0.78 11.68 11.68 16.91 16.91 90 —
MODIFIERS
INDICATORS
50 51 62 66 80,82 Suprv Status
0 4 NPD NPD NPD 09 A
CORRECT CODING EDITS
01810 l, 0213T n, 0216T n, 0228T f, 0230T f, 12032 f, 20526 n, 20527 n, 20550 n,
20551 n, 20552 n, 20553 n, 25000 f, 25118 f, 25259 f, 25295 f, 26135 f, 26140 f,
26185 m, 26340 f, 26460 f, 26546 3, 29075 r,29086 f, 29130 r,29131 r,29280 r,
29584 r,36000 f, 36400 f, 36405 f, 36406 f, 36410 f, 36420 f, 36425 f, 36430 f,
36440 f, 36600 f, 36640 f, 37202 n, 43752 f, 51701 f, 51702 f, 51703 f, 62310 f,
62311 f, 62318 n, 62319 n, 64400 f, 64402 f, 64405 f, 64408 f, 64410 f, 64412 f,
64413 f, 64415 n, 64416 n, 64417 n, 64418 f, 64420 f, 64421 f, 64425 f, 64430 f,
64435 f, 64445 f, 64446 f, 64447 f, 64448 f, 64449 f, 64450 n, 64479 f, 64483 f,
64490 n, 64493 n, 64505 f, 64508 f, 64510 f, 64517 f, 64520 f, 64530 f, 69990 n,
93000 f, 93005 f, 93010 f, 93040 f, 93041 f, 93042 f, 93318 f, 94002 f, 94200 f,
94250 f, 94680 f, 94681 f, 94690 f, 94770 f, 95812 f, 95813 f, 95816 f, 95819 f,
95822 f, 95829 f, 95955 f, 96360 f, 96365 f, 96372 f, 96374 f, 96375 f, 96376 f,
99148 n, 99149 n, 99150 n
26449
Tenolysis, complex, extensor tendon, finger, including forearm, each tendon
RELATIVE VALUE UNITS
OTHER
Work MP PE-nf PE-f Total-nf Total-f Global P MUE
8.59 1.51 10.86 10.86 20.96 20.96 90 —
MODIFIERS
INDICATORS
50 51 62 66 80,82 Suprv Status
0 4 NPD NPD DOC 09 A
CORRECT CODING EDITS
01810 l, 0213T n, 0216T n, 0228T f, 0230T f, 20526 n, 20527 n, 20550 n, 20551 n,
20552 n, 20553 n, 25000 f, 25118 f, 25259 f, 26135 f, 26140 f, 26185 m, 26340 f,
26445 t, 26460 f, 26546 3, 29075 r,29086 f, 29130 r,29131 r,29280 r,29584 r,
36000 f, 36400 f, 36405 f, 36406 f, 36410 f, 36420 f, 36425 f, 36430 f, 36440 f,
36600 f, 36640 f, 37202 n, 43752 f, 51701 f, 51702 f, 51703 f, 62310 f, 62311 f,
62318 n, 62319 n, 64400 f, 64402 f, 64405 f, 64408 f, 64410 f, 64412 f, 64413 f,
64415 n, 64416 n, 64417 n, 64418 f, 64420 f, 64421 f, 64425 f, 64430 f, 64435 f,
64445 f, 64446 f, 64447 f, 64448 f, 64449 f, 64450 n, 64479 f, 64483 f, 64490 n,
64493 n, 64505 f, 64508 f, 64510 f, 64517 f, 64520 f, 64530 f, 69990 n, 93000 f,
93005 f, 93010 f, 93040 f, 93041 f, 93042 f, 93318 f, 94002 f, 94200 f, 94250 f,
94680 f, 94681 f, 94690 f, 94770 f, 95812 f, 95813 f, 95816 f, 95819 f, 95822 f,
95829 f, 95955 f, 96360 f, 96365 f, 96372 f, 96374 f, 96375 f, 96376 f, 99148 n,
99149 n, 99150 n
26450
Tenotomy, flexor, palm, open, each tendon
RELATIVE VALUE UNITS
OTHER
Work MP PE-nf PE-f Total-nf Total-f Global P MUE
3.79 0.68 7.31 7.31 11.78 11.78 90 —
MODIFIERS
INDICATORS
50 51 62 66 80,82 Suprv Status
0 4 NPD NPD DOC 09 A
CORRECT CODING EDITS
01810 l, 0213T n, 0216T n, 0228T f, 0230T f, 11010 3, 20526 n, 20527 n, 20550 n,
20551 n, 20552 n, 20553 n, 25259 f, 26055 f, 26145 f, 26185 m, 26340 f, 26546 3,
29075 r,29086 f, 29130 r,29131 r,29280 r,29584 r,36000 f, 36400 f, 36405 f,
36406 f, 36410 f, 36420 f, 36425 f, 36430 f, 36440 f, 36600 f, 36640 f, 37202 n,
43752 f, 51701 f, 51702 f, 51703 f, 62310 f, 62311 f, 62318 n, 62319 n, 64400 f,
64402 f, 64405 f, 64408 f, 64410 f, 64412 f, 64413 f, 64415 n, 64416 n, 64417 n,
64418 f, 64420 f, 64421 f, 64425 f, 64430 f, 64435 f, 64445 f, 64446 f, 64447 f,
64448 f, 64449 f, 64450 n, 64479 f, 64483 f, 64490 n, 64493 n, 64505 f, 64508 f,
64510 f, 64517 f, 64520 f, 64530 f, 69990 n, 93000 f, 93005 f, 93010 f, 93040 f,
93041 f, 93042 f, 93318 f, 94002 f, 94200 f, 94250 f, 94680 f, 94681 f, 94690 f,
94770 f, 95812 f, 95813 f, 95816 f, 95819 f, 95822 f, 95829 f, 95955 f, 96360 f,
96365 f, 96372 f, 96374 f, 96375 f, 96376 f, 99148 n, 99149 n, 99150 n
26455
Tenotomy, flexor, finger, open, each tendon
RELATIVE VALUE UNITS
OTHER
Work MP PE-nf PE-f Total-nf Total-f Global P MUE
3.76 0.69 7.32 7.32 11.77 11.77 90 —
MODIFIERS
INDICATORS
50 51 62 66 80,82 Suprv Status
0 4 NPD NPD DOC 09 A
CORRECT CODING EDITS
01810 l, 0213T n, 0216T n, 0228T f, 0230T f, 11010 3, 20526 n, 20527 n, 20550 n,
20551 n, 20552 n, 20553 n, 25259 f, 26055 f, 26145 f, 26185 m, 26340 f, 26546 3,
29075 r,29086 f, 29130 r,29131 r,29280 r,29584 r,36000 f, 36400 f, 36405 f,
36406 f, 36410 f, 36420 f, 36425 f, 36430 f, 36440 f, 36600 f, 36640 f, 37202 n,
43752 f, 51701 f, 51702 f, 51703 f, 62310 f, 62311 f, 62318 n, 62319 n, 64400 f,
64402 f, 64405 f, 64408 f, 64410 f, 64412 f, 64413 f, 64415 n, 64416 n, 64417 n,
64418 f, 64420 f, 64421 f, 64425 f, 64430 f, 64435 f, 64445 f, 64446 f, 64447 f,
64448 f, 64449 f, 64450 n, 64479 f, 64483 f, 64490 n, 64493 n, 64505 f, 64508 f,
64510 f, 64517 f, 64520 f, 64530 f, 69990 n, 93000 f, 93005 f, 93010 f, 93040 f,
93041 f, 93042 f, 93318 f, 94002 f, 94200 f, 94250 f, 94680 f, 94681 f, 94690 f,
94770 f, 95812 f, 95813 f, 95816 f, 95819 f, 95822 f, 95829 f, 95955 f, 96360 f,
96365 f, 96372 f, 96374 f, 96375 f, 96376 f, 99148 n, 99149 n, 99150 n
26460
Tenotomy, extensor, hand or finger, open, each tendon
RELATIVE VALUE UNITS
OTHER
Work MP PE-nf PE-f Total-nf Total-f Global P MUE
3.58 0.63 7.24 7.24 11.45 11.45 90 —
MODIFIERS
INDICATORS
50 51 62 66 80,82 Suprv Status
0 4 NPD NPD NPD 09 A
CORRECT CODING EDITS
01810 l, 0213T n, 0216T n, 0228T f, 0230T f, 11010 3, 20526 n, 20527 n, 20550 n,
20551 n, 20552 n, 20553 n, 25116 f, 25118 f, 25259 f, 25295 f, 26135 f, 26140 f,
26185 m, 26340 f, 26546 3, 29075 r,29086 f, 29130 r,29131 r,29280 r,29584 r,
36000 f, 36400 f, 36405 f, 36406 f, 36410 f, 36420 f, 36425 f, 36430 f, 36440 f,
36600 f, 36640 f, 37202 n, 43752 f, 51701 f, 51702 f, 51703 f, 62310 f, 62311 f,
62318 n, 62319 n, 64400 f, 64402 f, 64405 f, 64408 f, 64410 f, 64412 f, 64413 f,
64415 n, 64416 n, 64417 n, 64418 f, 64420 f, 64421 f, 64425 f, 64430 f, 64435 f,
64445 f, 64446 f, 64447 f, 64448 f, 64449 f, 64450 n, 64479 f, 64483 f, 64490 n,
64493 n, 64505 f, 64508 f, 64510 f, 64517 f, 64520 f, 64530 f, 69990 n, 93000 f,
93005 f, 93010 f, 93040 f, 93041 f, 93042 f, 93318 f, 94002 f, 94200 f, 94250 f,
94680 f, 94681 f, 94690 f, 94770 f, 95812 f, 95813 f, 95816 f, 95819 f, 95822 f,
95829 f, 95955 f, 96360 f, 96365 f, 96372 f, 96374 f, 96375 f, 96376 f, 99148 n,
99149 n, 99150 n
26471
Tenodesis; of proximal interphalangeal joint, each joint
Surgery: Musculoskeletal System
RELATIVE VALUE UNITS
OTHER
Work MP PE-nf PE-f Total-nf Total-f Global P MUE
5.90 1.03 10.99 10.99 17.92 17.92 90 —
MODIFIERS
INDICATORS
50 51 62 66 80,82 Suprv Status
0 4 NPD NPD DOC 09 A
CORRECT CODING EDITS
01810 l, 0213T n, 0216T n, 0228T f, 0230T f, 20526 n, 20527 n, 20550 n, 20551 n,
20552 n, 20553 n, 25259 f, 26055 f, 26180 3, 26185 m, 26340 f, 26546 3, 26746 f,
26785 f, 29075 r,29086 f, 29130 r,29131 r,29280 r,29584 r,36000 f, 36400 f,
36405 f, 36406 f, 36410 f, 36420 f, 36425 f, 36430 f, 36440 f, 36600 f, 36640 f,
37202 n, 43752 f, 51701 f, 51702 f, 51703 f, 62310 f, 62311 f, 62318 n, 62319 n,
64400 f, 64402 f, 64405 f, 64408 f, 64410 f, 64412 f, 64413 f, 64415 n, 64416 n,
64417 n, 64418 f, 64420 f, 64421 f, 64425 f, 64430 f, 64435 f, 64445 f, 64446 f,
64447 f, 64448 f, 64449 f, 64450 n, 64479 f, 64483 f, 64490 n, 64493 n, 64505 f,
64508 f, 64510 f, 64517 f, 64520 f, 64530 f, 69990 n, 93000 f, 93005 f, 93010 f,
93040 f, 93041 f, 93042 f, 93318 f, 94002 f, 94200 f, 94250 f, 94680 f, 94681 f,
94690 f, 94770 f, 95812 f, 95813 f, 95816 f, 95819 f, 95822 f, 95829 f, 95955 f,
96360 f, 96365 f, 96372 f, 96374 f, 96375 f, 96376 f, 99148 n, 99149 n, 99150 n
l
f
u
Anesthesia Included in Surgical Procedure
Standards of Medical/Surgical Practice
CPT/HCPCS Procedure Code Definition
r
m
CPT/CMS Coding Manual Instructions
CPT Separate Procedure Definition
´
t
Designation of Gender-specific Procedures
More Extensive Procedure
© 2011 OptumInsight
CPT only © 2011 American Medical Association. All Rights Reserved.
January 2012
Musculoskeletal — 159

Medicare Correct Coding Guide (CCI Version18.0)
Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin saturation with
82820
oxygen)
RELATIVE VALUE UNITS
OTHER
Work MP PE-nf PE-f Total-nf Total-f Global P MUE
0.00 0.00 0.00 0.00 0.00 0.00 NA 1
MODIFIERS
INDICATORS
50 51 62 66 80,82 Suprv Status
NA NA NA NA NA 09 NON
CORRECT CODING EDITS
80500 f, 80502 f
82930
Gastric acid analysis, includes pH if performed, each specimen
RELATIVE VALUE UNITS
Work MP PE-nf
0.00 0.00 0.00
MODIFIERS
50 51 62
NA NA NA
CORRECT CODING EDITS
83986 u
82945
PE-f
0.00
66
NA
Glucose, body fluid, other than blood
RELATIVE VALUE UNITS
Work MP PE-nf
0.00 0.00 0.00
MODIFIERS
50 51 62
NA NA NA
CORRECT CODING EDITS
82947 3, 82948 3
PE-f
0.00
66
NA
OTHER
Total-nf Total-f Global P MUE
0.00 0.00 NA —
INDICATORS
80,82 Suprv Status
NA 09 NON
OTHER
Total-nf Total-f Global P MUE
0.00 0.00 NA —
INDICATORS
80,82 Suprv Status
NA 09 NON
82951
Glucose; tolerance test (GTT), 3 specimens (includes glucose)
RELATIVE VALUE UNITS
Work MP PE-nf PE-f
0.00 0.00 0.00 0.00
MODIFIERS
50 51 62 66
NA NA NA NA
CORRECT CODING EDITS
80500 f, 80502 f, 82948 f, 82953 3
OTHER
Total-nf Total-f Global P MUE
0.00 0.00 NA 1
INDICATORS
80,82 Suprv Status
NA 09 NON
Glucose; tolerance test, each additional beyond 3 specimens (List separately
82952
in addition to code for primary procedure)
RELATIVE VALUE UNITS
OTHER
Work MP PE-nf PE-f Total-nf Total-f Global P MUE
0.00 0.00 0.00 0.00 0.00 0.00 NA 3
MODIFIERS
INDICATORS
50 51 62 66 80,82 Suprv Status
NA NA NA NA NA 09 NON
CORRECT CODING EDITS
80500 f, 80502 f, 82947 3, 82953 3
82953
Glucose; tolbutamide tolerance test
RELATIVE VALUE UNITS
Work MP PE-nf
0.00 0.00 0.00
MODIFIERS
50 51 62
NA NA NA
CORRECT CODING EDITS
80500 f, 80502 f
PE-f
0.00
66
NA
Pathology and Laboratory Services
OTHER
Total-nf Total-f Global P MUE
0.00 0.00 NA 1
INDICATORS
80,82 Suprv Status
NA 09 NON
82947
Glucose; quantitative, blood (except reagent strip)
RELATIVE VALUE UNITS
Work MP PE-nf
0.00 0.00 0.00
MODIFIERS
50 51 62
NA NA NA
CORRECT CODING EDITS
80500 f, 80502 f, 82948 t,
PE-f
0.00
66
NA
82951 3, 82953 3
OTHER
Total-nf Total-f Global P MUE
0.00 0.00 NA —
INDICATORS
80,82 Suprv Status
NA 09 NON
Glucose, blood by glucose monitoring device(s) cleared by the FDA
82962
specifically for home use
RELATIVE VALUE UNITS
OTHER
Work MP PE-nf PE-f Total-nf Total-f Global P MUE
0.00 0.00 0.00 0.00 0.00 0.00 NA —
MODIFIERS
INDICATORS
50 51 62 66 80,82 Suprv Status
NA NA NA NA NA 09 NON
CORRECT CODING EDITS
82947 3, 82948 3, 82950 3, 82951 3, 82952 3, 82953 3
82948
Glucose; blood, reagent strip
RELATIVE VALUE UNITS
Work MP PE-nf PE-f
0.00 0.00 0.00 0.00
MODIFIERS
50 51 62 66
NA NA NA NA
CORRECT CODING EDITS
82950 3, 82952 3, 82953 3
OTHER
Total-nf Total-f Global P MUE
0.00 0.00 NA —
INDICATORS
80,82 Suprv Status
NA 09 NON
82985
Glycated protein
RELATIVE VALUE UNITS
Work MP PE-nf
0.00 0.00 0.00
MODIFIERS
50 51 62
NA NA NA
CORRECT CODING EDITS
83036 f, 83037 f
PE-f
0.00
66
NA
OTHER
Total-nf Total-f Global P MUE
0.00 0.00 NA 1
INDICATORS
80,82 Suprv Status
NA 09 NON
82950
Glucose; post glucose dose (includes glucose)
RELATIVE VALUE UNITS
Work MP PE-nf
0.00 0.00 0.00
MODIFIERS
50 51 62
NA NA NA
CORRECT CODING EDITS
82951 3, 82953 3
PE-f
0.00
66
NA
OTHER
Total-nf Total-f Global P MUE
0.00 0.00 NA 3
INDICATORS
80,82 Suprv Status
NA 09 NON
83001
Gonadotropin; follicle stimulating hormone (FSH)
RELATIVE VALUE UNITS
Work MP PE-nf
0.00 0.00 0.00
MODIFIERS
50 51 62
NA NA NA
CORRECT CODING EDITS
80500 f, 80502 f
PE-f
0.00
66
NA
OTHER
Total-nf Total-f Global P MUE
0.00 0.00 NA —
INDICATORS
80,82 Suprv Status
NA 09 NON
l
f
u
Anesthesia Included in Surgical Procedure
Standards of Medical/Surgical Practice
CPT/HCPCS Procedure Code Definition
r
m
CPT/CMS Coding Manual Instructions
CPT Separate Procedure Definition
´
t
Designation of Gender-specific Procedures
More Extensive Procedure
© 2011 OptumInsight
CPT only © 2011 American Medical Association. All Rights Reserved.
January 2012
Pathology — 9