9 series (medicine)

Bio feed- back:

It is a medical modality designed to control autonomic body responses by auditory and visual stimuli to
the senses.

Dialysis:

It is a procedure removing toxins from blood in patients with chronic renal failure (or) acute failure

Immunization and vaccination:

Immunization:

Administration of immunoglobulin into human body which results in to prevent the disease

Vaccination:

Administration of micro-organisms into human body which results in to prevent the disease.

 In immunization & vaccination default we have to code 2 CPTs one is administration code
another one is product code

1. Who all are called health care providers?

i) Physician /doctor/MD

ii) Mid-level providers (e.g) physician assistants, NP (nurse practitioner)

Example:

1. 25 YEAR OLD PT - Anthrax vaccine, for subcutaneous, Pneumococcal conjugate vaccine, 13

valent (PCV13), for intramuscular use, Typhoid vaccine, live, oral

Ans:

How to <18 years counseling

Product:

1 (or) 2 (or) more components combining administered through 1 injection (Each injection)

Component:

1 micro- organism = 1 component

MMR (Mumps Measles Rubella)

90460

Each product of the initial component it will go for initial code

90461

Remaining components of each product except initial

{If MD performing E/M with administration of vaccine then your answer format is 99xxx/25 vaccine
code, product code}

1. MMRV

M -> measles - 90460

M -> mumps -90461

R -> rubella -90461

V -> varicella -90461

Ans: 90460, 90461x3

Example:

1. Patient age is 4 years with counseling: MMR-SQ, DTaP-IM, and VAR-SQ:

2. Patient age is 44 years with counseling: MMR-SQ, DTaP-IM, and VAR-SQ:

 Psychiatry

Diagnosis Psychotherapy Crisis (90839, +90840)

90791

90792

Without E/M (90832) With E/M (99XXX, +90833)

90834 99XXX

+90836

90837 99XXX

+90838

Psychiatry Diagnostic evaluation:

It is an integrated bio psychosocial assessment including history, mental status, and recommendations.
The evaluation may include communication with family (or) other sources and review and ordering or
diagnostic studies.

Psychiatric diagnostic evaluation with medical service

 It is an integrated bio psychosocial and medical assessment, including, mental status, other
physical examinations elements as indicated, and recommendations
 It also include communication with family (or) other sources. Prescription of medications and
review of laboratory (or) other diagnostic studies

Psychotherapy (1 Question)

 Psychotherapy is the treatment of mental illness and behavioral disturbances in which the
physician (or) other qualified health care professional through definitive therapeutic
communication, attempts to alleviate the emotion disturbances, reverse (or) change
maladaptive patterns of behavior, and encourage personality growth and development.

1. 58 minutes psychotherapy only performed?

Psychotherapy For crisis

It is an urgent assessment and history of a crisis statue, a mental status exam, and a dislocation.

 Same to critical care concept

 90839 (minimum time 30 minutes) first (30MINS TO 1 HR)

+90840 (each additional 30 minutes) (15MINS TO 30MINS)

Example:

2. 110 minutes Psychotherapy For crisis?

3. 75 minutes Psychotherapy For crisis?
4. 74 minutes Psychotherapy For crisis?

Other psychotherapy:

1. Family psychotherapy (without the patient present! 45 minutes):

2. Family psychotherapy (with the patient present! 30 minutes):
3. Family psychotherapy (with the patient present! 25 minutes:
4. MD done EM for office visit NP, History: Comprehensive, Exam: Comprehensive, MDM; Moderate,
then psychotherapy given for 50 minutes AFTER THAT MD GIVEN Pharmacologic management. Including
prescription and review of medication, when performed with psychotherapy services:
5. 45 minutes psychotherapy performed with Pharmacologic management. Including prescription and
review of medication, when performed with psychotherapy services?
1. A patient with chronic renal failures is in the hospital being evaluated by his endocrinologist other just
placing catheter into peritoneal dialysis. The physician is evaluating the during time and running fluid
out of the cavity to make sure the volume of dialysis and the concentration of electrolytes and glucose
are correctly prescribed for this patient. What code should be reported for this service?

a) 90935 b) 90937 c) 90947 d) 90945

2. An inpatient with ESRD placed on a regular schedule of hemodialysis. A patient receives dialysis at the
hospital and he is re-evaluated area by the physician for possible revision of the prescribed treatment on
the re-evaluation the physician determines no changes in regimen is needed. Code for dialysis?

a) 90935 b) 90937 c) 90947 d) 90945

Hospital Monthly service (OP)

 0-less than 2years age--> 4(or) more visits = 90951

---> 2-3 visits = 90952
---> 1 visit = 90953
 2-11 years age---> 4 (or) more visits = 90954
---> 2-3 visits = 90955
---> 1 visits = 90956
 12-19 years age ---> 4 (or) more visits - 90957
2-3 visits - 90958
1 visit - 90959
 20 years (or) more age ---> 4 (or) more visits - 90960
---> 2-3 visits - 90961
---> 1 visits - 90962

Monthly services -> Home (only based one age)

0- <2 years ---> 90963

2-11 years ---> 90964

12-19 years ---> 90965

20 years (or) more ---> 90966

[30 days dialysis in home setting then only you have to go with these codes]

{If one (or) 2 days missing from 30 days means then you have to down codes to less than monthly
service}

Less than monthly service: - only based on age

0 - <2 years - 90967

2-11 years - 90968

12-19 years - 90969

20 years (or) more - 90970

These are per day codes [each day we have to give (e.g.) 10 days you have to code 909xx X 10]

Example:

1. Patient age 18 years initially planned to home dialysis but dialysis performed in home setting at 10
days only?

2. Patient is 55 year old toxins home dialysis for monthly service dialysis happened in home settings 30
days?

3. Patient is 55 year old came to t hospital for dialysis for monthly service dialysis happened in hospital
with 1 face to face visit
Ophthalmologic service

General ophthalmological service

Coding points

 First we have to look new (or) establish

 Intermediate (or) comprehensive

Intermediate ophthalmological service:

 Including history, general medical observation, external ocular and adnexal examination and
other diagnostic procedures as indicated may include the use of mydriasis for ophthalmoscopy.

Comprehensive ophthalmological service:

 Which including history, general medical examination, external and ophthalmoscopic

examination gross visual fields and basic sensorimotor examination, it often includes as
indicated bio microscopy, examination with cycloplegia (or) mydriasis and tonometry. It always
includes initiation of diagnostic and treatment programs

1. Ophthalmologist performed a review of history, external exam, ophthalmoscopy, bio-microscopy and

tonometry on an established patient with a new cataract?

a) 92014 b) 99212 c) 99002 d) 99202 e) 92012

3. Today in the office a 53 year old receives 2 allergy injections I/M in her left upper arm for ragweed
and cat dander the doctor administered the allergen extract brought in by the patient what is the CPT
code for this service?

a) 95115 b) 95144 C) 95165x2 d) 95117 E) 95125

4. 22 year old male is coming in for his immunotherapy to Desensitized him to rough weed the physician
provided serum with the allergenic extract and performed the injection after the injection was given the
patient was observed to make sure he did not experience in allergic reaction?

A) 95115 b) 95145 c) 95144 d) 95120

ECG (or) EKG (1 question)

93000-93015

93000 --> electrocardiogram, routine ECG with at least 12 leads; with interpretation and report.

93005 --> tracing only, without interpretation and report

93010 --> Interpretation and report only

93000, 93005 {we will use in office settings}

For ECG codes no need for TC, 26, (or) any modifiers

93010  {it will come in emergency department}

Moderate sedation: (1 question)

 Patient is having some conscious verbally response whereas anesthesia patient completely lost
conscious {Moderate (also known as conscious) sedation is a drug induced depression of
consciousness during which patients respond purposefully to verbal commands, either alone
(or) accompanied by light tactile stimulation}
 Moderate sedation cods 99151, 99152, 99153, 99155, 99156, 99157 are not used to report
administration of medication for pain control, minimal sedation (anoxiolysis), deep sedation (or)
monitored anesthesia care (00100, 01999)
 Sedation codes based on time
 We have select code based on intra service time of moderate sedation

Same physician:

 Procedure + sedation performed by same physician

Different physician:

 Sedation performed by physician-A

 Procedure performed by physician –B
Code based on age less than 5 years (or) 5 years/older

 Minimum requirement for sedation time is 10 minutes

 Less than 10 minutes not reported separately

Same physician Different physician

(10 min-15mins) 99151 – less than 5 year (10 min-15mins) 99155 – less than 5
old
(10 min-15mins) 99156 – greater than
(10 min-15mins) 99152 – greater than or or equal 5
equal 5
+99157 - add on code 15mins
+99153 -> add on code-each add 15mins

PTCA: (Percutaneous Trans luminal Coronary Angioplasty)

PTCA: 92920, 92921

PTCA with atherectomy: 92924, 92925

PTCA with Stent: 92928, 92929

PTCA with atherectomy+ Stent: 92933, 92934

Example:

1. PTCA with atherectomy with 3 stents placed in coronary artery?

2. PTCA with atherectomy, one stent placed in coronary artery and another placed in another artery?