Plugin-Introduction To CPT Medical Billing 101

National Center for Competency Testing
7007 College Boulevard, Suite 705

Overland Park, KS 66211
COURSE DESCRIPTION
This course is designed for individuals working in medical coding, billing,

medical fee contracting, insurance, auditing, or other positions related to
medical billing & coding. This course is a review of the basics of CPT
coding for medical services. The student will gain a fundamental
knowledge of the history, purpose, and utilization of CPT coding to receive
payment from insurance carriers.
Recommended Prerequisites:
Medical Terminology
Recommended Additional Resources:

Current year CPT manual
Medical Dictionary and/or Medical Abbreviations
Rev 1.0
October 2008
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COURSE TITLE: Introduction to CPT
Author: James D. Rigdon, CPC, NCICS, BS-HA

Coding Analyst
University Physicians, Inc.
Aurora, Colorado
Number of Clock Hours Credit: 4

Course # 1220409
P.A.C.E. Approved: Yes x No
Upon completion of this continuing education course, the professional

should be able to:
1. Define CPT code.

2. Describe the history of CPT codes.
3. Identify the differences between CPT, HCPCS, and ICD-9 codes.
4. Describe the purpose of CPT codes.
5. Apply accurate CPT coding fundamentals to medical billing practices
in everyday medical office or insurance company operations.
Disclaimer
The writers for NCCT continuing education courses attempt to provide factual information based on
literature review and current professional practice. However, NCCT does not guarantee that the
information contained in the continuing education courses is free from all errors and omissions.
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WHAT IS MEDICAL CODING?
Medical coding is a complex but necessary task in medical billing offices used to report,
track, and bill for services rendered by medical practitioners (e.g. physicians, nurse
practitioners), ancillary providers (e.g. chiropractors, psychologists), or facilities (e.g.
hospitals, nursing homes). Varieties of codes are used to consistently report medical
services, procedures, supplies and equipment, and diagnoses. Codes are used to
convey complex medical language quickly and effectively to insurance companies, as
well as to other organizations such as Medicare, the American Medical Association, and
the World Health Organization. Many organizations utilize statistics mined from billing
information for tracking purposes, such as frequency of office visits, severity of
diseases, or even disease progression.
WHAT ARE MEDICAL CODES?

There are six basic types of medical codes used in various aspects of medical billing:
Current Procedural Terminology, Fourth Revision (CPT-4) identifies
services and procedures
International Classification of Diseases, Ninth Revision (ICD-9) identifies
diagnoses
Healthcare Common Procedure Coding System (HCPCS) identifies
additional services and procedures not listed in CPT; drugs dispensed in the
physicians office or other facility (including injectables, topicals, and orally
administered); supplies and equipment dispensed to the patient
National Drug Codes (NDC) identifies pharmaceuticals dispensed to a patient
via a pharmacy
Revenue Codes identifies bundled facility and technical services (e.g. nursing
care, radiology or laboratory rendered in a facility setting, and room and board)
American Dental Association (ADA) Dental Billing Codes identifies services
rendered by dental practitioners (usually bundled into the HCPCS D section)
The focus of this course is CPT codes.
HISTORY OF CPT CODES

The American Medical Association (AMA) developed the CPT manual in 1966. The first
edition contained a mere 3,534 codes. To this day, the AMA maintains the CPT
manual, and it has been revised and updated on a yearly basis since 1977. The Health
Insurance Portability & Accountability Act (HIPAA) and Centers for Medicare & Medicaid
Services (CMS) require the use of standard code sets to be used when reporting any
service rendered to a patient. CPT is one of those standard code sets.
The 2008 CPT manual contains six sections with over 8,600 numeric, five-digit codes.
To conserve space, some CPT codes are indented or cross-referenced. A coder using
the CPT manual to report services should always look up the codes in the index first,
and not rely on the structure of the manual to be led to a code.
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Example of CPT code: 99213 = Outpatient or office visit, established patient,
level 3 service (see below for information on Evaluation & Management services)
CPT codes are considered Level I HCPCS (Health Care Financing Administration
Common Procedural Coding System) codes. Level II HCPCS codes are called
HCPCS codes (pronounced Hicks-Picks). Level II HCPCS codes are alphanumeric.
Level II codes were developed in the early 1980s and are maintained by CMS.
Example of Level II HCPCS code: A4550 = Surgical Tray
PURPOSE OF CPT
The main purpose of CPT is to provide a uniform language that accurately describes
medical, surgical, and diagnostic services. The codes were developed as a stand-alone
description of medical services. The codes systematically list services rendered to
patients by physicians, physical therapists, chiropractors, psychologists, or any number
of other practitioners. All codes are used on standardized billing forms, such as the
CMS1500 form (see following page). CPT codes provide consistent communication
among practitioners, patients, and payers, and assure consistency in reimbursement
(payment).
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This illustration is a CMS1500 form used for billing insurance carriers. Other standard billing
forms include UB92 and the ADA dental billing form.
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CPT MANUAL CONTENTS
Each CPT manual contains a number of sections. Each code listed within the CPT
manual is indexed and cross-referenced.
Table 1: Layout of the CPT manual
Section Description Code Range

Number
Contents, preface, and general guidelines
1 Evaluation and Management Services 99201 99499
2 Anesthesia 00100 01999
99100 99140
3 Surgery 10000 69999
4 Radiology 70000 79999
5 Pathology 80000 89999
6 Medicine (not anesthesia or medication) 90000 99099
99500 99999
Category II and III codes
Index
Appendices
CPT Index of Codes

The index of the CPT is organized in a number of different ways. The codes may be
indexed by:
Procedure or Service
Organ or Anatomic Site
Condition or Diagnosis
Synonyms, Eponyms, and Abbreviations
Modifying Terms
Code Ranges
The following are various examples of CPT index entries showing the different ways the
codes are indexed:
Procedure or Service:
Bunion Repair ............................................. 28296 28299
Keller Procedure 28292
Mitchell Procedure 28296
Organ or Anatomic Site:

Breast
Abscess
Incision and Drainage ....................................... 19020
Condition or Diagnosis:
Abscess
Auditory Canal, External ......................................... 69020
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Synonyms, Eponyms, and Abbreviations:
Backbone see Spine
Fitzgerald Factor 85293
EKG see Electrocardiography
Modifying Term:
Heart
Repair
Ventricle
Obstruction .................................................. 33619
Code Ranges:
Face
CT Scan.................................................... 70486 - 70488
CPT Appendices
There are thirteen useful yet overlooked appendices in the back of the CPT manual. A
resourceful coder will reference these appendices frequently. It is recommended that
every coder review the appendices annually, especially A, B, and M, as well as any
other appendices appropriate to the specialty for which they are coding.
The Appendices in the CPT manual are:

A Modifiers
B Summary of Additions, Deletions, and Revisions
C Clinical Examples
D Summary of Add-on Codes
E CPT Codes exempt from Modifier 51
F CPT Codes exempt from Modifier 63
G CPT Codes, which Include Moderate (Conscious) Sedation
H Alpha Index of Performance Measures by Clinical Condition or Topic
I Genetic Testing Code Modifiers
J Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves
K Products Pending FDA Approval
L Vascular Families
M Crosswalk to Deleted Codes *New for 2007*
Appendix A Modifiers
Modifiers are used to report additional information about a service or procedure, or are
used to modify how payment will be processed. Modifiers are two-digit codes
appended to CPT codes. The modifiers do not change the essential definition of any
CPT code, but rather alter the circumstances. Modifiers may be used to report an
increase or reduction of service, specific body part, the number of times a procedure
was performed, unusual events, or if a particular component of service was not
performed. This appendix lists the modifiers that can be used in combination with CPT
codes in a variety of scenarios.
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Table 2: Modifiers used for CPT codes (2007 edition)
Modifier Description Usage

-21 Prolonged Evaluation and Use when time spent with patient is greater
Management (E & M) than 30 minutes beyond time stated in
Service highest level E & M visit in a given
categorys CPT code description
-22 Unusual Procedural Use when service provided is greater than
Service what is usually required for a procedure
(extra work for the practitioner)
-23 Unusual Anesthesia Use when general anesthesia is provided
for a procedure that usually requires no
anesthesia, or usually only local or topical
anesthesia is required
-24 Unrelated E & M Service Use when the practitioner provides an
by the Same Physician E&M service during a postoperative period
During a Postoperative for reason(s) unrelated to the original
Period procedure
-25 Significant, Separately Use when the practitioner performs a
identifiable E & M Service procedure on the same day as an E & M
by the Same Physician on service beyond the usual preoperative and
the Same Day of the postoperative care associated with the
Procedure or Other procedure performed
Service
-26 Professional Component Many procedures are a combination of a
Only physician component (interpretation) and a
technical component (exam or test). Use
this modifier when only the professional
(physician) component is rendered
-27 Multiple Outpatient E & M Use when the patient is seen at multiple
Encounters on the Same times by the same practitioner in an
Date outpatient department of a facility
-32 Mandated Services Use when a service is mandated by an
individual or organization (e.g.
governmental/legislative/regulatory
requirements, third-party payor, etc)
-47 Anesthesia by Surgeon Use when regional or general anesthesia is
provided by the surgeon, not an
anesthesiologist
-50 Bilateral Procedure Use when a procedure is provided
bilaterally (on both sides of the body),
except when the code is explicitly listed as
a bilateral procedure
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Table 2: Modifiers used for CPT codes (2007 edition) (continued)

-51 Multiple Procedures Use when more than one procedure is
performed at the same operative session,
by the same provider. Append this
modifier to secondary procedures, not the
primary procedure. Note: Some CPT
codes are modifier 51 exempt. See
Appendix E
-52 Reduced Services Use when a procedure is partially reduced
or eliminated at the physicians discretion,
as documented in the medical record. This
provides a means of reporting the reduced
services without disturbing the primary
identification of the basic service as
described in CPT
-53 Discontinued Procedure Use when a procedure is stopped abruptly
due to extenuating circumstances, or those
that threaten the well-being of the patient.
Do not use this modifier when the patient
elects to cancel the procedure prior to
anesthesia or preparation in the operating
suite. Used for inpatient settings only.
-54 Surgical Care Only Use when the practitioner performs only
the surgical procedure, and not the
preoperative or postoperative care
-55 Postoperative Use when the practitioner performs only
Management Only postoperative care, and not the surgical
procedure or postoperative management
-56 Preoperative Management Use when the practitioner performs only
Only preoperative care, and not the surgical
procedure or postoperative management
-57 Decision for Surgery Use on E & M services that resulted in the
initial decision to perform a major surgery
on the day before, or on the day of the
surgery
-58 Staged or Related Use when a procedure or surgery:
Procedure or Service by a) was planned in advance to be
the Same Physician During performed at a different time from the basic
the Postoperative Period procedure or surgery,
b) is more extensive than the basic
procedure or surgery, or
c) is therapeutic in nature, following a
diagnostic procedure
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-59 Distinct Procedural Service Use when the practitioner renders a
procedure or service distinct or
independent from other services performed
on the same day by the same practitioner,
not normally reported together, but
appropriate under the circumstances
-62 Two Surgeons Use when two surgeons work together as
primary surgeons performing distinct parts
of a procedure, each surgeon reporting
their distinct operative work, and both
surgeons report the same CPT code
-63 Procedure Performed on Use when a surgical procedure is
Infants Less than 4 kg performed on neonates and infants that are
less than a present body weight of 4 kg (8
lbs 13 oz, or 141 oz, or 4000 gm) and may
involve significantly increased complexity
and work by the practitioner NOT for use
with procedures correcting congenital
anomalies
-66 Surgical Team Use when a highly complex procedure or
surgery requires the related services of
several physicians, often of different
specialties, plus other highly skilled,
specially trained personnel, and/or various
types of specialized and complex
equipment
-73 Discontinued Outpatient or Use when a procedure is stopped abruptly
ASC Procedure Prior to prior to administration of anesthesia due to
Administration of extenuating circumstances, or those that
Anesthesia threaten the well-being of the patient; use
only in an outpatient surgery setting or
ambulatory surgical center
-74 Discontinued Outpatient or Use when a procedure is stopped abruptly
ASC Procedure After after administration of anesthesia due to
Administration of extenuating circumstances, or those that
Anesthesia threaten the well-being of the patient; use
only in an outpatient surgery setting or
ambulatory surgical center
-76 Repeat Procedure by Use when the same practitioner repeats a
Same Physician procedure or service on the same day
-77 Repeat Procedure by Use when a different practitioner repeats a
Another Physician procedure or service on the same day
-78 Return to the Operating Use when the practitioner performs
Room for a Related another procedure during the postoperative
Procedure During the period, related to the initial procedure, and
Postoperative Period requires the use of the operating room
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-79 Unrelated Procedure or Use when the practitioner performs
Service by the Same another procedure during the postoperative
Physician During the period, NOT related to the initial procedure,
Postoperative Period and requires the use of the operating room
-80 Assistant Surgeon Use when a surgical assistant is present
for the entire procedure or substantial
portion of the procedure
-81 Minimum Assistant Use when a surgical assistant is present
Surgeon for a relatively short time during a
procedure
-82 Assistant Surgeon, When Use in a teaching setting when a surgical
Qualified Resident assistant is present for the entire
Surgeon Not Available procedure or substantial portion of the
procedure, but a resident (trainee) surgeon
is not available to assist in the procedure
-90 Reference (Outside) Use when laboratory services are
Laboratory performed by an outside laboratory, but the
service is billed by the practitioner
-91 Repeat Clinical Diagnostic Use when the same laboratory test is
Testing performed multiple times on the same day
when a normal, one-time, reportable result
is all that is usually required (not to be
used because of testing problems,
specimen contamination, or confirmatory
results)
-99 Multiple modifiers When multiple modifiers are used on a
claim, use this modifier to tell the insurance
company that more are to follow. Note:
Modifier 99 is not widely accepted by any
third party payer (insurance company) and
therefore will not be addressed further in
this course.
Appendix B - Summary of Additions, Deletions, and Revisions
This section of the CPT manual outlines new codes, deleted codes, and revised codes
for the year of publication. It is advised to thoroughly review Appendix B annually and
take note of any code changes in effect for the current year.
New codes are preceded with a bullet ( ), revised codes are preceded with a triangle
( ), deleted language appears with a strikethrough, and new text appears underlined.
Codes with Conscious (Moderate) sedation included are denoted with a bulls-eye ( ),
add-on codes are denoted with a plus sign (+), and vaccines pending FDA approval are
denoted with a lightning bolt symbol ( ) (see Appendix K).
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Examples of entries in Appendix B (2007 entries):
00625 Code Added

+27315 Neurotomy, hamstring muscle
37210 Code Added
+ 49326 Code Added
64595 Revision or removal of peripheral or gastric neurostimulator pulse
generator or receiver
Appendix C Clinical Examples
This appendix lists some scenarios to assist the coder in selecting the most appropriate
code for the service or procedure rendered. While this invaluable resource is by no
means comprehensive in nature, it does provide guidance to the coder when stumped
by which code to select. The Clinical Examples are to be used only as a guide and
never as the primary source of information always refer to the CPT manual text for
coding guidelines and code descriptions.
An example of a Clinical Example listed in Appendix C:
99291 First hour of critical care of a 65 year-old man with septic shock following
relief of urethral obstruction caused by a stone
Appendix D Summary of Add-on Codes
This appendix lists all codes listed in CPT that are classified as add-ons. Add-on
codes are codes that require another code to be billed in conjunction with it. Add-on
codes are NEVER billed alone. To determine which code must be billed in conjunction
with the add-on code, the coder will reference the beginning of the section where the
add-on code is found. Add-on codes usually do not require the usage of modifiers (e.g.
51, -59, -76, etc) except in very rare and bizarre circumstances. In the main listing of
the CPT, the symbol (+) denotes which codes are classified as add-ons.
Table 3: Example of an Add-on code
Base CPT Code Add-on CPT Code Description

11200 Removal of skin tags, multiple fibrocutaneous
tags, any area; up to and including 15 lesions
+11201 each additional ten lesions (List separately in
addition to code for primary procedure)
22630 Arthrodesis, posterior interbody technique,
including laminectomy and/or discectomy to
prepare interspace (other than for
decompression), single interspace; lumbar
+22632 each additional interspace (List separately in
addition to code for primary procedure)
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Example: A doctor removes 25 skin tags from a patient. The codes reported for
the service are:
11200 (x1 unit) Removal of skin tags, multiple fibrocutaneous tags, any
area; up to and including 15 lesions
+11201 (x1 unit) each additional 10 lesions (list separately in addition to
code for primary procedure)
Note: If the provider had removed a total of 35 lesions at the same session, an
additional unit of 11201 would be added to the bill (11201 x2 units).
Appendix E CPT Codes exempt from Modifier -51
Sometimes a practitioner will elect to perform multiple procedures on the same day. In
some cases, the procedures can be billed at the same time and not require the use of
modifier 51. Appendix E lists the codes that do not require a modifier -51
Some examples of CPT codes exempt from Modifier 51:
17004 Destruction, premalignant lesions, 15 or more lesions

32000 Thoracentesis, puncture of pleural cavity for aspiration, initial or
subsequent
90632 Hepatitis A vaccine, adult dosage, for intramuscular use
99143 Moderate (conscious) sedation servicesyounger than 5 years old,
first 30 minutes
Appendix F CPT Codes exempt from Modifier -63
As noted above, modifier 63 is used on CPT codes for procedures performed on

infants less than 4 kg. There are, however, some codes that are specifically for infants,
especially those under 4kg. In that case, it is not necessary to append a modifier 63.
The coder should always check appendix F if the patients weight is less than 4 kg (8
lbs, 13 oz, or 141 oz, or 4000 gm).
Some examples of CPT codes exempt from Modifier 63:
47700 Exploration for congenital atresia of bile ducts, without repair, with or
without liver biopsy, with or without cholangiography (Do not report
modifier 63 in conjunction with 47700)
63700 Repair of meningocele; less than 5cm diameter (Do not report modifier 63
in conjunction with 63700)
Appendix G CPT Codes that Include Moderate (Conscious) Sedation
For some surgical procedures, the patient may not be under general anesthesia (fully
sedated). In the case where the patient is not fully sedated, they may be under
moderate (or conscious) sedation. Some codes may include the moderate (conscious)
sedation, and therefore the moderate (conscious) sedation cannot be billed separately.
The CPT codes including Moderate (Conscious) sedation are denoted in the main CPT
section with a ( ) symbol. If the coder is coding for surgeries, they should reference
Appendix G to find out if the moderate (conscious) sedation can be billed separately.
Page 13 of 47
Examples of CPT codes that include Moderate (Conscious) Sedation:
43200 Esophagoscopy, rigid or flexible; diagnostic, with or without collection of

specimen(s) by brushing or washing (separate procedure)
77600 Hyperthermia, externally generated; superficial (i.e., heating to a depth
of 4cm or less)
Appendix H Alpha Index of Performance Measures by Clinical Condition or Topic
Appendix H is used in conjunction with the voluntary Physician Quality Reporting

Initiative (PQRI) for Medicare patients and possibly other carriers in the future. Note:
This course does not address PQRI.
Appendix I Genetic Testing Code Modifiers
Laboratories performing genetic testing are required to submit modifiers that describe
any genetic mutations found. The first character (always numeric) identifies the disease
category; the second character (always alpha) identifies the gene type. The modifiers
are divided into groups as follows:
Neoplasia (solid tumor, excluding sarcoma and lymphoma)

Neoplasia (sarcoma)
Neoplasia (lymphoid/hematopoietic)
Non-Neoplastic Hematology & Coagulation
Histocompatibility / Blood Typing / Identity / Microsatellite
Neurologic, non-neoplastic
Muscular, non-neoplastic
Metabolic, other
Metabolic, transport
Metabolic Pharmacogenetics
Dysmorphology
Genetic Testing Code Modifiers are not addressed any further in this course.
Appendix J Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves
Appendix J is useful when coding for Neurological testing. This appendix helps the
coder identify nerve branches and their assignments to some CPT codes used to report
services rendered by a Neurologist or other provider rendering nerve conduction
studies, reported with CPT codes 959000, 95903, and 95904.
Appendix J will not be addressed any further in this course.
Appendix K Products Pending FDA Approval
Appendix K is a cross reference to codes listed in the main CPT Category I section.
The codes listed identify products listed in the Medicine section of Category I, which are
pending FDA approval. Codes with this designation are denoted in the Category I
section of the CPT manual with the ( ) symbol. Additional products pending FDA
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approval and their respective CPT codes are listed at www.ama-
assn.org/ama/pub/category/10902.html.
In 2007, only one vaccine had been assigned a CPT code that was pending FDA
approval at the time of the publication. Insurance company policies for this CPT code
will vary until FDA approval is final. Once FDA approval has been obtained, insurance
companies may change coverage policies again. It is advised to contact the respective
insurance company about payment policy.
90698 Diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus

influenza Type B, and poliovirus vaccine, inactivated (DtaP/Hib/IPV)
combination vaccine for intramuscular use.
Appendix L Vascular Families
Coders in cardiovascular specialties will find Appendix L useful not only in selecting
CPT codes, but in also appropriate diagnosis (ICD-9) codes. The appendix breaks out
vascular families by branch order.
Example of an entry in Appendix L:
To find the order of the Lateral Circumflex Artery:
Common Common Profunda Lateral

Iliac Femoral Femoris Circumflex
The Lateral Circumflex Artery is of the Common Iliac Vascular Family.
Appendix M Crosswalk to Deleted Codes *New for 2007*
If a code has been deleted and replaced with a new code or a modified code, the code
will be referenced in this appendix. Coders are advised to review this appendix every
year and check for code changes appropriate to their specialty.
An example of an entry listed in Appendix M
Deleted CPT CPT 2007 CPT 2006 Code Descriptor

2006 Code Code
15000 15002, 15004 Surgical preparation or creation of recipient site by
excision of open wounds, burn eschar, or scar
(including subcutaneous tissues), or incisional
release of scar contracture; first 100sq cm or one
percent of body area of infants and children
This entry means in 2006 the description on the right was identified by a single code
listed on the left but in 2007, the CPT code 15000 was deleted, and the CPT
descriptions for codes 15002 and 15004 changed to include what was described by
15000 in 2006.
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CPT SYMBOLS
The CPT manual uses a series of symbols to convey information to the user. This
information is very important to watch for when selecting CPT codes when reporting
medical services.
Table 4: Symbols used in CPT
Symbol Definition Corresponding Appendix

New code for service or procedure Appendix B
a. Revised code Appendix B
8w Indicates new or revised text Appendix B
+ Add-on codes Appendix D
Modifier 51 exempt Appendix E
Reference Material N/A
Conscious Sedation Included Appendix G
Codes for vaccines pending FDA approval Appendix K
CPT GUIDELINES
Specific guidelines appear at the beginning of each of the sections of the CPT manual.
Guidelines give direction to interpret appropriately and report procedures and services
contained in each section. Before searching for any code in any section, be sure to
thoroughly read and understand the guidelines printed at the beginning of each section.
Additionally, be sure to read the entire code description before selecting it for reporting
or billing purposes.
Each section of the CPT manual contains Unlisted Procedures or Services. When a
specific code has not been defined within the CPT manual, nor can an appropriate
modifier be appended to an existing code to appropriately and accurately report the
service or procedure rendered to the patient, an unlisted code may be used. When
selecting an unlisted code, the payer (insurance company) will undoubtedly require the
biller/coder to send a copy of the documentation (SOAP note, surgical report, pathology
report, etc.) along with the bill.
Note not all medical services or procedures are assigned CPT codes. The CPT book
does not contain codes for infrequently used, new, and experimental procedures. Each
code section contains codes that have been set aside specifically for reporting unlisted
procedures. Before choosing an unlisted procedure code, review the CPT manual
carefully to ensure a more specific code is not available, and then check the Category III
section for an appropriate code. If after the coder has checked the CPT manual and
Category III section, a look in the HCPCS manual is advised to see if a temporary code
has been assigned. Once all these resources have been exhausted, an unlisted code
may be reported.
Special reports may be required of the provider by various payors, agencies, or firms
(e.g. Workers Compensation, Social Services, Schools, etc.). If a special report is
required, sometimes an additional code can be reported in addition to the Evaluation
and Management code. Check with the report requester prior to billing, on how
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payment will be made. You may have to bill the insurance company, patient, lawyer, or
other individual or entity. Often the requesting party (e.g. lawyer) will pay in advance for
the special report and therefore the report should not be billed to the patient or
insurance company.
PLACES OF SERVICE (POS)

The place of service code is a two-digit code that describes where the services were
performed. Examples of place of service are physicians office, outpatient hospital,
inpatient hospital, land ambulance, rural health clinic, or independent laboratory. A
complete list of Place-of-Service Codes for Professional Claims is listed in the front of
the CPT manual. Some codes are Unassigned, which means they are reserved for
future expansion. An example of an Unassigned code is POS 02. POS code 02 has
no description because the AMA has reserved it for future use.
Place of Service codes are listed on the next page.
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Table 5: POS Codes
POS POS POS

Pos Name POS Name POS Name
Codes Codes Codes
Inpatient psychiatric
01 Pharmacy 21 Inpatient hospital 51
facility
Psychiatric facility-
03 School 22 Outpatient hospital 52
partial hospitalization
Emergency room- Community mental

04 Homeless Shelter 23 53
hospital health center
Intermediate care
Indian Health Service- Ambulatory surgical
05 24 54 facility for the mentally
freestanding facility center
retarded
Residential substance
Indian Health Service-
06 25 Birthing center 55 abuse treatment
provider-based facility
facility
Tribal 638 Military treatment Psychiatric residential

07 26 56
freestanding facility facility treatment center
Tribal 638 provider- Mass immunization

08 31 Skilled nursing facility 60
based facility center
Comprehensive
Prison-correctional
09 32 Nursing facility 61 inpatient rehabilitation
facility
facility
Comprehensive
11 Office 33 Custodial care facility 62 outpatient
rehabilitation facility
End-stage renal
12 Homeless Shelter 34 Hospice 65 disease treatment
facility
13 Assisted living facility 41 Ambulance - land 71 Public health clinic
Ambulance - air or
14 Group home 42 72 Rural health clinic
water
Independent
15 Mobile unit 49 Independent clinic 81
laboratory
Federally qualified
20 Urgent care facility 50 99 Other place of service
health center
Page 18 of 47
DIVISIONS OF THE CPT MANUAL
Evaluation and Management (E&M) Services (99201 99499)
The first section of the CPT manual is one of the most commonly used sections and is
listed first as a matter of convenience. Evaluation and Management (E&M) services are
often referred to as visits. When a provider sees a patient in any setting (except OR)
the provider will obtain a history, perform an examination, and make a medical decision
about the patient. The appropriate way to bill for these services is with E&M codes.
The E&M codes listed in the CPT manual are always located at the beginning of the
book, but the codes begin with 99 (e.g. 99214).
The E&M codes were first established in 1992 to give providers guidance in reporting
and billing for visits. The first set of codes were very confusing and vague; the codes
were called Brief, Intermediate, and Comprehensive with no consistency between
settings. In 1995 the American Medical Association (AMA) revised the codes and
established the codes and guidelines used today. In 1997, the AMA set out to revise
the codes again in hopes to make the guidelines easier to understand. However, many
providers only found the 1997 guidelines too cumbersome to use, and the 1997
guidelines did not address certain specialties such as Pediatrics. It was determined by
Medicare that providers may use either the 1995 guidelines or 1997 guidelines when
reporting and billing for services rendered, regardless of specialty or setting
(http://www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp).
Any billable provider regardless of specialty may report E&M services, just be aware of
any local requirements for non-physician providers (e.g. Nurse Practitioners, Physician
Assistants, Chiropractors, etc). The extent of the service provided must be clearly
documented in the medical record.
Some E&M Services are classified as the following:

New Patient A new patient is one who has not received any professional
services from a physician or another physician of the same specialty in the same
group practice within three years.
Established Patient An established patient is one who has received
professional services from a physician or another physician of the same specialty
in the same group practice within three years.
o Example: Drs. Johnson & Smith are cardiologists in the same office. If a
patient sees Dr. Johnson and the visit in just a few weeks he sees Dr.
Smith, the patient is not classified as a new patient to Dr. Smith.
Initial Visit An initial visit is the first visit by a practitioner to a patient in certain
settings
Subsequent Visit A subsequent visit is any visit after the initial visit by a
practitioner in certain settings
Discharge Service A discharge is performed in certain settings on the last day
a patient is seen in a facility
Page 19 of 47
E&M services may be performed in any setting. Some E&M codes are categorized by
locations, while others are categorized by service type:
Office, Clinic, or other Outpatient (e.g. Urgent Care, School, etc)
o New Patient
o Established Patient
Hospital Observation (outpatient)
Hospital Observation (inpatient)
Hospital Inpatient
o Initial the first visit by the provider for the specified episode
o Subsequent any visit by the provider after the initial visit day,
except discharge day
o Discharge a visit by the provider on the day the patient will be
discharged
Consultations
o Office
o Initial Inpatient (note: subsequent inpatient consultations should be
reported as Hospital Inpatient Subsequent visits)
Note: A consultation is rendered when advice or an opinion
is requested by another physician (or other appropriate
source such as a Physician Assistant).
Emergency Department
Pediatric Patient Transport
Critical Care
o Adult (age 18 years or older)
o Pediatric (age 28 days to 18 years)
o Neonatal (first 28 days of life)
Note: Critical Care rendered to the patient does not
necessarily mean the patient was in the ICU or NICU ward.
Sometimes Critical Care can be rendered in other settings
(e.g. Emergency Room, Inpatient, Office)
Continuing Intensive Care Services for Neonates
o Non-critical care service rendered to neonates
Very Low Birth Weight (<1500 gm) (<3.3 lbs)
Low Birth Weight (1500 2500 gm) (3.3-5.5 lbs)
Normal Birth Weight (>2500 gm) (>5.5 lbs)
Nursing Facility Services
o Initial Nursing Facility Care
o Subsequent Nursing Facility Care
o Discharge from Nursing Facility
o Other Nursing Facility Services
Domiciliary, Rest Home, or Custodial Care
o New Patient
Note: These codes are used to report services rendered to
patients in non-medical facilities (e.g. Alzheimers home,
assisted living, etc)
Page 20 of 47
Home Care
o New Patient
Prolonged Services
o With Direct Patient Contact (face-to-face)
o Without Direct Patient Contact (not face-to-face)
Physician Standby Services
Case Management Services
o Team Conferences
o Telephone Calls
Care Plan Oversight
Preventative Services
o New Patient
o Individual Counseling
o Group Counseling
o Other Preventative Care
Newborn (Neonate) Care
Special E&M Services
Unlisted E&M Services
Table 6: E&M Modifiers
The following modifiers can be used on E&M CPT codes. See Appendix A for modifier
descriptions.
Modifier Description
-21 Prolonged E&M Services
-24 Unrelated E&M Services by same physician during post-op period
-25 Significant, separately identifiable E&M Service by the same physician on
the same day of procedure or service
-27 Multiple outpatient hospital E&M encounters on the same date
-32 Mandated Services
-57 Decision for surgery
Anesthesia (00100 01999)
Anesthesia codes are used to report anesthesia services rendered by an

anesthesiologist, Certified Registered Nurse Anesthetists, or others who are trained to
render anesthesia services rendering General Anesthesia (not Local, Topical, Digital
Block, or Conscious Sedation anesthesia).
Tabers Cyclopedic Medical Dictionary defines anesthesia as partial or complete loss of

sensation, with or without loss of consciousness, as a result ofadministration of an
anesthetic agent, usually by injection or inhalation. Tabers goes on to further define
various types of anesthesia as follows.
Page 21 of 47
1. General Anesthesia: Anesthesia that is complete and affects the entire body
with loss of consciousness when the anesthetic acts on the brain. This type of
anesthesia is usually accomplished following administration of inhalation or
intravenous anesthetics. It is commonly used for surgical procedures
The following anesthesia terms are taken from Medline Plus Medical Dictionary
(http://www.nlm.nih.gov/medlineplus/mplusdictionary.html)
2. Local Anesthesia: loss of sensation in a limited and usually superficial area

especially from the effect of an anesthetic administered to a specific site
3. Topical Anesthesia: anesthesia applied to the surface of a part of the body to

achieve a numbness of the skin
4. Regional Anesthesia: anesthesia of a region of the body accomplished by a

series of encircling injections of anesthetic (compare Block Anesthesia)
5. Block Anesthesia: local anesthesia (as by injection) produced by interruption of

the flow of impulses along a nerve trunk (compare Regional Anesthesia)
6. Conscious Sedation: an induced state of sedation characterized by a minimally

depressed consciousness such that the patient is able to continuously and
independently maintain a patent airway, retain protective reflexes, and remain
responsive to verbal commands and physical stimulation (compare Deep
Sedation)
7. Deep Sedation: an induced state of sedation characterized by depressed

consciousness such that the patient is unable to continuously and independently
maintain a patent airway, retain protective reflexes, and remain responsive to
verbal commands and physical stimulation (compare Conscious Sedation)
Anesthesia services listed in the CPT manual are generally subdivided by anatomical
site, with the exception of radiological procedures, burn treatments, and obstetrics.
Anesthesia services also require a Physical Status Modifier appended to each code.
The Physical Status Modifiers are consistent with the American Society of
Anesthesiologists (ASA) physical status classifications.
Page 22 of 47
Table 7: Physical Status Modifiers (P-Status)
P-Status Description
Modifier
P1 A normal healthy patient
P2 A patient with mild systemic disease
P3 A patient with severe systemic disease
P4 A patient with severe systemic disease that is a constant threat to life
P5 A moribund patient who is not expected to survive without the operation
P6 A brain-dead patient whose organs are being removed for donor purposes
Example: General anesthesia is performed on a patient with diabetes and diabetic renal
manifestations, for a biopsy of intranasal tissue. The anesthesiologist would report CPT
code 00164 with P-Status modifier P4 (00164-P4).
Check with local regulations on what the requirements are for billing for anesthesia
services.
Table 8: Other Anesthesia Modifiers
The following modifiers can be used on Anesthesia CPT codes. See Appendix A for
modifier descriptions.
-22 Unusual services
-23 Unusual Anesthesia
-51 Multiple procedures
-53 Discontinued procedures
-59 Distinct procedural service
Note: Conscious (Moderate) Sedation is reported with CPT codes 99143 99150.
Anesthesia CPT categories are:

Procedures on the Head
Procedures on the Neck
Procedures on the Thorax (Chest Wall & Shoulder Girdle)
Intrathoracic Procedures
Procedures on the Spine & Spinal Cord
Procedures on the Upper Abdomen
Procedures on the Lower Abdomen
Procedures on the Perineum
Procedures on the Pelvis (except hip)
Procedures on the Upper Leg (except knee)
Procedures on the Knee and Popliteal Area
Procedures on the Lower Leg (below knee, including ankle & foot)
Procedures on the Shoulder & Axilla
Procedures on the Upper Arm & Elbow
Procedures on the Forearm, Wrist, & Hand
Page 23 of 47
Radiological Procedures
Procedures for Burn Excisions or Debridement
Obstetric Anesthesia
Other Anesthesia Procedures
Surgery (10000 69999)
The Surgery section of the CPT manual includes simple procedures (e.g. simple
laceration repair, nursemaids elbow reduction), moderately complex procedures (e.g.
bronchoscopy, amniocentesis), and complex procedures (e.g. hip replacement, ileoanal
anastomosis). Do not be fooled about where to find the simplest procedures (e.g.
venipuncture, skin tag removal, and foreign body removal from ear canal) they may be
found in the surgery section of the CPT manual! Be sure to watch for codes that
include Moderate (conscious) sedation, Add-ons, pending FDA approval, or that are
Modifier 51 exempt (see table 4 above).
Subdivisions of the Surgical section are:

Integumentary System (10021 19499)
Musculoskeletal System (20100 29999)
Respiratory System (30000 32999)
Cardiovascular System (33010 39599)
Digestive System (40490 49999)
Urinary System (50010 59899)
o Male Genital System (54000 55899)
o Intersex Surgery (55970 55980)
o Female Genital System (56405 59899)
Perinatal procedures (e.g. delivery)
Endocrine System (60000 60699)
Nervous System (61000 69979)
o Eye (65091 68899)
o Ear (69000 69979)
Operating Microscope Usage (69990)
Table 9: Surgery Modifiers
The following modifiers can be used on Surgery CPT codes. See Appendix A for
-22 Unusual Services
-26 Professional component (on surgeries that also include a technical
component)
-47 Anesthesia by surgeon
-50 Bilateral procedure
-52 Reduced Services
Page 24 of 47
Table 9: Surgery Modifiers (continued)
-53 Discontinued procedure
-54 Surgical care only
-55 Postoperative management only
-56 Preoperative management only
-58 Staged or related procedure by same physician during postoperative
period
-62 Two surgeons
-63 Procedure performed on infants less than 4kg (8lb 13oz)
-66 Surgical team
-73 Discontinued outpatient/ASC procedure prior to anesthesia
-74 Discontinued outpatient/ASC procedure after initiation of anesthesia
-76 Repeat procedure by the same physician
-77 Repeat procedure by another physician
-78 Return to operating room for a related procedure during the postoperative
period
-79 Unrelated procedure or service by the same physician during a
postoperative period
-80 Assistant surgeon
-81 Minimum assistant surgeon
-82 Assistant surgeon when qualified resident surgeon is not available
Radiology (70000 79999)
Radiology includes all types of imaging procedures: X-rays (radiographs), angiogram,

Computed Tomography scan (CT), Magnetic Resonance Imaging (MRI), Positron
Emission Tomography scan (PET), ultrasound (US), and fluoroscopy. Radiology also
includes technical procedures such as Radiation Oncology for cancer treatment, and
other radiopharmaceutical administrations.
Radiological procedures include two components: technical and professional. Both

components must be considered when billing for radiological procedures. The technical
component includes the time and expertise of technicians (e.g. Radiographer), while the
professional component includes the time and expertise of the provider (Radiologist).
The appropriate modifier must be appended when billing for radiological procedures:
modifier TC (not listed above) is appended for the technical fee while modifier 26 is
appended for the professional fee. Sometimes the provider will perform both
components, which no modifier will be appended to the CPT code.
The radiology section, like other sections of the CPT manual, is subdivided into
subsections. The subsections are also divided by anatomy (e.g. Head and Neck,
Chest, etc), and divided again by technique (Computed Tomography, Magnetic
Resonance Imaging), and sometimes divided again by quantity of views (e.g. three
views) or contrast material (e.g. without contrast, without contrast followed by contrast).
Page 25 of 47
Subdivisions of Radiology section are:
Diagnostic Radiology (Diagnostic Imaging) (70010 76499)
o CT
o MRI
o PET
o Vascular Imaging
Diagnostic Ultrasound (76506 76999)
Radiologic Guidance (77001 77032)
o Fluoroscopic
o CT
o MRI
Mammography (77051 77059)
Bone & Joint Studies (77071 77084)
Radiation Oncology (77261 77799)
Nuclear Medicine (78000 7899)
Other Therapeutic Radiation Procedures (79005 7999)
Table 10: Radiology Modifiers
The following modifiers can be used on Radiology CPT codes. See Appendix A for
-26 Professional Component
-51 Multiple Procedures
-66 Surgical Team
-76 Repeat procedure by same physician
Pathology & Laboratory (80000 89999)
Like radiology, pathology & laboratory procedures are comprised of two components:
technical and professional. Same modifiers apply (TC and 26). Note: when TC
and/or 26 are not present, it is implied the physician or an employee of the physician
performed both components.
Just as sections listed above, Pathology & Laboratory is subdivided into subsections:
Organ or Disease-Oriented Panels (80040 80076)
Drug Testing (80100 80103)
Therapeutic Drug Assays (80150 80299)
Evocative & Suppression Testing (80400 80440)
Clinical Pathology Consultation (80500 80502)
Urinalysis (81000 81099)
Page 26 of 47
Chemistry (82000 84999)
Hematology & Coagulation (85002 85999)
Immunology (86000 86849)
Transfusion Medicine (excluding apheresis & therapeutic phlebotomy) (86850
86999)
Microbiology (87001 87999)
Anatomic Pathology (postmortem examination) (88000 88099)
Cytopathology (88140 88199)
Cytogenic Studies (88230 88299)
Surgical Pathology (88300 88399)
Transcutaneous Procedures (88400)
Other Laboratory Procedures (89049 89240)
Reproductive Medicine Procedures (89250 89356)
Table 11: Pathology & Laboratory Modifiers
The following modifiers can be used on Pathology & Laboratory CPT codes. See
Appendix A for modifier descriptions.
-26 Professional component
-90 Reference (outside) laboratory
-91 Repeat clinical diagnostic laboratory test
Medicine (90000 99199)
This section is not to be confused with medication. Medication is reported and billed
with HCPCS level II codes, which are not addressed in this course.
Medicine procedures and services are reported in many different settings. The
Medicine section includes services and procedures such as immunizations, chiropractic,
psychiatry, echocardiography, allergy testing, and physical therapy. When selecting a
code from the Medicine section, make sure the insurance carrier you are billing will
accept the code being billed, as some carriers may require a HCPCS level II code or
E&M code be billed in lieu of a Medicine code.
Medicine is subdivided as follows:

Immune Globulins (90281 90399)
Immunization Administration (for vaccines & toxoids) (90465 90474)
Vaccines & Toxoids (90476 90749)
Hydration, Therapeutic, Prophylactic, and Diagnostic Injections & Infusions
(excluding Chemotherapy) (90760 90779)
Psychiatry (90801 90899)
Biofeedback (90901 90911)
Page 27 of 47
Dialysis (90918 90999)
Gastroenterology Procedures (91000 91299)
Ophthalmology (92002 92499)
Special Otorhinolaryngologic Services (92502 92700)
Cardiovascular Procedures & Services (92950 93799)
Noninvasive Vascular Diagnostic Studies (93875 93990)
Pulmonary (94002 94799)
Allergy & Clinical Immunology (95004 95199)
Endocrinology (95250 95251)
Neurology & Neuromuscular Procedures (95805 96020)
Medical Genetics & Genetic Counseling Services (96040)
Central Nervous System Assessments & Testing (96101 96120)
Health & Behavior Assessment & Interventions (96150 96155)
Chemotherapy Administration (96401 96549)
Photodynamic Therapy (96567 96571)
Special Dermatological Procedures (96900 96999)
Physical Medicine & Rehabilitation (97001 97799)
Medical Nutrition Therapy (97802 97804)
Acupuncture (97810 97814)
Osteopathic Manipulative Treatment (98925 98929)
Chiropractic Manipulative Treatment (98940 98943)
Education & Training for Patient Self-Management (98960 98962)
Special Services, Procedures & Reports (99000 99091)
Qualifying Circumstances for Anesthesia (99100 99140)
Moderate (Conscious) Sedation (99143 99150)
Other Services & Procedures (99170 99199)
Home Health Procedures & Services (99500 99602)
Table 12: Medicine Modifiers
The following modifiers can be used on Medicine CPT codes. See Appendix A for
-22 Unusual services
-26 Professional component
-52 Reduced services
-55 Postoperative management only
-56 Preoperative management only
-57 Decision for surgery
-58 Staged or related procedure by same physician during the postoperative
period
-73 Discontinued outpatient/ASC procedure prior to anesthesia
Page 28 of 47
Table 12: Medicine Modifiers-continued
-74 Discontinued outpatient/ASC procedure after initiation of anesthesia
-76 Repeat procedure by the same physician
-78 Return to operating room for a related procedure during the postoperative
period
-79 Unrelated procedure or service by the same physician during a
postoperative period
-90 Reference (outside) laboratory
STEPS TO LOOKING UP A CPT CODE
Now that you know about the CPT manual, here are the basic steps of looking up the
appropriate CPT code for reporting/billing.
1. Identify the procedure or service documented in the report or medical record

2. Search for the main term in the index of the CPT manual
3. Locate the code in the main section of the CPT manual that best describes the
service rendered
Happy coding!
EXERCISE
Obtain a current copy of a CPT manual (copies to borrow may available at your local
library, medical school, or hospital). Find the CPT description for the following codes.
Be sure to indicate any special markings (e.g. +, , ). Answers follow on next page
(2007 CPT manual used your answers may vary slightly depending upon which
manual date you use)
1. 99204___________________________________________________________
2. 99283___________________________________________________________
3. 01490___________________________________________________________
4. 11200___________________________________________________________
5. 35490___________________________________________________________
6. 59400___________________________________________________________
7. 69990___________________________________________________________
8. 71020___________________________________________________________
9. 78580___________________________________________________________
Page 29 of 47
10. 80061__________________________________________________________
11. 89260___________________________________________________________
12. 90656___________________________________________________________
13. 90911___________________________________________________________
14. 97001___________________________________________________________
15. 99510___________________________________________________________
Page 30 of 47
Answers to Exercise
1. 99204 = Office or other outpatient visit for the evaluation and management of a
new patient, which requires these three key components: Comprehensive
History, Comprehensive Examination, Medical Decision Making of Moderate
Complexity
2. 99283 = Emergency department visit for the evaluation and management of a

patient, which requires these three components: Expanded Problem Focused
History, Expanded Problem Focused Examination, Medical Decision Making of
Moderate Complexity
3. 01490 = Anesthesia for lower leg cast application, removal, or repair
4. 11200 = Removal of skin tags, multiple fibrocutaneous tags, any area; up to and
including 15 lesions
5. 35490 = Transluminal peripheral atherectomy, percutaneous; renal or other

visceral artery
6. 59400 = Routine obstetric care including antepartum care, vaginal delivery (with
or without episiotomy, and or/forceps) and postpartum care
7. +69990 = Microsurgical techniques, requiring the use of operating microscope
8. 71020 = Radiologic examination, chest, two views, frontal and lateral
9. 78580 = Pulmonary perfusion imaging, particulate
10. 80061 = Lipid Panel
11. 89260 = Sperm isolation; simple prep (e.g., sperm wash and swim-up) for
insemination or diagnosis with semen analysis
12. 90656 = Influenza virus vaccine, split virus, preservative free, when
administered to 3 years and older, for intramuscular use
13. 90911 = Biofeedback training, perineal muscles, anorectal, or urethral sphincter,

including EMG and/or manometry
14. 97001 = Physical therapy evaluation
15. 99510 = Home visit for individual, family, or marriage counseling
Page 31 of 47
References
Adams, Wanda L, CPC, Adams' Coding and Reimbursement: A Simplified Approach,

second edition. Elsevier Mosby: St. Louis, Missouri. 1994
American Medical Association: CPT Category I Vaccine Codes. 2008, American

Medical Association. www.ama-assn.org/ama/pub/category/10902.html, accessed
September 10, 2008
Beebe, Michael, et al, Current Procedural Terminology (CPT) 2007 Professional

Edition: American Medical Association 2006
Buck, Carol J, MS, CPC, Step-By-Step Medical Coding. Elsevier Saunders: St. Louis
Missouri. 2005
Centers for Medicare & Medicaid Services, 1995 & 1997 Documentation Guidelines:
http://www.cms.hhs.gov/MLNEdWebGuide/25_EMDOC.asp, accessed September 8,
2008
Medline Plus Online Medical Dictionary:

http://www.nlm.nih.gov/medlineplus/mplusdictionary.html, accessed September 8, 2008
Schreck, Bonnie G, CCS, CPC, CPC-H, CCS-P, et al, Coders' Desk Reference for
Procedures 2004. Ingenix Inc/St. Anthony Publishing: Eden Prairie, MN. 2003. Pgs
1-23
Page 32 of 47
TEST QUESTIONS
Introduction to CPT
Course #1220409
Directions:
Before taking this test, read the instructions on how to correctly complete the answer
sheet.
Select the response that best completes each sentence or answers each question
from the information presented in the module.
If you are having great difficulty answering a question, go to www.ncctinc.com and
select Recertification/CE, then select Updates/Revisions to see if course content
and/or a test question have been revised. If you do not have internet access, call
Customer Service at 800-874-4404.
1. The purpose of medical coding is to __________.
a. provide jobs to many individuals in a comfortable setting

b. frustrate physicians in hopes they will quit practicing medicine
c. report, track, and bill for services rendered to patients in a variety of
healthcare settings
d. ensure patient safety in healthcare facilities
2. Many organizations utilize medical coding in a variety of ways. Some of these

organizations include __________.
a. Medicare, Medicaid, World Health Organization

b. Grocery stores, mortgage brokers, business owners
c. Physician spousal organizations, landlords for medical office spaces, hospital
maintenance workers
d. Veterinarians, Mechanics, and garbage collectors
3. The six types of codes used in reporting and billing for medical services are
__________.
a. Fixed, changing, modified, collection, contract, billing

b. Diagnostic, therapeutic, injection, imaging, office, hospital
c. CPT, ICD9, HCPCS, NCD, Revenue, ADA Dental Codes
d. Physician, nurse, technician, facility, transport, nutrition
4. Which one of these organizations has responsibility for maintaining the CPT
manual?
a. American Dental Association (ADA)

b. American Medical Association (AMA)
c. Centers for Medicare & Medicaid (CMS)
d. World Health Organization (WHO)
Page 33 of 47
5. In what year was the first CPT manual published?
a. 1996
b. 1800
c. 2000
d. 1966
6. CPT codes are also called __________.
a. HCPCS Level I codes

b. HCPCS Level II codes
c. HCPCS Level V codes
d. Diagnosis codes
7. What is the purpose of CPT?
a. To provide a uniform language that accurately describes medical, surgical,

and diagnostic services
b. To provide a convoluted, obscure way to randomly report medical services
with the goal of swindling insurance companies and unsuspecting patients
c. To track potential epidemics and provide necessary information to authorities
in an attempt to thwart the spread of disease
d. None of the above
8. Which of the following is an index entry describing a specific procedure?
a. Abscess, Auditory Canal, External69020

b. Bunion Repair..28296 28299
c. EKG see Electrocardiography
d. Backbone see Spine
9. Modifiers change the essential definition of the CPT code.
a. True
b. False
10. Which modifier would be used to report Unrelated E & M Service by the Same
Physician during a Postoperative Period?
a. 76
b. 25
c. TC
d. 24
Page 34 of 47
11. To report a bilateral procedure performed on a patient, which one of the
modifiers below would be appended to the reported CPT code?
a. 99
b. 82
c. 50
d. Bi
12. Which modifier is reported with the CPT code when a surgical team performs a
surgery on a patient?
a. 66
b. 50
c. TC
d. 99
13. A patient comes to the emergency room with a laceration on his arm. The ED
doctor repairs the laceration and then advises the patient to see their Primary
Care Physician (PCP) in 10 days to have the sutures removed. The ED
physician reports CPT code 12002 (Simple repair of extremities, 2.6cm-7.5cm).
Which modifier is used on CPT code 12002 to inform the insurance that
the ED doctor is not expecting the patient to return to the ED for suture
removal?
a. 80: Assistant surgeon

b. 54: Surgical care only
c. 79: Unrelated procedure by same physician during post-op period
d. 99: Multiple modifiers
14. A cardiologist performs a transesophageal echocardiography (TEE) on a pediatric

patient with Tetralogy of Fallot (a congenital cardiac anomaly) prior to having a
cardiac catheterization procedure. The cardiologist reports CPT code 93317. After
the procedure, the cardiologist performs a repeat TEE on the patient, and reports
CPT code 93317. Which modifier is appended to the second 93317?
a. 66: Surgical team

b. 52: Reduced services
c. 54: Surgical care only
d. 76: Repeat procedure by same physician
Page 35 of 47
15. A two year old in apparent distress was brought to the doctors office. She had a fall
and is not using her arms. After a thorough examination and X-rays of both arms,
the physician diagnoses the problem as bilateral nursemaids elbow (elbow
dislocation). The physician snaps the elbows back in place and the patient is sent
home. The physician reports an office visit E&M code 99214 and CPT code 24640
(reduction of nursemaids elbow) for both elbows. Which modifiers are required on
the claim?
a. 9221425: E&M on same day as procedure; 24640-50: Bilateral procedure

b. 9221457: Decision for surgery; 24640-P1: A normal healthy patient
c. 9221458: Staged or related procedures; 24640-99: Multiple modifiers
d. No modifiers are required on either code
16. Which appendix lists codes with the symbol (+)?
a. Appendix C: Clinical Examples

b. Appendix D: Summary of CPT Add-on Codes
c. Appendix E: Summary of CPT Codes Exempt From Modifier 51
d. Appendix F: Summary of CPT Codes Exempt From Modifier 63
17. Which appendix lists codes with the symbol ( )?
a. Appendix B: Summary of Additions, Deletions, and Revisions

b. Appendix C: Clinical Examples
c. Appendix D: Summary of CPT Add-on Codes
d. Appendix E: Summary of CPT Codes Exempt From Modifier 51
18. Which appendix lists codes with the symbol ( )?
a. Appendix K: Products Pending FDA Approval

b. Appendix A: Modifiers
c. Appendix D: Summary of CPT Add-on Codes
d. Appendix G: Summary of CPT Codes That Include Moderate (Conscious)
Sedation
19. Which symbol below is used to identify FDA approval pending?
a.
b.
c.
d.
20. Which symbol below is used to identify a new code?
a.
b.
c.
d.
Page 36 of 47
21. An unlisted code can be used __________.
a. when the insurance carrier denies the claim

b. when a more appropriate code that describes the service rendered can not
be found
c. when you do not want to charge the patient
d. at the physicians request
22. E&M stands for __________.
a. Exact & Moderate

b. Evaluation & Medical billing
c. Evaluation & Management
d. Employment & Management
23. What is the code range for E&M services?
a. 99201 99499
b. 00100 01999
c. 70000 79999
d. 90000 99199
24. E&M codes were first established in __________, revised in __________, and
revised again in __________.
a. 1966, 1972, 2000

b. 1999, 2000, 2004
c. 1992, 1995, 1997
d. 1992, 1997, 2000
25. Which guidelines does Medicare allow providers to use for E&M billing?
a. 1995 guidelines
b. 1995 or 1997 guidelines
c. 1997 guidelines
d. 1992, 1995 or 1997 guidelines
26. A patient can once again be considered a New patient if they have NOT been
seen by the provider or one of their colleagues in the same specialty in the
same office for at least 3 years.
a. True
b. False
Page 37 of 47
27. Discharge Service is a __________.
a. service rendered to a patient who has been discharged from the military
b. service rendered to a patient who has any discharge from one or more of
their orifices (mouth, nose, etc)
c. patient who is fired (or discharged) from the practice for chronically not
showing for appointments
d. service rendered to a patient on the last day being confined to a facility; a
patient who is being discharged from the facility on that day
28. Non-critical care services rendered to neonates are classified into which of the
following three weight classes?
a. Low Birth Weight 1500gm 2500gm

Normal Birth Weight 2500gm 3500gm
High Birth Weight Baby >3500gm
b. Very Low Birth Weight <1500gm

Low or Moderate Birth Weight 1500gm 3000gm
Very High Birth Weight >3000gm
c. Very Low Birth Weight <1500gm

Low Birth Weight 1500gm 2500gm
Normal Birth Weight >2500gm
d. Normal Birth Weight >2500gm

Near Normal Birth Weight 2000gm 2500gm
Low Birth Weight <2000gm
29. Anesthesia services listed in the CPT manual are generally subdivided by
anatomical site, with the exception of __________.
a. codes with a P-Status

b. oncology procedures, mammography, and E&M
c. local anesthesia and topical anesthesia
d. radiological procedures, burn treatments, and obstetrics
30. An expectant mother sees her OB/GYN for 12 visits prior to delivery. On the
day of delivery, the OB/GYN is called to the hospital to deliver the baby. It is a
normal, spontaneous, vaginal delivery (NSVD) with episiotomy. The patient
returns to the OB/GYN six weeks later for a routine postpartum visit. Which of
the following surgical CPT codes should be used to report this service?
a. 59409 Vaginal delivery only (with or without episiotomy and/or forceps)

b. 59426 Antepartum care only, 7 or more visits
c. 59430 Postpartum care only (separate procedure)
d. 59400 Routine obstetric care including antepartum care, vaginal delivery
(with or without episiotomy and/or forceps) and postpartum care
Page 38 of 47
31. A cardiologist is called to the operating room to repair a cardiac
wound on a patient who is on cardiopulmonary bypass (heart-lung machine).
Once in the OR, he performs a cardiac wound repair. Which of the following
surgical CPT codes should be used to report this service?
a. 33300 Repair of cardiac wound; without bypass

b. 33005 Repair of cardiac wound; with cardiopulmonary bypass
c. 33310 Exploratory cardiotomy without bypass
d. 33315 Exploratory cardiotomy with cardiopulmonary bypass
32. A medical assistant is asked by the physician to draw blood from a 35 year old
patient for diagnostic lab tests. The medical assistant performs one
venipuncture and successfully draws the blood as requested. Which of the
following surgical CPT codes should be used to report the medical assistants
service?
a. 61020 Ventricular puncture through previous burr hole, fontanelle,

suture, or implanted ventricular catheter/reservoir without injection
b. 36415 Collection of venous blood by venipuncture
c. 36410 Venipuncture, age 3 years or older, necessitating physicians skill
for diagnostic or therapeutic purposes
d. 36561 Insertion of tunneled centrally inserted central venous access
device, with subcutaneous port; age 5 years or older
33. A 45-year-old patient comes is brought to the emergency room after a motor
vehicle accident. The emergency physician stabilizes the patient and
determines the patients right eye is so badly damaged it may need to be
removed. An ophthalmologist examines the patient and agrees the eye must
be immediately removed. The patient is taken to the operating room where the
ophthalmologist performs an enucleation of the patients eye, but does not
implant an artificial eye at that time. Which of the following surgical CPT codes
should be used to report the ophthalmologists service?
a. 65091 Evisceration of ocular contents; without implant

b. 65093 Evisceration of ocular contents; with implant
c. 65101 Enucleation of eye; without implant
d. 65103 Enucleation of eye; with implant; muscles not attached
34. A patient is sent by their PCP to a local podiatrist for an office consultation
because of chronic, infected toenails of bilateral great-toes. After a detailed
examination, the podiatrist decides to completely remove both toenails at that
visit. The patient is prepped in the usual manner and the procedure is started.
The right nail is avulsed without any problem. The podiatrist begins the left
nail avulsion but halfway through the procedure he stops because the patient
says it is too painful. The podiatrist administers additional digital block
anesthesia. After a few minutes, the patient is ready to continue the procedure.
The podiatrist finishes the procedure on the left toe without complication. The
wounds are dressed, and the patient is asked to come back in 5 days for
postoperative wound check. Which of the following CPT code combinations
and modifiers should be used to report the podiatrists services?
Page 39 of 47
a. 99243-25,-57 Office consultation with detailed history, detailed exam, medical
decision making low complexity
11730 Avulsion of nail plate, partial or complete, simple or single nail
11732 Avulsion of nail plate, partial or complete, each additional nail
b. 99214-25 Office visit for an established patient with detailed history,
detailed exam, medical decision making moderate complexity
11730-50 Avulsion of nail plate, partial or complete, simple or single nail
c. 99221-25 Initial hospital care with detailed history, detailed examination,
medical decision making low complexity
01462-P1 Anesthesia for all closed procedures on lower leg, ankle, and foot
11752-47,-50 Excision of nail and nail matrix, partial or complete, for
permanent removal; with amputation of tuft of distal phalanx
d. 99253-25,-57,-74 Inpatient consultation with detailed history, detailed
exam, medical decision making low complexity
11730-54,-57 - Avulsion of nail plate, partial or complete, simple or single nail
11732-54,-57,-74 Avulsion of nail plate, partial or complete, each additional nail
35. Which of the following is NOT a radiological imaging procedure?
a. X-ray
b. CT
c. Fluoroscopy
d. Anesthesia
36. Radiology includes technical procedures such as __________.
a. Hemodialysis
b. Radiation Oncology for cancer treatment
c. Open spine surgery
d. Photodynamic Therapy
37. What are the two components of radiology CPT codes?
a. Radiation and Ultrasound

b. Diagnostic and Therapeutic
c. Technical and Professional
d. With Contrast and Without Contrast
38. A patient presents to their PCP with shortness of breath, coughing, and fever.
After an examination of the patient, the doctor orders an in-office frontal &
lateral chest x-ray. The radiographer performs the chest x-ray and the physician
reads it. What is the appropriate radiology CPT code to report for the x-ray?
a. 71010-99,-TC,-26 Radiologic examination, chest; single view, frontal

b. 71020 Radiologic examination, chest, two views, frontal and lateral
c. 71030-26 Radiologic examination, chest, complete, minimum of four
views
d. 71035-TC Radiologic examination, chest, special views (e.g. Later
decubitus, Bucky studies)
Page 40 of 47
39. A female patient comes to her OB/GYN with complaints of lower pelvic pain.
The OB/GYN determines an MRI of the patients pelvic cavity if needed. He
requests this be done without contrast, then additional images with contrast.
The MRIs are performed as requested, and a Radiologist reads the films,
writes the report, and send the report to the OB/GYN. Which radiology CPT
code and modifier combination(s) that would be reported for the radiologists
service?
a. 72195-26 Magnetic resonance imaging, pelvis; without contrast material

72196-26 Magnetic resonance imaging, pelvis; with contrast material
b. 72195-26 Magnetic resonance imaging, pelvis; without contrast material
72197-26 Magnetic resonance imaging, pelvis; without contrast material,
followed by contrast material and further sequences
c. 72197-26 Magnetic resonance imaging, pelvis; without contrast material,
followed by contrast material and further sequences
d. 72198 Magnetic resonance angiography, pelvis, with or without contrast
material
40. A 5-year-old patient is brought to the ED with complaints of abdominal pain.

The ED physician performs an examination and determines that a single view
abdomen x-ray would help him determine the final diagnosis. The child is brought
to the radiology suite and a single view anteroposterior x-ray is performed. The
radiologist reads the x-ray and determines the patient has constipation of the large
intestine with fecal impaction. What is the appropriate code for the radiologists
service?
a. 74270-26 Radiologic examination, colon; barium enema, with or without

KUB
b. 74260-26 Duodenography, hypotonic
c. 74000-26 Radiologic examination, abdomen; single anteroposterior view
d. 74022-26 Radiologic examination, abdomen, complete acute abdomen
series, including supine, erect and/or decubitus views, and single view
chest
41. A 50-year-old female patient sees her PCP for a regularly scheduled yearly
exam. The PCP requests she get a mammography to screen for problems
as it is recommended for her age. The patient goes to the mammography center
where the technician performs a 2-view mammography study of each breast, as
prescribed by the PCP. What is the appropriate radiology CPT code and modifier
to report for the technicians service?
a. 77057-TC Screening mammography, bilateral (2-view film study of each

breast
b. 77056-TC Mammography; bilateral
c. 77055-TC-50 Mammography; unilateral
d. 71035-TC Radiologic examination, chest, special views (e.g., lateral
decubitus, Bucky studies)
Page 41 of 47
42. What is the code range within the Pathology & Laboratory section of the CPT
manual identifying Surgical Pathology?
a. 80100 80103
b. 86000 86849
c. 88300 88399
d. 80500 80502
43. A 60-year-old man visits his doctor for his annual exam. His doctor orders a
total serum cholesterol, triglycerides, and direct measurement of HDL
cholesterol. What is the CPT code of the panel that needs to be ordered?
a. 80053 - Comprehensive Metabolic Panel

b. 80061 Lipid Panel
c. 80048 Basic Metabolic Panel
d. 82465 Total serum cholesterol + 84478 Triglycerides
44. A medical assistant performs a manual urine dipstick test at the request of a
physician. Which CPT code listed below best describes the service rendered by
the medical assistant?
a. 81025 Urine pregnancy test, by visual color comparison method

b. 81005 Urinalysis; qualitative or semiquantitative, except immunoassay
c. 81000 Urinalysis by dipstick, non-automated, with microscopy
d. 81002 Urinalysis by dipstick, non-automated, without microscopy
45. A 35-year-old male presents to his PCP with fever, night sweats, and sudden
loss of weight. The doctor suspects HIV infection and orders an HIV test. The
lab performs a single assay HIV-1 test, which has abnormal results. The
pathologist requests the clinical laboratory scientist perform an HIV confirmatory
test using a Western Blot method. Which code below should be reported for the
confirmatory test ?
a. 86701 HIV-1
b. 86702 HIV-2
c. 86703 HIV-1 & HIV-2, single assay
d. 86689 HTLV or HIV antibody, confirmatory test (e.g., Western Blot)
46. A young couple goes to a reproduction specialist after several unsuccessful

attempts of getting pregnant. The doctor orders a semen analysis to include an
analysis for sperm presence and sperm motility. What is the appropriate CPT
code for the semen analysis?
a. 89321 Semen analysis, presence and/or motility of sperm

b. 89325 Sperm antibodies
c. 89329 Sperm evaluation; hamster penetration test
d. 89335 Cytopreservation, reproductive tissue, testicular
Page 42 of 47
47. Medication (e.g. Tylenol) administered to the patient is reported with CPT
codes from the Medicine section.
a. True
b. False
48. A 5-year-old goes for a pre-Kindergarten checkup. After a comprehensive
checkup, the physician asks the medical assistant to give the child a
diphtheria/tetanus/acellular pertussis (DtaP) vaccination, an intramuscular
vaccine. Select the code combination to report the services rendered.
a. 99392 Preventative medicine exam for established patient age 1-4
years
90467 Immunization administration younger than age 8, with physician
counseling, for intranasal or oral immunization administration
90700 DTaP for patient younger than 7 years, intramuscular use
b. 99411 Preventative medicine counseling in a group setting, 30 minutes
90473 Immunization administration by intranasal or oral route
90701 Diphtheria, tetanus, and whole cell pertussis (DTP),
intramuscular use
c. 99429-22 Unlisted preventative medicine service
d. 99393 Preventative medicine exam for established patient age 5-11
years
90471 Immunization administration; percutaneous, intradermal,
subcutaneous, or intramuscular administration
90700 DTaP for patient younger than 7 years, intramuscular use
49. An adult female patient sees a psychiatrist twice per month to help her deal with
depression & anxiety. The psychiatrist performs insight oriented and behavior
supportive psychotherapy for 30 minutes each session. After a medical evaluation
today, he wrote a prescription for Celexa 10mg. What is the appropriate
psychotherapy code to report for the psychiatrists service today?
a. 90805 Individual psychotherapy; insight oriented, behavior modifying
and/or supportive; in an office or outpatient facility, approx 23-30 minutes
face-to-face with the patient; with medical evaluation and management
service
b. 90807 Individual psychotherapy; insight oriented, behavior modifying
and/or supportive; in an office or outpatient facility, approx 45-50 minutes
service
c. 90809 Individual psychotherapy; insight oriented, behavior modifying
and/or supportive ;in an office or outpatient facility, approx 75-80 minutes
service
d. 99214 Office visit for an established patient with detailed history, detailed
exam, medical decision making moderate complexity
Page 43 of 47
50. An adult patient is injured and referred by her physician to a physical therapist
for rehabilitation therapy. On the patients first visit, the physical therapist performs
an evaluation and determines she needs to have mechanical traction, ultrasound
therapy, and massage therapy. The physical therapist begins the therapy and the
patient is given 15 minutes of traction, 15 minutes of ultrasound, and 30 minutes of
massage. The total time spent with the patient (including evaluation and therapy
procedures) is 80 minutes. What are the appropriate codes used to report todays
physical therapists services?
a. 97001 Physical therapy evaluation (x1)

97012 Application of mechanical traction (x1)
97035 Application of ultrasound, each 15 minutes (x2)
97124 Therapeutic massage, each 15 minutes (x3)
b. 97001 Physical therapy evaluation (x1)

c. 97002 Physical therapy re-evaluation (x1)

d. 97002 Physical therapy re-evaluation (x1)

99354 Prolonged physician service in outpatient setting; face-to-face first
hour
51. The patient in question #50 is sent to a chiropractor for 5 visits. The chiropractor
manipulates the patients cervical, thoracic, and lumbar spine, as well as
manipulating her right scapula, clavicle, and arm. What code(s) should the
chiropractor use to report these services?
a. 98942 Chiropractic manipulative treatment; spinal, 5 regions
b. 98927 Osteopathic manipulative treatment, 5 or 6 body regions
c. 98925 Osteopathic manipulative treatment, 1 or 2 body regions

98926-59 Osteopathic manipulative treatment, 3 or 4 body regions
98927-59 Osteopathic manipulative treatment, 5 or 6 body regions
d. 98941 Chiropractic manipulative treatment; spinal, 3 or 4 regions

98943 Chiropractic manipulative treatment, extraspinal, one or more
regions
Page 44 of 47
52. A 3-year-old female is brought to the local emergency room after she told her
mother that while at daycare, an older boy put an unidentified object into her
vagina and anus The physician performs an extensive examination and thorough
interview. The physician needs to perform an anogenital examination with
colposcopic magnification, but the child refuses. The mother agrees to allow the
child to be given sedation by the emergency physician for the exam. The child is
adequately sedated for a total of 45 minutes, and a colposcopic exam is performed
of the anus and vagina. What codes are appropriate to bill for the emergency room
physicians service?
a. 99236-25 Observation or inpatient hospital care, including discharge on the

same date, with comprehensive history, comprehensive examination, and
high complexity medical decision making
99148 Moderate sedation service provided by a physician other than the
health care professional performing the diagnostic or therapeutic service,
younger than 5 years of age, first 30 minutes
+99150 Moderate sedation serviceeach additional 15 minutes
57420 Colposcopy of the entire vagina, with cervix
b. 99223-25 Inpatient hospital care, per day, with comprehensive history,

comprehensive examination, and high complexity medical decision making
+99145 Moderate sedation service provided by the same physician
performing the diagnostic or therapeutic service, younger than 5 years of age,
each additional 15 minutes (x3)
57452 Colposcopy of the cervix including upper/adjacent vagina
46600-59 Anoscopy, diagnostic, with or without collection of specimens
c. 99285-25 Emergency department visit with comprehensive history,

comprehensive exam, and high complexity medical decision making
99143 Moderate sedation service provided by the same physician
performing the diagnostic or therapeutic service, younger than 5 years of age,
first 30 minutes
+99145 Moderate sedation serviceeach additional 15 minutes
99170 Anogenital examination with colposcopic magnification in childhood
for suspected trauma
d. 99288 Physician direction of emergency medical systems emergency care,

advanced life support
99291-25 Critical care evaluation and management of the critically ill or
critically injured patient; first 30-74 minutes
58999 Unlisted procedure, female genital system (nonobstetrical)
46600-59 Anoscopy, diagnostic, with or without collection of specimens
Page 45 of 47
53. An 82-year-old male is brought to the local emergency room with complaints of
chest pain and shortness of breath. The ED doctor examines the patient and
transfers him to the cardiac unit. In the cardiac unit, a cardiologist performs a
comprehensive history and admits the patient for overnight observation. The
patient is monitored by telemetry and hourly vitals are taken. The next morning
after another exam by the physician, the patient is discharged home. What
codes are used to report these events?
a. Day 1: 99217 Observation care discharge

Day 2: 99215 Office or other outpatient visit with comprehensive
history, comprehensive examination, and high complexity medical
decision making
b. Day 1: nothing is to be reported

Day 2: 99236 Observation or inpatient hospital care including
discharge on the same date, with comprehensive history,
comprehensive examination, and high complexity medical decision
making
c. Day 1: 99220 Initial observation care, per day, with comprehensive

history, comprehensive exam
Day 2: 99217 Observation care discharge
d. Day 1: 99220 Initial observation care, per day, with comprehensive

Day 2: 99220 Initial observation care, per day, with comprehensive
54. Which of the following symbols identifies Add-on codes?
a. +
b.
c.
d.
55. Which of the following is an Add-on code?
a. 99211
b. 22630
c. +22632
d. 80048
56. A patient who is injured on a ski slope is airlifted to the nearest medical center.
What POS is used to report the air ambulance?
a. 41
b. 42
c. 21
d. 22
Page 46 of 47
57. As a convenience to the community, the health department establishes
an outreach mobile clinic. The modified RV is equipped so a physician (or other
qualified healthcare provider) can see patients with acute illnesses such as sore
throat, headache, earache, etc. at any location. The doctor who takes the mobile
clinic on Mondays likes to park the RV at the local supermarket parking lot to see
patients. What is the POS code reported when the physician sees patients in the
mobile clinic in the supermarket parking lot?
a. 02
b. 20
c. 15
d. 41
58. Which code or codes are to be reported when 80 minutes of critical care is
rendered to a patient?
a. 99291 Critical Care first 30-74 minutes; +99292 Critical Care each
additional 30 minutes
b. 99285 Emergency Department Visit (comprehensive history,

comprehensive examination, medical decision making of high complexity)
c. 99255 Inpatient Consultation (comprehensive history, comprehensive

examination, medical decision making of high complexity)
d. 99220 Initial observation care (comprehensive history, comprehensive

examination, medical decision making of high complexity)
59. A CMS 1500 form is a standard insurance billing form.
a. True
b. False
*End of Test
Page 47 of 47

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Plugin-Introduction To CPT Medical Billing 101

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National Center for Competency Testing

7007 College Boulevard, Suite 705

This course is designed for individuals working in medical coding, billing,

Recommended Additional Resources:

Author: James D. Rigdon, CPC, NCICS, BS-HA

Number of Clock Hours Credit: 4

Upon completion of this continuing education course, the professional

1. Define CPT code.

WHAT ARE MEDICAL CODES?

The focus of this course is CPT codes.

HISTORY OF CPT CODES

Example of Level II HCPCS code: A4550 = Surgical Tray

Table 1: Layout of the CPT manual

Section Description Code Range

CPT Index of Codes

Organ or Anatomic Site:

The Appendices in the CPT manual are:

Modifier Description Usage

Modifier Description Usage

Modifier Description Usage

Modifier Description Usage

Appendix B - Summary of Additions, Deletions, and Revisions

00625 Code Added

Appendix C Clinical Examples

An example of a Clinical Example listed in Appendix C:

Appendix D Summary of Add-on Codes

Table 3: Example of an Add-on code

Base CPT Code Add-on CPT Code Description

Appendix E CPT Codes exempt from Modifier -51

Some examples of CPT codes exempt from Modifier 51:

17004 Destruction, premalignant lesions, 15 or more lesions

Appendix F CPT Codes exempt from Modifier -63

As noted above, modifier 63 is used on CPT codes for procedures performed on

Some examples of CPT codes exempt from Modifier 63:

Appendix G CPT Codes that Include Moderate (Conscious) Sedation

43200 Esophagoscopy, rigid or flexible; diagnostic, with or without collection of

Appendix H Alpha Index of Performance Measures by Clinical Condition or Topic

Appendix H is used in conjunction with the voluntary Physician Quality Reporting

Appendix I Genetic Testing Code Modifiers

Neoplasia (solid tumor, excluding sarcoma and lymphoma)

Appendix J Electrodiagnostic Medicine Listing of Sensory, Motor, and Mixed Nerves

Appendix J will not be addressed any further in this course.

Appendix K Products Pending FDA Approval

90698 Diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus

Appendix L Vascular Families

Example of an entry in Appendix L:

To find the order of the Lateral Circumflex Artery:

Common Common Profunda Lateral

The Lateral Circumflex Artery is of the Common Iliac Vascular Family.

Appendix M Crosswalk to Deleted Codes *New for 2007*

An example of an entry listed in Appendix M

Deleted CPT CPT 2007 CPT 2006 Code Descriptor

Table 4: Symbols used in CPT

Symbol Definition Corresponding Appendix

PLACES OF SERVICE (POS)

Place of Service codes are listed on the next page.

POS POS POS

Emergency room- Community mental

Tribal 638 Military treatment Psychiatric residential

Tribal 638 provider- Mass immunization

13 Assisted living facility 41 Ambulance - land 71 Public health clinic

Evaluation and Management (E&M) Services (99201 99499)

Appendix M Crosswalk to Deleted Codes New for 2007