Medicine

1
Chapter 12

• Medicine

2
Medicine

• Includes a wide variety of services and
  procedures
• Common to assign multiple codes
• Modifiers may not be necessary for most codes
• See Table 12-1 for medicine chapter categories.

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Medicine (cont.)

• Immune globulins
• Administered to prevent disease after exposure to
  the illness
• All codes in this series are -51 exempt.

4
Medicine (cont.)

• Immunization administration
• Codes are assigned when physician counsels the
  patient and family.
• Some immunizations are combination.
• Two codes are assigned for immunizations
• Administration of vaccine
• Vaccine and toxoid

5
Medicine (cont.)

• Therapeutic infusions
• IV therapy infused over time
• Codes based on time
• Cannot bill for prolonged services with these
  codes
• Additional HCPCS codes needed to identify
  medication or solution given

6
Medicine (cont.)

• Injections
• Injection administration coded in addition to the
  vaccine medication code
• Psychiatry
• Office versus hospital facility
• E/M only, E/M with therapy, or just therapy
• Psychiatric therapeutic care

7
Medicine (cont.)

• Biofeedback
• Very specialized and selectively used
• Dialysis
• ESRD dialysis code is selected one time for an
  entire month (30 days) of dialysis
• Peritoneal dialysis is coded per date of service

8
Medicine (cont.)

• Gastroenterology
• Selected when diagnostic services are defining
  the function or disease of stomach or esophagus

9
Ophthalmology

• Used to report ophthalmologic services alone,
  services with E/M (intermediate or
  comprehensive), or just E/M services
• Contact lens services
• Ocular prosthetics
• Spectacle services

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Medicine

• Otorhinolaryngology
• Diagnostic testing
• Cardiology
• Pulmonary
• Codes include the laboratory procedure with
  interpretation and results
• Medications are coded separately

11
Allergy and Clinical Immunology

• Sensitivity services
• History, exam, observation of patient
• Cutaneous and mucous membrane tests
• Immunotherapy
• Provision of allergen extracts

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Medicine

• Endocrinology
• Sleep testing
• Polysomnography
• Extra parameters
• Neurology and neuromuscular procedures
• Intraoperative neurophysiology
• Neurostimulator analysis-programming

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Medicine (cont.)

• Motion analysis
• Central nervous system assessments
• Health and behavior assessment
• Selected when someone other than an MD performs
  service

14
Medicine (cont.)

• Chemotherapy administration
• Preparation of the chemotherapy is included
• Separate code used for each method of
  administration and medication

15
Medicine (cont.)

• Photodynamic therapy and dermatological
  procedures
• Physical medicine and rehabilitation
• Modalities
• Therapeutic procedures
• Active wound care management

16
Medicine (cont.)

• Medical nutrition therapy
• Acupuncture
• Osteopathic manipulation
• Chiropractic manipulative treatment

17
Medicine (cont.)

• Special services
• Qualifying circumstances for anesthesia
• Other services
• Home health procedures