National Correct Coding Policy Manual

TOC.doc

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TABLE OF CONTENTS

FOR

NATIONAL CORRECT CODING POLICY MANUAL

FOR PART B MEDICARE CARRIERS

The Centers for Medicare and Medicaid Services (CMS), formerly the Health Care Financing Administration, is responsible for the content of this product. No endorsement by the American Medical Association (AMA) is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any uses, non-use, or interpretation of information contained or not contained in this product. These Correct Coding Policies do not supersede any other specific Medicare coding, coverage, or payment policies.

Introduction

Introductionvii

Purposevii

Correct Codingviii

Policy Manual Conditions and Formatix

Edit Development and Review Processx

Sources of Information about NCCIxi

Correspondence to CMS about NCCI and its Contentsxi

Chapter I - General Correct Coding Policies

A.IntroductionIA-1

B.Coding Based on Standards of Medical/SurgicalIA-2

Practice

C.Medical/Surgical PackageIA-5

D.Evaluation and Management ServicesIA-9

E. Modifiers and Modifier IndicatorsIA-9

F.Standard Preparation/Monitoring ServicesIA-14

G.Anesthesia Service Included in the Surgical

ProcedureIA-14

H.HCPCS/CPT Procedure Code DefinitionIA-15

I.HCPCS/CPT Coding ManualInstruction/GuidelineIA-16

J.Separate ProcedureIA-16

K.Family of CodesIA-17

L.More Extensive ProcedureIA-17

M.Sequential ProcedureIA-18

N.Laboratory PanelIA-19

O.Misuse of Column 2 Code with Column 1 CodeIA-19

P. Mutually Exclusive ProcedureIA-20

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Q.Gender-Specific Procedure (formerlyDesignationIA-20

of Sex)

R. Add-on Codes IA-21

S. Excluded ServiceIA-22

T. Unlisted Service or ProcedureIA-23

U. Modified, Deleted, and Added Code Pairs/EditsIA-23

Chapter II - Anesthesia Services(CPT codes 00000 - 09999)

A.IntroductionIIA-1

B.Standard Anesthesia CodingIIA-1

C.Radiologic Anesthesia CodingIIA-8

D.Monitored Anesthesia CareIIA-9

E.Anesthesiologists and CRNAsIIA-9

Chapter III - Surgery: Integumentary System (CPT Codes 10000 - 19999)

A.IntroductionIIIA-1

B.Evaluation and ManagementIIIA-1

C.AnesthesiaIIIA-2

D.Incision and DrainageIIIA-3

E.Lesion RemovalIIIA-4

F.Repair and Tissue TransferIIIA-7 G. Grafts and Flaps IIIA-7 H. Breast (Incision, Excision, Introduction, IIIA-8 Repair and Reconstruction)

I.Add-on CodesIIIA-9

J.General Policy StatementsIIIA-10

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Chapter IV - Surgery: Musculoskeletal System (CPT Codes 20000 - 29999)

A.IntroductionIVA-1

B.AnesthesiaIVA-1

C.BiopsyIVA-1

D.FracturesIVA-2

E.General Policy StatementsIVA-3

Chapter V - Surgery: Respiratory, Cardiovascular, Hemic and Lymphatic Systems (CPT Codes 30000 - 39999)

A.IntroductionVA-1

B.Respiratory SystemVA-1

C.Cardiovascular SystemVA-5

D.Hemic and Lymphatic SystemsVA-9

E. General Policy StatementsVA-9

Chapter VI - Surgery: Digestive System (CPT Codes 40000 - 49999)

A.IntroductionVIA-1

B.Endoscopic ServicesVIA-1

C.Abdominal ProceduresVIA-4

D.General Policy StatementsVIA-5

Chapter VII - Surgery: Urinary, Male Genital, Female Genital, Maternity Care and Delivery Systems (CPT Codes 50000 - 59999)

A.IntroductionVIIA-1

B.Urinary SystemVIIA-1

C.Male Genital SystemVIIA-4

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D.Female Genital SystemVIIA-5

E.Maternity Care and DeliveryVIIA-6

F. General Policy StatementsVIIA-6

Chapter VIII - Surgery: Endocrine, Nervous, Eye and Ocular Adnexa, Auditory Systems (CPT Codes 60000 - 69999)

A.IntroductionVIIIA-1

B.Endocrine and Nervous SystemsVIIIA-1

C.OphthalmologyVIIIA-4

D.Auditory SystemVIIIA-6

E.General Policy StatementsVIIIA-6

Chapter IX - Radiology Services (CPT Codes 70000 - 79999)

A.IntroductionIXA-1

B.Non-interventional Diagnostic ImagingIXA-1

C.Interventional/Invasive Diagnostic ImagingIXA-2

D.Evaluation and ManagementIXA-4

E.Nuclear MedicineIXA-4

F. Radiation OncologyIXA-5

G.General Policy StatementsIXA-5

Chapter X - Pathology and Laboratory Services (CPT Codes 80000 - 89999)

A.IntroductionXA-1

B.Organ or Disease Oriented PanelsXA-2

C.Evocative/Suppression TestingXA-2

D.General Policy StatementsXA-2

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Chapter XI - Medicine, Evaluation and Management Services (CPT Codes 90000 - 99999)

A.IntroductionXIA-1

B.Therapeutic or Diagnostic Infusions/Injections and XIA-1

Immunizations

C.Psychiatric ServicesXIA-3

D.BiofeedbackXIA-3

E.GastroenterologyXIA-4

F.OphthalmologyXIA-4

G.Otorhinolaryngologic ServicesXIA-4

H.Cardiovascular ServicesXIA-5

I.Pulmonary ServicesXIA-7

J.Allergy Testing and ImmunotherapyXIA-8

K.Neurology and Neuromuscular ProceduresXIA-9

L.Chemotherapy AdministrationXIA-10

M.Physical Medicine and RehabilitationXIA-12

N.Osteopathic Manipulative TreatmentXIA-13

O.Chiropractic Manipulative TreatmentXIA-13

P.Miscellaneous ServicesXIA-13

Q.Evaluation and ManagementXIA-13

R.General Policy StatementsXIA-15

Chapter XII - Supplemental Services (HCPCS Level II Codes A0000 - V9999)

A.IntroductionXIIA-1

B.General Policy StatementsXIIA-1

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Chapter XIII – Category III Codes (CPT Codes 0001T – 0099T)

A.IntroductionXIIIA-1