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Cpt Code 22523 Descriptive Essay

Earlier, we introduced you to Current Procedural Terminology, or CPT. This expansive, important code set is published and maintained by the American Medical Association (AMA), and it is, with ICD, one of the most important code sets for medical coders to become familiar with. Note also that all the codes featured in this course, and every course that touches on CPT codes, are copyrighted by the AMA.

CPT codes are used to describe tests, surgeries, evaluations, and any other medical procedure performed by a healthcare provider on a patient. As you might imagine, this code set is extremely large, and includes the codes for thousands upon thousands of medical procedures.

CPT codes are an integral part of the billing process. CPT codes tell the insurance payer what procedures the healthcare provider would like to be reimbursed for. As such, CPT codes work in tandem with ICD codes to create a full picture of the medical process for the payer. “This patient arrived with these symptoms (as represented by the ICD code) and we performed these procedures (represented by the CPT code).

Like ICD codes, CPT codes are also used to track important health data and measure performance and efficiency. Government agencies can use CPT codes to track the prevalence and value of certain procedures, and hospitals may use CPT codes to evaluate the efficiency and abilities of individuals or divisions within their facility.


Let’s look a little closer at what these codes look like and how they’re organized. Each CPT code is five characters long, and may be numeric or alphanumeric, depending on which category the CPT code is in. Don’t confuse this with the ‘category’ in ICD. Remember that in ICD codes the ‘category’ refers to the first three characters of the code, which describe the injury or disease documented by the healthcare provider.

With CPT, ‘Category’ refers to the division of the code set. CPT codes are divided into three Categories. Category I is the most common and widely used set of codes within CPT. It describes most of the procedures performed by healthcare providers in inpatient and outpatient offices and hospitals. Category II codes are supplemental tracking codes used primarily for performance management. Category III codes are temporary codes that describe emerging and experimental technologies, services, and procedures.

Note that while CPT codes have five digits, there are not 99,000-plus codes. CPT is designed for flexibility and revision, and so there is often a lot of “space” between codes. Unlike ICD, each number in the CPT code does not correspond to a particular procedure or technology.

Here’s a closer look at the three categories of CPT codes.

Category I

Medical coders will spend the vast majority of their time working with Category I CPT codes. For the sake of simplicity, we’ll refer to the CPT codebook when we’re describing the code set. This book, which is updated yearly by the AMA and the CPT Editorial Board, is an essential tool for every medical coder. In the next few minutes, you’ll learn the basic layout, format, and instructions found in the CPT codebook.

Like the ICD code set and its division into chapters by type of injury or illness, Category I CPT codes are divided into six large sections based on which field of health care they directly pertain to. The six sections of the CPT codebook are, in order:

  • Evaluation and Management
  • Anesthesiology
  • Surgery
  • Radiology
  • Pathology and Laboratory
  • Medicine

CPT codes are, for the most part, grouped numerically. The codes for surgery, for example, are 10021 through 69990.

In the CPT codebook, these codes are listed in mostly numerical order, except for the codes for Evaluation and Management. These Evaluation and Management, or E&M, codes are listed at the front of the codebook for ease of access. Physician’s offices frequently use E&M codes for reporting a number of their services. The code 99214, for a general checkup, is listed in the E&M codes, for example.

Note also that some codes appear out of numerical sequence but near similar procedures. This may seems slightly confusing, but having these codes clustered near similar procedures prevents having to delete and resequence codes, and so is seen as a sort of necessary evil.

Here’s a quick look at the sections of Category I CPT codes, as arranged by their numerical range.

  • Evaluation and Management: 99201 – 99499
  • Anesthesia: 00100 – 01999; 99100 – 99140
  • Surgery: 10021 – 69990
  • Radiology: 70010 – 79999
  • Pathology and Laboratory: 80047 – 89398
  • Medicine: 90281 – 99199; 99500 – 99607

Within each of these code fields, there are subfields that correspond to how that topic—say, Anesthesia—applies to a particular field of healthcare. For instance, the Surgery section, which is by far the largest, is organized by what part of the human body the surgery would be performed on. If you’d like to learn more about the anatomy and physiology terms used in the Surgery section, follow this link to Course 2-10. Likewise, the Radiology section is organized into sections on diagnostic ultrasound, bone and joint studies, radiation oncology, and other fields. Please refer to the eBook for a complete breakdown of the subfields used in each of the code fields.

Each of these fields has its own particular guidelines when it comes to use. For example, the Surgery section has a guideline for how to report extra materials used (such as sterile trays or drugs) and how to report follow-up care in the case of surgical procedures.

Like ICD codes, many CPT codes are arranged by indentation. If a procedure is indented below another code, the indented procedure is an important or noteworthy variation on the above procedure, and would replace the first code. Let’s take a look at an example of an indented code.

The code for “management of liver hemorrhage; simple suture of liver wound or injury” is 47350. This is a surgical procedure, and would be found in the surgery/digestive system portion of the CPT book.

It’s helpful to look at a code like this in two parts. The first, which comes before the semicolon, is the general procedure. In this case, that’d be “liver management.” The phrase that comes after the semicolon is additional, specific information. In this example, we could read the code as “liver management, with a simple suture of liver wound or injury.”

If, however, a doctor performed a more complicated procedure on a patient’s liver, 47350 would no longer be the correct code to use. If we look in the CPT manual, we find the code 47360 below 47350. Code 47360 reads “complex suture of liver wound or injury, with or without hepatic artery ligation.” That phrase is meant to take the place of the phrase that comes after the semicolon in code 47350.

You could therefore read code 47360 as “liver management, with complex suture of liver wound or injury, with or without hepatic artery ligation.”

CPT codes also have a number of modifiers. These modifiers are two-digit additions to the CPT code that describe certain important facets of the procedure, like whether the procedure was bilateral or was one of multiple procedures performed at the same time. CPT modifiers are relatively straightforward, but are very important for coding accurately. For this reason, we’ll cover them in a later video.

Like ICD codes, many CPT codes also have additional instructions featured below the code. These instructions, which are in parentheses below the code you’ve looked up, tell the coder that, in certain situations, another code might be better suited than the present code. For now, just recognize that the CPT code set has a number of instructions that inform the medical coder on how to best code the procedure performed. Remember that you always need to code to the highest level of specificity, and a miscoded procedure can be the difference between an accepted and rejected claim.

The CPT code set also instructs coders on when to use multiple codes, when to use codes in tandem with one another (add-on codes), and which codes are “modifier exempt.”

This is an awful lot of information to take in regarding Category I CPT codes, so let’s review briefly.

Category I CPT codes are numeric, and are five digits long.

They are divided into six sections: Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine.

Each of these sections has its own subdivisions, which correspond to what type of procedure, or what part of the body, that particular procedure relates to.

The sections are grouped numerically, and, aside from Evaluation and Management, are in numerical order. That is, the codes for Anesthesia come before, or are “lower” than the codes for Pathology and Laboratory.

Each of these sections also has specific guidelines for how to use the codes in that section.

Certain codes have related procedures indented below them. These indented codes are important variations on the code above them, and denote different methods, outcomes, or approaches to the same procedure. For example, the code for the elevation of a simple, extradural depressed skull fracture is 62000. The code for the elevation of a compound or comminuted, extradural depressed skull fracture is 62005.

There are a few important CPT Modifiers, which provide additional information about the procedure performed. We’ll cover these in just a little bit.

Some codes have instructions for coders below them. These instructions are found in parentheses below the code, and they instruct the coder that there may be another, more accurate code to use.

Now that we’ve given you a brief glimpse of Category I CPT codes, let’s take a look at the next section of CPT.

Category II

These codes are five character-long, alphanumeric codes that provide additional information to the Category I codes. These codes are formatted to have four digits, followed by the character F. These codes are optional, but can provide important information that can be used in performance management and future patient care.

Here’s a quick example. If a doctor records a patient’s Body Mass Index (BMI) during a routine checkup, we could use Category II code 3008F, “Body Mass Index (BMI), documented.”

These codes never replace Category I or Category III codes, and instead simply provide extra information. They are divided into numerical fields, each of which corresponds with a certain element of patient care. For a list of these fields in oder as well as examples, please refer to our ebook and powerpoints.

  • Composite codes
    • These codes combine a number of procedures that typically occur in conjunction with one main procedure.
      • Example: 0001F: heart failure assessed (includes all of the following):
        • Blood pressure measured
        • Level of activity assessed
        • Clinical symptoms of volume overload assessed
        • Weight recorded
        • Clinical signs of volume overload assessed
    • Patient Management
      • Includes patient care provided for specific clinical purposes like pre- and postnatal care.
        • Example: 0503F: Postpartum care visit
    • Patient History
      • Describes measures for select elements of patient history or symptom review
        • Example: 1030F: Pneumococcus immunization status assessed
    • Physical Examination
      • Example: 2014F: Mental status assessed
    • Diagnostic/Screening Processes or Results
      • Includes results of tests ordered, including clinical lab tests and radiological procedures
        • Example: 3006F: Chest X-ray documented and reviewed
    • Therapeutic, Preventive, or Other Interventions
      • Describes pharmacologic, procedural or behavioral therapies
        • Example: 4037F: influenza immunization ordered or administered
    • Follow-up or Other Outcomes
      • These codes describe the review and communication of test results to a patient, patient satisfaction, patient functional status, and patient morbidity or mortality
        • Example: 5005F: patient counseled on self-examination for new or changing moles
    • Patient Safety
      • Includes codes that describe patient safety precautions
        • Example: 6015F: Patient receiving or eligible to receive foods, fluids, or medication by mouth
    • Structural Measures
      • This short section includes codes that describe the setting of the delivered care, and also covers the capabilities of the healthcare provider
        • Example: 7025F: patient information entered into a reminder system with a target due date for the next mammogram

    There are not nearly as many Category II CPT codes as there are in Category I, and in general you will not use Category II nearly as much. Still, it is an important element of the CPT code set, and you should be familiar with the basics of Category II codes as you prepare for a career in the field.

    Category III

    The third category of CPT codes is made up of temporary codes that represent emergent or experimental services, technology, and procedures. In certain cases, you may find that a newer procedure does not have a Category I code. There are codes in Category I for unlisted procedures, but if the procedure, technology, or service is listed in Category III, you are required to use the Category III code.

    Category III codes allow for more specificity in coding, and they also help health facilities and government agencies track the efficacy of new, emergent medical techniques.

    Think of Category III as codes that may become Category I codes, or that just don’t fit in with Category I. Category I codes must be approved by the CPT Editorial Panel. This Panel mandates that procedures or services must be performed by a number of different facilities in different locations, and that the procedure is approved by the FDA. Due to the nature of emerging medical technology and procedures, it’s not always possible for an experimental procedure to meet these criteria, and thus become a Category I code.

    Whether a Category III code becomes a Category I code or not, all Category III codes are archived in the CPT manual for five years. If at the end of this five year period the code has not been converted to Category I, this procedure must be marked with a Category I “unspecified procedure” code. When flipping through the Category III section of the CPT manual, you’ll notice that each of the codes has a phrase listing its sunset date below the code. Think of the sunset dates as expiration dates on the code.

    Like Category II, these codes are five characters long, and are comprised of four digits and a terminal letter. In this case, the last letter of Category III codes is T. For example, the code for the fistulization of sclera for glaucoma, through ciliary body is 0123T.

    Now that you have a better idea of what CPT looks like, how it’s formatted, and when to use which category of codes, let’s dive a little deeper into modifiers and how CPT codes look in action.

Video: Introduction to Cost Procedural Terminology (CPT)

CPT codes allow coders to describe exactly what service a healthcare provider has performed for a patient. Learn more about these invaluable codes in this video.

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December 2014

Radiology Billing and Coding: 2015 Coding Changes
By Melody W. Mulaik, MSHS, CRA, FAHRA, RCC, CPC, CPC-H
Radiology Today
Vol. 15 No. 12 P. 12

Editor's Note: This article contains coding information from the 2015 Physician's Current Procedural Terminology (CPT®) Manual. CPT is a registered trademark of the American Medical Association. CPT® five-digit codes, nomenclature, and other data are copyright 2014 American Medical Association. All rights reserved.

A new year is almost upon us and with it will come new coding, compliance, and reimbursement changes and challenges. Some are small and will likely have little or no impact. Others promise some degree of chaos, either with processes currently in place or for the third-party payers. As of this writing, the complete authoritative guidance and reimbursement information has not yet been released for the new 2015 procedure codes, but we do have the codes, which provide a good idea of potential questions and concerns.

Breast Imaging
Perhaps the biggest change in radiology coding for 2015 is the area of breast imaging. There are big changes for both breast ultrasound and tomosynthesis. The current breast ultrasound code (76645) has been deleted, and two new codes (76641-76642) have been created, one each for complete and limited exams. Procedure code 76641 represents a complete examination of all four quadrants of the breast and the retroareolar region. The limited code, 76642, is for a focused exam of the breast that is limited to one or more of the elements included in 76641. Both code definitions also include an examination of the axilla, if performed. There is a new note in the CPT® Manual that directs the assignment of the limited extremity code 76882 if only the axilla is evaluated using ultrasound.

As with all ultrasound examinations, there must be a thorough evaluation of the anatomic area, image documentation, and a final written report to ensure that it is separately reportable. However, this is generally not an area of concern for radiology practices and/or departments.




Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete


… limited



Additionally, three new codes have been created for digital breast tomosynthesis (DBT) to address both screening and diagnostic studies. The screening DBT code +77063 is an add-on code that will be reported together with the screening mammogram code 77057.




Digital breast tomosynthesis; unilateral


… bilateral


Screening digital breast tomosynthesis, bilateral (list separately in addition to code for primary procedure)



In the 2015 Medicare Physician Fee Schedule Final Rule, CMS announced that the codes for diagnostic tomosynthesis (77061 and 77062) will not be valid for Medicare billing. Instead, providers must report diagnostic tomosynthesis to Medicare using a new HCPCS code, +G0279 [Diagnostic digital breast tomosynthesis, unilateral or bilateral (List separately in addition to G0204 or G0206)]. Note that unlike 77061 and 77062, G0279 is an add-on code, meaning that it cannot be reported as a stand-alone service. For those payors that do accept codes 77061 and 77062, these codes may not be reported with the regular screening mammography code 77057. This may create some challenges when appropriately reporting screening and diagnostic studies on the same date of service. It is important to note that while new procedure codes have been created for this technology, there is no guarantee that all payers will provide separate payment. There will be a lot more information regarding the coding and reimbursement of mammography, and specifically DBT, in the coming months so it is important to consider this issue and to stay current with payers.

Myelography procedures may also be an area of note in 2015. Two myelogram injection codes have been revised and four new comprehensive codes have been established for myelogram contrast injection and imaging.

For the injection codes, the description of 61055 has been changed and the words "(eg, C1-C2)" have been removed, presumably to eliminate redundancy. Also, the description of 62284 was changed from "Injection … spinal" to "Injection … lumbar."




Cisternal or lateral cervical (C1-C2) puncture; with injection of medication or other substance for diagnosis or treatment


Injection procedure for myelography and/or computed tomography, lumbar (other than C1-C2 and posterior fossa)





Myelography via lumbar injection, including radiological supervision and interpretation; cervical


… thoracic


… lumbosacral


… two or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical)

The new comprehensive codes include the lumbar injection as well as the myelogram supervision and interpretation. The existing myelogram imaging codes (72240-72270) have not been deleted for 2015. The ACR had previously noted that these codes would be retained because different physicians perform the injection and the imaging guidance in given situations. If a physician performs the entire procedure, a comprehensive code, and not the component codes, would be submitted.

However, there is some concern regarding the performance and reporting of traditional myelography in conjunction with CT studies of the spine. These new codes were discussed in the September 2014 issue of CPT Assistant and specific guidance was provided regarding the reporting of traditional myelography in addition to a CT study.

To summarize, myelography should not be reported solely for the documentation of needle placement; a complete procedure with full imaging must be performed and documented, as has previously been the case. However, new clarifying language states that "the supervision and interpretation for myelography should not be reported without the referring physician or other qualified health care professional requesting an X-ray myelogram." Additional information recommended appending modifier 59 to the CT of the spine if it is performed on the same day as a traditional X-ray myelogram.

On July 1, 2014, the Centers for Medicare & Medicaid Services implemented Correct Coding Initiative (CCI) edits that bundle the codes for radiographic myelogram supervision and interpretation into the codes for CT of the spine, but not the inverse. For example, a radiographic cervical myelogram (code 72240) is bundled into a contrast CT of the cervical spine (72126). These edits can be bypassed with a modifier; therefore, since the CT scan is the Column 1 code of the CCI code pair, the modifier to the radiographic myelogram code must be applied in order for the myelogram, and not the CT of the spine, to be paid. Revised guidance will likely be forthcoming on this issue so this is another item to watch for in 2015.

Vertebroplasty, Vertebral Augmentation, Sacroplasty
The existing vertebroplasty codes (22520-22522) have been deleted for 2015, and three new codes have been established. These codes include all imaging guidance, so the supervision and interpretation codes 72291 and 72292 have also been deleted. Instead of codes for thoracic and lumbar vertebroplasty, CPT® now provides codes for cervicothoracic and lumbosacral procedures. All of the vertebroplasty, kyphoplasty, and sacroplasty codes include bone biopsy when performed at the same level.




Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic


… lumbosacral


… each additional cervicothoracic or lumbosacral vertebral body (list separately in addition to code for primary procedure)

The existing vertebral augmentation (kyphoplasty) codes (22523-22525) have also been deleted, and three new codes have been established. These codes include all imaging guidance associated with the procedure.




Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), one vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic


… lumbar


… each additional thoracic or lumbar vertebral body (list separately in addition to code for primary procedure)

The Category III sacroplasty codes (0200T-0201T) have been revised to include imaging guidance and bone biopsy (when performed).

Other Changes
Several other changes may impact coding and billing practices depending upon current scope of service. Other keys items to review include the following:

• Arthrocentesis: The three existing arthrocentesis codes (20600, 20605, 20610) have been revised to specify procedures performed without ultrasound guidance, and three new codes (20604, 20606, 20611) have been added for procedures performed with ultrasound guidance. The Category III code for sacroiliac joint stabilization/arthrodesis (0334T) has been deleted and replaced with a Category I code (27279).

• Tumor ablation: The bone tumor ablation code (20982) has been revised to indicate that the procedure is for reduction or eradication of the tumor(s) and includes adjacent soft tissue involved by tumor extension. It also includes imaging guidance when performed. A new code (20983) has also been established for cryoablation of bone tumors, as has a new code for percutaneous cryoablation of liver tumors (47383).

• Fenestrated endovascular aortic repair (FEVAR): A new code has been created for physician planning that requires at least 90 minutes for FEVAR (34839).

• Scelerotherapy: The code for the treatment of facial spider veins (36469) has been deleted and no replacement code or guidance has been provided.

• Carotid and vertebral stents: The codes for transcatheter carotid stent placement (37215-37217) have been revised and a new code (37218) for open or percutaneous antegrade approach treatment of intrathoracic common carotid artery or innominate artery has been added for 2015.

• Arterial stent placement: The description of codes 37236-37237 has been revised to indicate that they are not to be used for lower extremity artery stenting for occlusive disease as codes are already available for this purpose.

• Vertebral fracture assessment (VFA): The existing VFA code (77082) has been deleted, and two new VFA codes (77085-77086) have been created. Code 77085 is a combination code that includes axial dual-energy X-ray absorptiometry (DXA) as well as VFA, while 77086 represents a stand-alone VFA. The existing codes for axial and appendicular DXA studies (77080, 77081) are not changing and will be used whenever DXA is performed without VFA.

— Melody W. Mulaik, MSHS, CRA, FAHRA, RCC, CPC, CPC-H, is president and cofounder of Coding Strategies, which provides specialty-specific auditing and educational services for physicians, hospitals, and billing companies nationwide.

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