Covering Procedures Related to:
Cardiovascular Medicine
Electrocardiography (ECG) & Cardiac Monitoring
93000 – Electrocardiogram, complete, with interpretation and report
93010 – Electrocardiogram, tracing only
93227 – External cardiac event monitoring, 30 days
93228 – External cardiac event monitoring, 30 days with interpretation
AMA Guidelines
- Specify the type of ECG performed (e.g., complete, tracing only).
- Clarify the duration of cardiac event monitoring (e.g., 30 days).
Stress Testing
93015 – Cardiovascular stress test, exercise, with physician supervision
93016 – Cardiovascular stress test, pharmacological, with physician supervision
93350 – Echocardiography, transthoracic, with Doppler
AMA Guidelines
- Specify if the stress test is exercise or pharmacological.
- Indicate whether Doppler studies are included in the echocardiography.
Cardiac Catheterization and Intervention
93454 – Coronary angiography, catheter placement, diagnostic
93456 – Coronary angiography, catheter placement, diagnostic with selective right and left heart catheterization
92920 – Angioplasty, coronary, with stent placement
92928 – Percutaneous coronary intervention (PCI), coronary artery, including stent placement
AMA Guidelines
- Clarify the type of catheterization (e.g., diagnostic, therapeutic).
- Specify the number of arteries treated (e.g., single, multiple).
Pulmonary Medicine
Pulmonary Function Testing
94010 – Spirometry, with or without volume measurement
94060 – Bronchodilator response testing
94760 – Pulmonary stress testing
94761 – Pulmonary function testing, complete
AMA Guidelines
- Clarify the type of pulmonary function test (e.g., spirometry, bronchodilator response).
- Specify if the testing is complete or focused (e.g., bronchodilator response vs. complete pulmonary function testing).
Oximetry & Oxygen Therapy
94762 – Oximetry, continuous, with interpretation
94640 – Pressurized inhalation therapy, for asthma or other obstructive conditions
94660 – Continuous positive airway pressure (CPAP) initiation
AMA Guidelines
- Specify the modality of oxygen therapy (e.g., continuous oximetry, CPAP).
- Document any associated therapeutic interventions (e.g., inhalation therapy for asthma).
Neurology Medicine
Electroencephalography (EEG)
95812 – Electroencephalogram, routine, awake and asleep
95813 – Electroencephalogram, awake
95816 – Electroencephalogram, sleep-deprived
AMA Guidelines
Specify the type of EEG (e.g., routine, sleep-deprived).
Document whether the EEG is conducted during sleep or wakefulness.
Nerve Conduction Studies (NCS) and EMG
95900 – Nerve conduction study, upper extremity
95903 – Nerve conduction study, lower extremity
95860 – Needle electromyography (EMG), one or more muscles
95861 – Needle electromyography (EMG), each additional muscle
AMA Guidelines
- Specify the location of the nerve conduction study (e.g., upper or lower extremity).
- Document the number of muscles studied for EMG and the specific muscles involved.
Endocrinology Medicine
Thyroid Testing
84443 – Thyroid-stimulating hormone (TSH)
84436 – Thyroxine (T4), total
84439 – Triiodothyronine (T3), total
AMA Guidelines
- Specify the specific thyroid test being conducted (e.g., TSH, T4, T3).
- Document the reason for testing (e.g., hyperthyroidism, hypothyroidism).
Insulin and Glucose Testing
82947 – Glucose, quantitative
82950 – Glucose tolerance test, 3-hour
83718 – Insulin, serum
AMA Guidelines
- Clarify if the glucose test is quantitative or part of a tolerance test.
- Document any insulin tests performed (e.g., for diabetes evaluation).
Gastroenterology Medicine
Endoscopic Procedures
45378 – Colonoscopy, diagnostic
45380 – Colonoscopy, with biopsy
43235 – Upper gastrointestinal endoscopy, diagnostic
43239 – Upper gastrointestinal endoscopy, with biopsy
AMA Guidelines
- Clarify whether biopsies or other interventions (e.g., removal of polyps) were performed during the procedure.
- Specify the level of complexity (e.g., diagnostic vs. therapeutic).
Hepatitis Testing
86803 – Hepatitis B surface antigen, qualitative
86804 – Hepatitis B surface antibody, quantitative
86805 – Hepatitis C antibody, screening
AMA Guidelines
- Specify the type of hepatitis test (e.g., B antigen, C antibody).
- Document the indication for the test (e.g., screening, monitoring, diagnosis).
Modifier 22
Increased Procedural Services
Use when the procedure is more complex or takes significantly longer than usual.
Modifier 50
Bilateral Procedures
Use when the same procedure is performed on both sides (e.g., bilateral carotid endarterectomy).
Modifier 51
Multiple Procedures
Use when multiple procedures are performed during the same session by the same provider.
Modifier 59
Distinct Procedural Service
Use when a procedure is separate and distinct from other procedures performed on the same day.
Modifier 78
Return to Operating Room for Related Procedure
Use when a patient requires a return to the operating room within the same postoperative period for a procedure related to the initial surgery.
Modifier 79
Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Use when a patient undergoes an unrelated procedure during the postoperative period.
Documentation and Reporting Requirements
General AMA Guidelines for Endocrine System Procedures:
Accurate Documentation: Ensure the type of procedure, approach (e.g., open vs. endoscopic), laterality (left or right), and associated interventions (e.g., grafting) are documented.
Modifiers: Use modifiers when applicable, especially for bilateral procedures, additional services (e.g., biopsy, device implantation), or increased procedural complexity.
Correct Code Selection: Select the appropriate CPT code based on the procedure performed. Include the specific reason for surgery (e.g., tumor resection, decompression).
Example Scenarios
Scenario 1:
Cervical Spinal Fusion (Posterior Approach)
CPT Code(s):Â
22630 – Spinal fusion, lumbar, posterior approach
Modifier(s): None
Documentation:
Confirm that the fusion is performed on the lumbar spine, using the posterior approach.
Scenario 2:
Unilateral Carotid Endarterectomy
CPT Code(s):Â
35301 – Carotid endarterectomy, unilateral
Modifier(s): None
Documentation:
Document that the unilateral carotid endarterectomy is performed.
Â
Scenario 3:
Deep Brain Stimulation (Bilateral Electrode Placement)
CPT Code(s):
61885 – Deep brain stimulation, bilateral electrode placement
Modifier(s): None
Documentation:
Specify that bilateral electrode placement is performed, and the targeted area (e.g., subthalamic nucleus).