Module 4: CPT & HCPCS Procedure Coding
Code what the provider did: CPT structure and categories, office visit level selection under the current rules, and the modifiers that keep legitimate claims from being denied.
What You'll Learn
- CPT structure, its three categories, and how it differs from HCPCS Level II
- Selecting an office visit level by medical decision making or by total time
- The new versus established patient rule and why it affects payment
- Modifiers 25 and 59, the two most misused codes in the field
Real-World Scenario
The diagnosis code says the patient has osteoarthritis of the left knee. That explains why care was needed and says nothing about what the provider did — the examination, the injection, the X-ray. Twenty-two of the day's twenty-four encounters are office visits, and each needs a level that the documentation actually supports.
Lessons
Complete each lesson in order. Watch the video, review the notes, and finish the challenge.
CPT Structure and Categories
Learn how procedure codes are organized, what the three CPT categories are for, and how to navigate the code set to find the right one.
Evaluation and Management Coding
Code office visits under the current rules, which are based on medical decision making or total time rather than the old history-and-exam bullet counts.
Modifiers
Use two-character modifiers to tell a payer that something about a service was different from the default assumption.