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CPC: CPT® and HCPCS Level II Procedure, Service, and Supply Coding

CPC · Work through your exam, one topic at a time.

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CPT® and HCPCS Level II Procedure, Service, and Supply Coding

This domain tests how you select procedure and supply codes from CPT® and HCPCS Level II, apply section guidelines and modifiers, and avoid unbundling. Expect questions on add-on codes, global packages, units, and the boundary between CPT® and HCPCS Level II.

CPT® structure and conventions

  • CPT® has six sections: Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, and Medicine. Section guidelines and parenthetical notes are binding.
  • Add-on codes are marked with a plus sign; report them with the primary procedure, never with modifier 51.
  • Modifier 51 signals multiple procedures; 50 bilateral; 26 professional component; TC technical component; 22 increased procedural service; 59 or X{E,S,P,U} distinct service.
  • The global surgical package is 0, 10, or 90 days and includes preoperative, intraoperative, and postoperative care. Complications may require modifiers 24, 25, 57, 78, or 79.
  • Unlisted codes require a report and documentation; choose the section closest to the service.

HCPCS Level II

  • HCPCS Level II covers drugs, supplies, DME, prosthetics, and temporary codes. J codes report drugs per unit; A codes supplies; E codes DME; K, Q, and G codes reflect payer-specific coverage.
  • Calculate units from the dose and vial size, not the number of injections. For example, J3301 is triamcinolone acetonide 10 mg, so 40 mg is 4 units.
  • C codes are for hospital outpatient reporting and are not used in physician offices.

Worked example

A patient is seen for hypertension and also has two plantar warts destroyed by cryotherapy. Report 17110 for destruction of benign lesions and 99213-25 for the separately identifiable E/M. The destruction has its own global package, so modifier 25 signals that the E/M was significant and separate. If the visit were only for the warts, no E/M would be reported. If a drug were used, units would follow the HCPCS dose descriptor.

Traps

  • Billing an add-on code alone or with modifier 51.
  • Using modifier 59 when a more specific X modifier applies.
  • Missing units on J codes.
  • Reporting a supply separately when the CPT® code already includes it.
  • Assuming a 90-day global period for every procedure.