DX code 630.00 - 759.99

COMPLICATIONS OF PREGNANCY, CHILDBIRTH, AND THE PUERPERIUM [630-677]
[630-633] Ectopic and molar pregnancy.
[634-639] Other pregnancy with abortive outcome.
[640-648] Complications mainly related to pregnancy.
[650-659] Normal delivery, and other indications for care in pregnancy, labor, and delivery.
[660-669] Complications occuring mainly in the course of labor and delivery.
[670-677] Complications of the puerperium.

DISEASES OF THE SKIN AND SUBCUTANEOUS TISSUE [680-709]
[680-686] Infections of skin and subcutanious tissue.
[690-698] Other inflammatory conditions of skin and subcutaneous tissue.
[700-709] Other diseases of skin and subcutaneous tissue.

DISEASES OF THE MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE [710-739]
[710-719] Arthropathies and related disorders.
[720-724] Dorsopathies.
[725-729] Rheumatism, excluding the back.
[730-739] Osteopathies, chondropathies, and acquired musculoskeletal deformities.

CONGENITAL ANOMALIES [740-759]
[740-744] Head and spine anomalies.
[745-747] Heart and circulatory system anomalies.
[748-751] Respiratory and digestive system anomalies.
[752-753] Genitals and urinary system anomalies.
[754-757] Musculoskeletal and integumentary system anomalies.
[758-759] Chromosonal and other anomalies.

CERTAIN CONDITIONS ORIGINATING IN THE PERINATAL PERIOD [760-779]
[760-763] Maternal causes of perinatal morbidity and mortality.
[764-779] Other conditions originating in the perinatal period.
SYMPTOMS, SIGNS, AND ILL-DEFINED CONDITIONS [780-799]
[780-789] Symptoms.
[790-796] Nonspecific abnormal findings.
[797-799] Ill-defined and unknown causes of morbidity and mortality.

Anesthesia Modifiers - P1 - P6 modifier

Anesthesia Modifiers Including Physical Status Modifiers:



All anesthesia services are reported by use of the anesthesia five-digit procedure code (00100-01999) plus
the addition of a physical status modifier. The use of other optional modifiers may be appropriate.

Physical Status Modifiers
Physical Status modifiers are represented by the initial letter 'P' followed by a single digit from 1 to 6
defined below:



P1 - A normal healthy patient.
P2 - A patient with mild systemic disease.
P3 - A patient with severe systemic disease.
P4 - A patient with severe systemic disease that is a constant threat to life.
P5 - A moribund patient who is not expected to survive without the operation.
P6 - A declared brain-dead patient whose organs are being removed for donor purposes.

The above six levels are consistent with the American Society of Anesthesiologists (ASA) ranking of patient physical status. Physical status is included in CPT to distinguish between various levels of
complexity of the anesthesia service provided.

Example: 00100-P1


Other Modifiers (Optional)
Under certain circumstances, medical services and procedures may need to be further modified. Other
modifiers commonly used in Anesthesia are included below. A complete list of modifiers and their
respective codes are listed in Appendix A.

-22 Unusual Procedural Services: When the service(s) provided is greater than that usually
required for the listed procedure, it may be identified by adding modifier '-22' to the usual procedure
number or by use of the separate five digit modifier code 09922. A report may also be appropriate.

-23 Unusual Anesthesia: Occasionally, a procedure which usually requires either no anesthesia or
local anesthesia, because of unusual circumstances must be done under general anesthesia. This
circumstance may be reported by adding the modifier '-23' to the procedure code of the basic service
or by use of the separate five digit modifier code 09923. Note: Modifier '-47', Anesthesia by
Surgeon, (see modifier section) would not be used as a modifier for the anesthesia procedures 00100-
01999.

-32 Mandated Services: Services related to mandated consultation and/or related services (eg,
PRO, 3rd party payer) may be identified by adding the modifier '-32' to the basic procedure, or the
service may be reported by use of the five digit modifier 09932.

Medicine CPT code List

Immunization Injections 90700 - 90749
Therapeutic/ Diagnostic Infusions ( excludes chemo) 90780 - 90781
Therapeutic or Diagnostic Injections 90782 - 90799
Psychiatry 90801 - 90899
Biofeedback 90901 - 90911
Dialysis 90918 - 90999
Gastroenterology 91000 - 91299
Ophthalmology 92002 - 92499
Special Otorhinolaryngologic Services 92502 - 92599
Cardiovascular 92950 - 93799
Non-Invasive Vascular Diagnostic Studies 93875 - 93990
Pulmonary 94010 - 94799
Allergy and Clinical Immunology 95004 - 95199
Endocrinology 95250
Neurology and Neuromuscular Procedures 95805 - 96004
Central Nervous System Assessments/Tests 96100 - 96117
Health and Behavior Assessment/Intervention 96150 - 96155
Chemotherapy Administration 96400 - 96549
Photodynamic Therapy 96567 - 96571
Special Dermatological Procedures 96900 - 96999
Physical Medicine and Rehabilitation 97001 - 97799
Medical Nutrition Therapy 97802 - 97804
Osteopathic Manipulative Treatment 98925 - 98929
Chiropractic Manipulative Treatment 98940 - 98943
Special Services Procedures and Reports 99000 - 99091
Qualifying Circumstances for Anesthesia 99100 - 99140
Sedation With or Without Analgesia 99141 - 99142
Other Services and procedures 99170 - 99199
Home Health Procedures/Services 99500 - 99539
Home Infusion Procedures 99551 - 99569

Medical Billing Code Changes - Keep up with updation.

Medical billing coding is used to claim from insurance companies, and change frequently, usually on an annual basis. When billing codes become obsolete, insurance companies do not accept them, and as a consequence, claims are rejected.

There are a few methods which one can employ to stay in touch with changes and maintain a current medical billing code. The Code Books like CPT give a definition for each billing code, and list each billing code alphanumerically, making it easy to follow. Billing codes recorded in the CPT Code Books are revised with each issue on annual basis. Within each book is an appendix of changes, which show how a service has been modified from the current procedural terminology while maintain the same definition. By following the changes in the CPT Code Book every year, one is able to maintain an up to date database of billing code changes.
Another possible method to handle billing code changes involves using the International Classification of Diseases (ICD9). This system is used primarily as a means of reporting statistical data, and works by grouping the procedures of the related diseases. Similar to the CPT Code Books, ICD9 Books sort their diseases and diagnoses alphanumerically, and are updated annually.

Having to cross-reference billing codes with two referencing systems can be very time consuming, and there can be an element of human error involved. Using Medical Billing Software is a worthwhile alternative for referencing code books, which is likely to be updated frequently. Another advantage is that one does not require cross-referencing or the need to refer a range of billing code books when coding any medical procedure. Electronic software completely removes this problem, and more importantly, online referencing features are available that cannot be matched by using code reference books.

With such distinct advantages, one can see that medical software for code billing is the most effective way to handle changes in billing codes. Apart from being more efficient in filing claims with the billing codes, offices that make use of online billing and coding software will have an easier migration from outdated billing codes and procedures to current items. All this is possible since the software itself can handle most of the comparison and referencing, providing there are regular updates to its database.

Maintaining an up to date billing code database not only streamlines administrative work, but it ensures that the billing practices used and the standard of service one can provide to consumers is improved, and a high standard maintained.

RESPIRATORY, DIGESTIVE SYSTEM, GENITOURINARY SYSTEM - DX CODE

DISEASES OF THE RESPIRATORY SYSTEM [460-519]
[460-466] Acute respiratory infections.
[470-478] Other diseases of the upper respiratory tract.
[480-487] Pneumonia and influenza.
[490-496] Chronic obstructive pulmonary disease and allied conditions.
[500-508] Pneumoconioses and other lung diseases due to external agents.
[510-519] Other diseases of respiratory system.

DISEASES OF THE DIGESTIVE SYSTEM [520-579]
[520-529] Diseases of oral cavity, salivary glands. and jaws.
[530-537] Diseases of esophagus, stomach, and duodenum.
[540-543] Appendicitis.
[550-553] Hernia of abdominal cavity.
[555-558] Noninfectious enteritis and colitis.
[560-569] Other diseases of intestines and peritoneum.
[570-579] Other diseases of digestive system.

DISEASES OF THE GENITOURINARY SYSTEM [580-629]
[580-589] Nephritis, nephrotic syndrome, and nephrosis.
[590-599] Other diseases of urinary system.
[600-608] Diseases of male genital organs.

[610-611] Disorders of breast.
[614-616] Inflammatory disease of female pelvic organs.
[617-629] Other disorders of female genital tract.

How costly is Medical Billing Mistakes and Fraud?

Even though working from the comfort of home as a medical billing professional may seem like the near-perfect career, offering benefits and advantages that within a doctor’s office or healthcare center are unavailable, the ramifications of possible mistakes can be very costly.

An example of how things can go wrong can be shown by MSO Washington, Inc. MSO is a medical practice management and billing service company that had to agree a settlement against claims of healthcare fraud, to the value of $565,000. The Dept. of Justice alleges that the company made claims to Medicare and Medicaid for settlement which failed to include the proper records and claims for procedures that were deemed medically unnecessary. The Department found that in some cases the procedures claimed for were never completed, or they were executed but charged for at rates above the industry standard.

It seems as though the healthcare providers were allegedly not aware of the questionable billing practices, and consequently, they were not a part of the investigation. The system that was under investigation was a home visitation program, in which doctors and medical professionals visited homes to inspect the residence itself.

As a professional and highly-trained medical professional, one would be able to detect anomalies and point out possible fraudulent activities. There is great value placed on such individuals, and as a result, insurance companies and government-based agencies will depend heavily on that person’s skills and training, as well as their moral character. After all, one would have medical documentation of many patients at hand.

Throughout the education and billing services classes, one is expected to learn every part of the coding systems that are used and relate to procedures, medical products and the services that their respective companies provide. Important aspects that medical offices and hospitals seek out when looking for specialists include a concern and prioritization of getting their job done; correctly and efficiently.

Where claims are concerned, most companies/offices will seek out a fair reimbursement for their services. Companies can lose vast sums of money through malpractice, accidental or intentional.

The owner of MSO Washington Inc. did not admit liability, so it can be deemed that the fraud was accidental and not intentional. This only highlights the importance of personnel who can account for their work and ensure that there are no errors. High-quality personnel are able to seek out the correct compensation while preserving a fraud-free status.

ICD 9 - DX code Mandatory Fiftt digit

Mandatory Fifth Digit


A 3-digit code is the primary classification for an illness or injury, a 4-digit code is a secondary classification of the same illness or injury, and a 5-digit code is a classification of the same illness or injury.

Notes are also used to list the fifth-digit sub classifications for subcategories – such as entries “Tuberculosis” or Diabetes mellitus.” Only the four-digit code is given for the individual entry, and you must refer to the note following the main term to locate the appropriate fifth-digit sub classification.

Not all ICD codes are valid for use on insurance claim forms. Carriers require the greatest specificity possible when using the codes. The idea is never to use a 3-digit code that has been sub-classified into 4-digit codes, and never use a 4- digit code that has been sub-classified as a 5-digit code.

Not all codes have fourth and fifth digits, but when a fourth or fifth digit is available, it must be used. It is a good idea to highlight codes with which a fifth digit is listed. This will serve as a reminder to you to always use that fifth digit. The following is a list of fifth digits that are used to identify location.

0 site unspecified
1 shoulder region
2 upper arm
3 forearm
4 hand
5 pelvic region and thigh
6 lower leg
7 ankle and foot
8 other specified sites
9 multiple sites

Pathology and Laboratory CPT code list

• CPT Divided into fourteen subsections:

Organ or Disease Oriented Panels 80048* - 80076
Drug Testing 80100 - 80103
Therapeutic Drug Assays 80150 - 80299
Evocative/Suppression Testing 80400 - 80440
Consultations (Clinical Pathology) 80500 - 80502
Urinalysis 81000 - 81099
Chemistry 82000 - 84999
Hematology and Coagulation 85002 - 85999
Immunology 86000 - 86849
Transfusion Medicine 86850 - 86999
Microbiology 87001 - 87999
Anatomic Pathology 88000 - 88099
Cytopathology 88104 - 88199
Cytogenetic Studies 88230 - 88299
Surgical Pathology 88300 - 88399
Transcutaneous Procedures 88400
Other Procedures 89050 - 89399

Anesthesia Billing Guideline CPT 99200, 99000,99070

Time Reporting:


Time for anesthesia procedures may be reported as is customary in the local area. Anesthesia time begins
when the anesthesiologist begins to prepare the patient for the induction of anesthesia in the operating
room or in an equivalent area and ends when the anesthesiologist is no longer in personal attendance, that
is, when the patient may be safely placed under postoperative supervision.

Physicians Services:
Physician's services rendered in the office, home, or hospital, consultation and other medical services are
listed in the "Codes" section entitled Evaluation and Management Services (99200 series). "Special
Services and Reporting" (99000 series) are presented in the Medicine section.

Materials Supplied by Physician:
Supplies and materials provided by the physician (eg, sterile trays, drugs) over and above those usually
included with the office visit or other services rendered may be listed separately. List drugs, tray supplies,
and materials provided. Identify as 99070.

How to Get Medical Billing and Coding Certification

The number of people opting for medical and healthcare insurance has increased drastically in the last few years. With it the need has siren for a modern, efficient and streamlined method to manage the accounts and billing records of the medical facility. This has increased the demand for professional billing and coding specialists.

Medical billing and coding is actually the procedure of filing claims on insurance companies and following them to recover the medical expenditure of an insurance policy holder. Generally the pay for people handling this job is quite high and that has caused an increase in the number of people looking to acquire this job whether part-time or full-time.

If you want to work in a medical facility to manage the billing system, you should look at some certification courses to qualify for the job. Once you have completed the course you work at many medical establishments including medium and large sized hospitals, individual and physicians’ group clinics, medical offices infirmaries, diagnostic laboratories, and insurers.

If you are interested in joining this field, you should start searching for a college near you that offers certification and teaching of medical billing and coding. If you already have a job that makes it impossible for you to attend regular classes, you also have the opportunity to take an online course offered by many institutions.

If you are US, there are two programs for you; professional coder and coding specialist. Each study program is about a year long and has to be certified either by the Academy of Professional Coders, Registered Health Information Association (RHIA), Registered Health Information Technician (RHIT) or the American Health Information Management Association (AHIMA); if you want to eventually acquire a job in this profession. AMIHA certification is more appropriate for people who want to join this field and have little or no prior relevant experience. But if you are an experienced medical coder and are looking for a certification, you should contact the Professional Association of Healthcare.

Like everything else around you, medical billing has also become fast-tracked and easy by the help of revolutionary software packages. But before you start learning this software, you must familiarize yourself with the root words for body systems. Without learning the medical language, you cannot get very far. But by chance even if you do, you will be responsible for some major confusion or mix-up eventually due to your ignorance.

You also have to pass the coding certification examination to become finally eligible for the job. The test is very comprehensive and will test your knowledge on about the different protocols and procedures that you need to know to become a qualified medical coder. You will be asked about the current HCPCS procedures and also about ICD-9-CM to make sure that you understand properly the demands of the job.

Primary Care Physician Protocols

If these Primary Care Physician Protocols differ from or conflict with other Protocols in connection with any matter pertaining to Evercare Institutional Customers, these Primary Care Physician Protocols will govern unless statutes and regulations dictate otherwise.

The Primary Care Physician will cooperate with and be bound by these additional protocols:

1. A ttend Primary Care Physician orientation session and annual Primary Care Physician meetings thereafter.
2. C onduct face-to-face initial and ongoing assessments of the medical needs of Evercare Institutional Customers, including all assessments mandated by regulatory requirements.
3. D eliver health care to Evercare Institutional Customers at their place of residence in collaboration with the Primary Care Team.
4. Family Care Conferences - Participate in formal and informal conferences with responsible parties, family and/or legal guardian of the Evercare Institutional Customer to discuss the Evercare Institutional Customer’s condition, care needs, overall plan of care and goals of care, including advance care planning.
5. Primary Care Team Collaboration and Coordination - Collaborate with other members of the Primary Care Team designated by Evercare and any other treating professionals to provide and arrange for the provision of covered services to Evercare Institutional Customers. This includes, but is not limited to, making joint visits with other Primary Care Team members to Evercare Institutional Customers and participating in formal and informal conferences with Primary Care Team members and/or other treating professionals following a scheduled Evercare Institutional Customer reassessment, significant change in plan of care and/or condition.
6. C ollaborate with Evercare when a change in the Primary Care Team is necessary.
7. Provide Evercare a minimum of forty-five (45) calendar days prior notice when discontinuing delivery of covered services at any facility where Evercare Institutional Customers reside.
8. When admitting an Evercare Institutional Customer to a hospital, notify Evercare or Payer immediately if the admission is for an emergency or for observation.