CPC-A Practicum Guidelines

It is the policy of AAPC to provide accurate, complete, and consistent coding of all cases in accordance with AMA CPT®, HCPCS Level II, and ICD-10-CM Coding Guidelines.

ICD-10-CM Codes

1. All cases will be coded following the current year ICD-10-CM Official Guidelines for Coding and Reporting.
2. Assign external cause codes when coding injuries in the ED, procedural complications codes in any setting, as well as any disease or condition caused by external cause as documented by the physician.

CPT Codes

1. CPT codes should be listed in the order of work RVUs, with the highest RVUs listed first. A free Work RVU Calculator can be found at https://www.aapc.com/tools/rvu-calculator.aspx.
2. There is a separate section to report E/M codes versus other CPT® codes. Be sure to place the E/M codes (99024, 99202-99499) in the E/M section and all other CPT® codes in the CPT section.
3. Report units for instances where a CPT code would be repeated multiple times to cover the documentation reporting.
4. Conscious (Moderate) Sedation
   If the same physician or QHP performs both the primary procedure and the moderate sedation, he or she will supervise and direct an independent, trained observer whose sole responsibility is to monitor the patient's level of consciousness and physiological status during the procedure.  In this case, these 2 individuals need to be identified & the treating physician reports the appropriate procedure code(s) and the moderate sedation code(s).
   If a different provider, other than the physician or other QHP performing the primary procedure, provides the moderate sedation, the different physician or QHP reports the moderate sedation code, while the physician or QHP performing the procedure reports only the procedure code.
   EKGs: If an EKG is documented as performed on the same date of service, the EKG is reported according to the guidelines for the place of service
   To report conscious (moderate) sedation, documentation must include the following elements:
   1. Age of the patient
   2. Sedating agents administered
   3. Physician that supervised the moderate sedation
   4. An independent, trained observer was present and monitored the patient throughout the procedure with no other duties performed (if required)
   5. The total intra-service time of the moderate sedation
   6. Documentation of blood pressure, oxygen saturation, and heart rate/pulse

Modifiers

1. When a service is bilateral, report modifier 50 (12345-50) instead of the CPT® code with RT and LT (12345-RT, 12345-LT).
2. When a CPT code is performed unilaterally and has a bilateral indicator of 1, 2, or 3, apply modifier RT or LT, as necessary.  Codes with a bilateral indicator of 0 or 9, do NOT append modifier RT or LT. The bilateral indicator can be found in the Medicare Physician Fee Schedule Look-up Tool (https://www.cms.gov/medicare/medicare-fee-for-service-payment/pfslookup).  A help document is provided on this CMS page with instructions on how to use the tool.
3. When a CPT code has a PCTC indicator of 1, apply modifier 26 or TC as necessary.  When a CPT code has a PCTC indicator of 0, 2, 3, or 4 do not append modifier 26 or TC. The PCTC indicator can be found in the Medicare Physician Fee Schedule Look-up Tool (https://www.cms.gov/medicare/medicare-fee-for-service-payment/pfslookup).  A help document is provided on this CMS page with instructions on how to use the tool.
4. Use modifier 59 instead of X{EPSU} if it is not a Medicare patient. Use modifier X{E PSU} for Medicare patients.
5. Do NOT append modifier 51 for multiple procedures.
6. X-Rays:
   1. When an X-Ray is performed in a provider’s office, report to the global unit.
   2. When an X-Ray is performed in a facility, and the provider completes the formal report, report the X-Ray with modifier 26.
   3. When an X-Ray is performed in a facility, and the provider does not complete the formal report, do not report the X-Ray.