RB Medical Coding Class
2025 CPT Chapter-Wise Guidelines with Descriptions
Chapter I: Evaluation and Management (E/M) Services – CPT Codes 99202–99499
Description: This chapter covers physician-patient encounters like office visits, hospital
visits, critical care, and preventive medicine. These codes reflect the complexity and nature
of patient interaction.
Key Guidelines:
● Code Selection: Based on either Medical Decision Making (MDM) or total time spent
on the date of encounter.
● New vs. Established Patients: Different code sets apply.
● Prolonged Services: Add-on codes used for time exceeding base service.
● Split/Shared Visits: Guidelines clarify shared E/M services between physicians and
qualified healthcare professionals.
● Telehealth: Certain E/M codes can be used for remote services when guidelines are
met.
Chapter II: Anesthesia – CPT Codes 00100–01999
Description: Codes for anesthesia during surgical procedures, categorized by the anatomic
site or procedure type. Includes both general and regional anesthesia.
Key Guidelines:
● Time Reporting: Based on the actual time spent providing anesthesia care.
● Modifiers:
○ Physical Status Modifiers (P1–P6) indicate the patient's preoperative
condition.
○ HCPCS Level II Modifiers like AA, QX, QZ indicate the provider's role.
● Qualifying Circumstances: Separate codes used for emergencies, extremes of
age, or other complicating factors.
Chapter III: Surgery – Integumentary System – CPT Codes 10021–19999
Description: Includes procedures related to the skin, subcutaneous, and breast tissue like
biopsies, excisions, repairs, and grafts.
Key Guidelines:
● Lesion Removal: Document size including margins; benign vs. malignant affects
code.
● Wound Repair: Categorized as simple, intermediate, or complex based on closure
technique.
● Grafts and Flaps: Codes are based on size, type (autograft, allograft), and method.
Chapter IV: Surgery – Musculoskeletal System – CPT Codes 20000–29999
Description: Covers fracture care, joint manipulation, soft tissue surgeries, and spinal
procedures.
Key Guidelines:
● Fracture Treatment: Codes differ for closed, open, or percutaneous treatment.
● Global Package: Includes pre-op, intra-op, and post-op care (usually 90 days).
● Arthroscopy: Separate codes for diagnostic vs. operative.
Chapter V: Surgery – Respiratory, Cardiovascular, Hemic & Lymphatic – CPT Codes
30000–39999
Description: Includes thoracic surgeries, endoscopy, cardiac catheterization, and vascular
access procedures.
Key Guidelines:
● Endoscopy: Codes are specific to body area; often bundled.
● Cardiac Procedures: Require documentation of vessels and findings.
● Central Lines: Coding differs by insertion technique and site.
Chapter VI: Surgery – Digestive System – CPT Codes 40000–49999
Description: Encompasses procedures from the oral cavity to rectum including endoscopy,
hernia repair, and bariatric surgeries.
Key Guidelines:
● Colonoscopy: Different codes for diagnostic, biopsy, and removal.
● Hernia Repairs: Use initial or recurrent, reducible or incarcerated distinctions.
● Laparoscopic vs. Open: Always report correct approach code.
Chapter VII: Surgery – Urinary, Genital & Maternity – CPT Codes 50000–59999
Description: Includes procedures on urinary tract, male/female genitalia, and
childbirth-related services.
Key Guidelines:
● Obstetric Care: Global (e.g., 59400) or itemized codes for antepartum, delivery,
postpartum.
● Urological Procedures: Endoscopic vs. open codes.
● Maternity Care: Accurate reporting of complications is essential.
Chapter VIII: Surgery – Nervous System, Eye, Ear – CPT Codes 60000–69999
Description: Covers neurosurgical procedures, ophthalmic and auditory system operations.
Key Guidelines:
● Spinal Surgeries: Levels and approach (anterior/posterior) are crucial.
● Ophthalmology: Codes specify laterality; bundling rules apply.
● Cochlear Implants: Codes include placement and testing.
Chapter IX: Radiology – CPT Codes 70000–79999
Description: Encompasses diagnostic imaging (X-ray, CT, MRI), nuclear medicine, and
radiation oncology.
Key Guidelines:
● Global vs. Technical vs. Professional Components: Identified using modifiers 26
(professional) and TC (technical).
● With/Without Contrast: Select correct code variant.
● Supervision and Interpretation: Required for interventional radiology.
Chapter X: Pathology and Laboratory – CPT Codes 80000–89999
Description: Includes diagnostic tests on blood, urine, tissues; panels, genetic testing, drug
screening.
Key Guidelines:
● Panels: Cannot be broken apart to code individually.
● Molecular Pathology: Tier 1 and Tier 2 based on complexity.
● Drug Testing: Presumptive (initial) vs. definitive (confirmed) testing codes.
Chapter XI: Medicine – CPT Codes 90000–99999
Description: Includes immunizations, dialysis, psychiatric services, vision testing, and other
non-surgical services.
Key Guidelines:
● Vaccine Coding: Use separate codes for product and administration.
● Prolonged Services: Time-based add-on codes apply.
● Dialysis: Distinct codes for ESRD monthly care vs. individual sessions.
● Cardiac Monitoring: Report per event or per time duration.
