MOD 120, UNIT2

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UNLISTED PROCEDURES

PROCEDURES THAT ARE CONSIDERED UNUSUAL, EXPERIMENTAL, OR NEW AND DO NOT HAVE A SPECIFIC CODE NUMBER ASSIGNED, UNLISTED PROCEDURES CODES ARE LOCATED AT THE END OD THE UBSECTIONS OR SUBHEADING AND MAY BE USED TO IDENTIFY AND PROCEDURE THAT LACKS A SPECIFIC CODE.

MODIFIERS

ADDED TO CODES TO SUPPLY MORE SPECIFIC INFORMATION ABOUT THE SERVICES PROVIDED.

CURRENT PROCEDURAL TERMINOLOGY (CPT)

A CODING SYSTEM DEVELOPED BY THE AMERICAN MEDICAL ASSOCIATION (AMA) TO CONVENT WIDELY ACCEPTED, UNIFORM DESCRIPTIONS OF MEDICAL, SURGICAL, AND DIAGNOSTIC SERVICES RENDERED BY HEALTH CARE PROVIDERS INTO FIVE-DIGIT CODES.

FOOD AND DRUG ADMINISTRATION (FDA)

RESPONSIBLE FOR THE SAFITY OF FOOD AND DRUGS IN AMERICA, IS AN AGENCY WITHIN THE U.S. PUBLIC HEALTH SEVICE, WHICH IS PART OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES.

APPENDIX-A

LOCATED NEAR THE BACK OF THE CPT MANUAL, LISTS ALL MODIFIERS WITH COMPLETE EXPLANATIONS FOR USE.

CATEGORY 1

CPT CODES APPROVED BY THE FDA AND REPRESENTING WIDELY USED SERVICES AND PROCEDURES.

SEE

A CROSS-REFERENCE TERMWITHIN THE INDEX OF THE CPT MANUAL USED TO DIRECT THE CODER TO ANOTHER TERM. OR OTHER TERMS. THE SEE INDICATES THAT THE CORRECT CODE WILL BE FOUND ELSEWHERE.

ADMISSION

ATTENTION TO AN ACUTE ILLNESS OR INJURY RESULTING IN ADMISSION TO A HOSPITAL.

CRITICAL CARE

THE CARE OF CRITICALLY ILL PATIENTS IN MEDICAL EMERGENCIES THAT REQUIRES THE CONSTANT ATTENDANCE OF THE PHYSICIAN (CARDIAC ARREST, SHOCK, BLEEDING, RESPIRATORY FAILURE) CRITICAL CARE IS USUALLY, BUT NOT ALWAYS, GIVEN IN A CRITICAL CARE AREA, SUCH AS THE CORONAROOYO CARE UINIT (CCU) OR THE INTENSIVE CARE UNIT (ICU).

CONSULTATION

INCLUDES THOSES SERVICES RENDERED BY A PHYSICIAN WHOSE OPINION OR ADVICE IS REQIUESTED BY ANOTHER PHYSICIAN OR AGENCY CONCERNING THE EVALUATION AND/OR TREATMENT OF A PATIENT, A CONSULTANT IS NOT AN ATTENDING PHYSICIAN.

CONCURRENT CARE

THE PROVISION OF SIMILAR SERVICES (HOSPITAL VISITS) TO THE SAME PATIENT BY MORE THAN ONE PHYSICIAN ON THE SAME DAY. EACH PHYSICIAN PROVIDES SERVICES FOR A SEPARATE CONDITION, NOT REASONABLY EXPECTED TO BE MANAGED BY THE ATTENDING PHYSICIAN. WHEN CONCURRENT CARE IS PROVIDED, THE DIAGNOSIS MUST REFLECT THE MEDICAL NECESSITY OF DIFFERENT SPECIALTIES.

ESTABLISHED PATIENT

A PATIENT WHO HAS RECEIVED FACE-TO-FACE PROFESSIONAL SERVICES FROM THE PHYSICIAN OR ANOTHER PHYSICIAN OF THE SAME SPECIALTY IN THE SOME GROUP WITHIN THE PAST 3 YEARS.

NEW PATIENT

A PATIENT WHO HAS NOT RECEIVED ANY FACE-TO-FACE PROFESSIONALSERVICES FROM THE PHYSICIAN OR ANOTHER PHYSICIAN OF THE SAME SPECIALTY IN THE SAME GROUP WITHIN THE PAST 3 YEARS.

OFFICE VISIT

A FACE-TO-FACE ENCOUNTER BETWEEN A PHYSICIAN AND A PATIENT IN THE PHYSICIAN'S PRIVATE OFFICE TO ALLOW FOR PRIMARY MANAGEMENT OF A PATIENT'S HEALTH CARE STATUS.

OUTPATIENT

A PATIENT WHO RECEIVES SERVICES IN AN AMBULATORY HEALTH CARE FACILITY AND IS CURRENTLY NOT AN INPATIENT.

EMERGENCY CARE SERVIES

SERVICES THAT ARE PROVIDED BY THE PHYSICIAN IN THE EMERGENCY DEPARTMENT FOR UNPLANNED PATIENT ENCOUNTERS, NO DISTINCTION IS MADE BETWEENNEW AND ESTABLISHED PATIENTS WHO ARE SEEN IN THE EMERGENCY DEPARTMENT.

INPATIENT

ONE WHO HAS BEEN FORMALLY ADMITTED TO A HEALTH CARE FACILITY.

KEY COMPONENTS

THE HISTORY, EXAMINATION, AND MEDICAL DECISION MAKING COMPLEXITIY OF AN E/M SERVICE.

REFERRAL

THE TRANSFER OF THE TOTAL OR A SPECIFIC PORTION OF CARE OF A PATIENT FROM ONE PHYSICIAN TO ANOTHER THAT DOES NOT CONSTITUTE A CONSULTATION.

ATTEDING PHYSICIAN

THE PHYSICIAN WITH THE PRIMARY RESPONSIBILITIY FOR CARE OF THE PATIENT.

BULLET SYMBOL

IS USED TO INDICATE A NEW PROCEDURE OR SERVICE CODE ADDED SINCE THE PREVIOUS EDITION OF THE CPT MANUAL.

SOLID TRIANGLE SYMBOL

PLACED IN FRONT OF A CODE NUMBER INDICATES THAT THE CODE HAS BEEN CHANGED OR MODIFIED SINCE THE LAST EDITION.

PLUS SYMBOL

IS USED TO INDICATE AN ADD ON CODE.

RIGHT/LEFT TRIANGLE SYMBOL

INDICATE THE BEGINNING AND END OF THE TEXT CHANGES.

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