unbundling cpt codes
Occurs because: Providers staff unintentionslly reports multiple codes based on misinterpreted coding guidelines; Reporting multiple code is intentional to maximize reimbursment.
also occurs when one service in divinded into its componants parts, and a code fror each componant part is reported as if they were different service.
multiple surgical procedures
two or more surgeries performed during the same operative session., First code highest level procedure, then the lesser surgeries listed in decending order of expense.
are used to report services and procedures performed on patients.
*By providers in office, clinics and private homes.
*When the provider is employed by the health care facitility.
*by a hospital outpatient department.(ambulatory, ER, outpatient labratory)
Unlisted procedure/unlisted service
assigned when the provider performs a procedure for which there is no cpt code
when an unlisted procedure or service code is reported and must accompany the claim to described the nature, extent, and need for the procedure or service aloing with timem effort, and equipment necessary to provide the service.
define terms and explain the assignment of codes for procedures and services located in a particular section., Located at the beginning of each CPT section and should be carefully reviewed before attempting to code. They give instructions on how to code certain sections.
CPT bullet symbol
located to the left of a code number identifies new procedures and services add to CPT
cpt triangle symbola
located to the left of a code identifies a code description that has been revised.
CPT horizontal triangles
surround revised guidelines and notes. this symbol is not used for revised code descriptions.
cpt semicolon symbol
is used to save space in CPT, and some codes descriptions are not printed in their entirety to a code number
cpt + plus symbol
identifies add-on codes for procedures that are commonly, but not always performed at the same time and by the same surgeon as primary procedures.
cpt forbidden symbol
identifies codes that are not to be used with modifier -51, are reported in addition to other codes, not classified as add-on codes
cpt bull's-eye symbol
indicates a procedure that includes moderate (conscious) sedation
cpt flash symbol
indicates codes that classify products that are pending FDA approval but have been assigned a CPT code
cpt # the number (pound) symbol
precedes CPT codes that appear out of numerical order.
organized alphabetical main terns printed in boldface,
is a cross-reference that directs coders to an index entry under which codes are listed in italicized type.
type used for cross-reference term
is use to save space in CPT index when referencing subterms
(essential modifiers) qualify the main term by listing alternate sites, etiology, or clinical status
clarify services and procedures performed by providers
are printed in boldface type and are followedby the code number
are supplementary words located in parenthese after a main term.
are supplementary terms that further modify subterms and other qualifiers.
the code located after the main term.
blocked unindented note
is located below a subsection title and contains instructions that apply to all codes in the subsection
indented parenthetical note
is located below a subsection title, code description, or code description that contains an example
Evaluation and Management (E/M)section
located at the beginning of CPT because these codes describe services most frequently provided by physicians
It is what has happens when cancer spreads from one part of the body to another
are use to report patient visits to a medical facility for a reason other than sickniss or injury, a supplementary health factor is used, not currently ill
coding procedures and services
Step 1: Read the introduction
Step 2: Review guidelines
Step 3: Review the procedure
Step 4: Refer to the CPT index
Step 5: Locate subterms
Step 6: Review descriptions of service
Step 7: Assign the applicable code
A patient who has not received professional services from a provider (or another provider with the same specialty in the same practice) within the past three years.
Individual who has received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past 3 years.