ICD-10-CM and CPT Modifiers

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The I-10 was develeoped by?

The National Center for Health Statistics (NCHS)

The NCHS is responsible for what parts of the I-10?

for the disease classification system (Volumes 1 and 2) entitiled ICD-10-CM (CM stands for Clinical Modification)

ICD-10-CM did what to reduce the number of codes needed to fully describe a condition?

they created combination diagnosis/symptom codes to reduce the number of codes needed

How many digits are the ICD-10-CM codes?

they added a sixth and seventh character

ICD-10-CM codes are formatted how?

They begin with an ALPHA but contain Alphanumeric. They are in alphanumeric order

What does GEMS stand for?

General Equivalence Mappings (two sets of a diagnosis code)

What is GEMS mapping?

the mapping is a type of crosswalk to find correspinding diagnosis codes between the two code sets.

The I-10 Index is?

it is alpabetical and presents the main terms in bold type. Subterms are indented under the main term.

After the index entry there is?

a code provided. Sometimes only the first four digits of the codes are listed.

CPT modifiers inform?

inform third party payers of circumstances that may affect the way payment is made.

CPT Modifiers indicate what type of information?

Altered Services (service greater than usually required, unusual circumstances, part of a service, and discontinued service). Bilateral Procedure, Multiple Procedures, Professional part of the service/procedure only, and more than one physician/surgeon.

Modifier -26 Professional Component is?

used to designate a physician (professional) component of procedures that have a professional and technical component, such as the interpretation of ultrasounds or x-rays,

Modifier -32 Mandated Services indicates?

a service that is required by some third-party entity. It is reported ONLY when service is MANDATED

Modifier -32 is not used to?

report a second opinion requested by a patient, a family member, or another physician.

Modifier -52 Multiple Procedures is assigned when?

multiple procedures (other than E/M services) are performed on the same session by the same provider.

Modifier -57 Decision for Surgery is reported with?

with an E/M code to indicate the day the decision to perform a major surgery was made.

Modifier -58 is used to?

notify the payer that a subsequent surgery was planned and staged at the time of the first surgery. -58 is for Staged Related Procedure or Service by the Same Physician During the Postoperative Period.

Modifier -59 Distinct Procedural Service is reported to?

indicate that services that are usually bundled into one payment were provided as separate services.

Modifier -79 Unrelated Procedure or Service by the Same Physician During the Postoperative Period explains?

that a patient required surgery for a condition totally unrelated to the condition for which the first operation was performed.

What is a Surgical Assistant?

is one who provides service (an extra pair of hands) to the primary surgeon during a surgical procedure.

Modifier -99 Multiple Modifiers is used?

only if the third-party payer does NOT accept multiple modifiers.

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