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RVUs represent

the total RVS for components of the schedule

Unit Value

a numerical value assigned by a relative value study to a procedure code. The unit value is multiplied by the conversion factor to determine the UCR allowance or a basic allowance


This surgery is considered reconstructive

Surgical pathology

report tests done in preparation for or during surgery

Moderate (conscious) sedation

used to bill for conscious sedation (with or without analgesia) when the actual procedure is provided by the same physician

Panel tests are composed of

Multiple tests that are combined and run from one specimen

consultation physician

cannot be responsible for the regular management of the patient

Special Services

these codes are used to bill for special circumstances regarding services performed, such as the handling of a laboratory specimen

The structure of nose

is responsible for airway obstruction are the septum and the nasal turbinates

Automated Laboratory charge

offer their services primarily to dr's offices

The basic benefit

usually has a dollar conversion factor specified in the plan document


when a surgeon bills separately for procedures that are a part of the major procedure

Amount in excess of UCR

are not considered allowed amount

Incidental procedure

is one that does not add significant time or complexity to the operative session

Modifier -57

was necessary to determine the need of subsequent surgery

Actual Time

Some carriers allow one time unit for each fifteen minutes, regardless of the amount of time a patient is under anesthesia

A procedure listed in the surgery section of the CPT

does not mean that the procedure is allowable under a benefit plan

In vitro fertilization

fertilization of the ovum within a test tube

In Utero fetal surgery

surgery performed on a fetus while it is in the mother's womb, also to remove the fetus from the womb, perform surgery, and return it back to the womb


is defined as the branch of medicine that treats diseases, injuries, and deformities through operative or invasive methods.

Therapeutic procedure

performed to remove or correct the functioning of a body part that is diseased or injured

Allowed amount

UCR - Usual, Customary and reasonable

fee schedule

Fees are assigned according to the particular CPT code, and this is considered the allowable amount for that particular procedure

Modifier code

numbers that are added on to a code to report particular fact

Procedure Code

codes that identify medical treatment or diagnostic services

Endocrine System

bill for procedures on the thymus, adrenal glands, thyroid and parathyroid

Hemic and Lymphatic system

used to bill for procedures of the spleen and lymph nods, as well as bone marrow transplants

Nervous system

bill for procedures on the organs of the nervous system, including the nerves, brain and spinal cord

Mediastinum and Diaphragm

bill for procedures of the mediastinum and diaphragm

Urinary system

bill for kidneys, ureter, bladder, urethra and includes prostate resections

Diagnostic x-ray

flat or two dimensional pictures of a particular body part or organ

Diagnostic Ultrasound

Ultrasoundgraphy provides a more definitive type of picture than x-rays

Radiation oncology

is used in conjunction with chemotherapy to treat malignant cancers

Nuclear Medicine

combines the use of radioactive elements and x-rays to image an organ or body part

prolonged service

used to bill for prolonged or standby service that is beyond the usual service for inpatient or outpatient services

Preventive medicine service

do not have an illness or injury

Therapeutic or diagnostic infusions

billed for infusion services provided by a physician who was in constant attendance during the infusion

Special E/M Services

bill for basic life or disability evaluations

Care plan oversight services

the reviewing of a patient's medical care and record usually for a patient under the care of a home health agency, hospice, or nursing home

Regional Anesthesia

the loss of sensation of a part of the body due to the interruption of nerve conduction

Topical Anesthesia

applied directly to the surface of the area to be anesthetized

local Anesthesia

affects only a localized area

Spinal Anesthesia

nerves blocked in the subarachnoid space

General Anesthesia

produces a sate of unconsciousness


determined by the organs the endoscope is passed through


coded according to the overall size of the lesion removed


coded according to the length of the wound being repaired

skin grafts

coded according to the size of the recipient area




provided by a specialist who has been requested to provide an opinion only

Custodial Care Services

primarily for the purpose of meeting the personal daily needs of the patient, can be provided with personnel without medical care skills or training

professional services

performed by a licensed individual

stat fee

charge for DXL services performed on an expedited priority basis

physical medicine

manipulation and physical therapy associated with the nonsurgical care and treatment of the patient

relative value study


relative value unit

represents the total RVS for components of the schedule

UCR calculation

the process of determining the fee usually charged by similar providers for the same procedure in the same geographic area during a specified period of time

Unit value

a numerical value assigned by a relative value study to a procedure code


Usual, customary and reasonable, define covered expenses as charges for the services and supplies

confirmatory consultations

surgeries that have a reputation for being done needlessly

Critical care services

involves the care of critically ill patients during a medical emergency that requires the constant attention of the provider

skilled nursing facility

skilled nursing care or rehabilitation services and other related health services

rest home service

primarily for the purpose of meeting the personal daily needs of the patient, can be provided with personnel without medical care skills or training

home service

in lieu of hospitalization

chromosomal analysis

amniocentesis is the transabdominal perforation of the uterus for the purpose of withdrawing amniotic fluid

Exogenous obesity

is obesity caused by overeating

Endogenous obesity

is obesity caused by an internal malfunction usually hormonal

global approach

the total billed amount should be compared with the total UCR amount

block procedures

multiple surgical procedures performed during the same operative session, in the same operative area


esophagus, stomach and intestines


eye care provided either by an optometrist or an ophthalmologist


the retaining of the muscles that control vision

otorinoaryngologics services

services associated with the head

pulmonary services

used for billing procedures of the lungs and airways

Medical direction of anesthesiology

the monitoring of the patient will be performed by an anesthesia assistant or a certified registered nurse anesthetist (DRNA) under the direction of a physician


glucose monitoring

integumentary system

lesions, repair, and skin grafts

Repairs to the outer ear

are in the surgery section for the integumentary system

2 ways to calculate anesthesia time

actual time and block time

photodynamic therapy

treatment method for some type of cancer


denote that claim is for MAC services

UCR for assistant surgeon

would be calculated as RVS

surgical repair of the eye lids is called


Sterilization is

a surgical method to achieve permanent infertility

Basic allowance is paid at

100% under basic benefits

special services

lab specimen handling

Medical services categories

professional services, facility services, misc services

charges made by a staff anesthesiologist

are usually covered as a hospital ancillary expense

multiple procedure

more than one surgical procedure performed during the same operative session

Medical section in the CPT

listed towards the back of the book

modifier denoted to the left of the CPT code

by Astrix


test used to document airway obstruction

Modifier is required for

of an operative report

Modifier for 3rd party consultation


laboratory examination

consist of the analyzing of body substances to determine their chemical or tissue make-up

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