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51 terms

CPT/HCPCS

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CPT
Used to report services and procedures by physicians
The CPT is published and updated annually and becomes effective
January 1st
The CPT is published and updated annually and comes out in
November
Category II Codes
Supplemental codes used for performance measurements
Category III Codes
Temporary codes for emerging technology, services and procedures
Category I Codes
Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA
Guidelines
Are at the beginning of each section and provide specific coding rules for that section
The CPT manual is composed of
Eight sections
The CPT coding system used indented format
to save space
Stand-alone codes
Contain the full description of the procedure for the code
Indented codes
Are listed under associated stand-alone codes
Add-on codes
used for procedures that are always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately
Modifiers
Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code
Triangle
Represents a change in the code description since the last edition
Two triangular symbols
represent changes in the text or definition between the triangles
Bullet
Represents a new procedure or service code added since the previous edition of the manual
Plus Sign
Indicates add-on codes
Circle with a line through it
respresents exemption from the use of modifier -51
The three parts of the CPT manual are
the main text, the appendices, and the alphabetic index
Evaluation & Management
99201-99499
Anesthesia
00100-01999,99100-99140
Surgery
10021-69990
Radiology
77010-79999
Pathology & Laboratory
80048-89356
Medicine
90281-99199,99500-99602
Never used alone; rather they are always reported in addition to a primary procedure code
Add-on codes
The CPT Index is arranged in alphabetical order by
Main terms, which are further divided by subterms
Parentheses
Used to enclose supplementary words; non essential modifiers
Brackets
Used to enclose synonyms, alternative wording, or explanatory phrase
One of five location methods in the CPT
Synonym/Eponym
Level I Codes
Consist of codes found in the CPT manual
Level II Codes
National codes; codes for physician and non-physician services not found in the CPT (Level I)
Is for the Durable Medical Equipment category which covers reusable medical equipment ordered by the physician for use in the home, such as wheel chairs or portable oxygen tanks
Ex. E Section
Level III Codes
Were used locally or regionally and have been eliminated by the CMS since the implementation of HIPAA
Modifier -24
Attached to the code of the E/M service provided to a patient during the postoperative period to indicate that the service is not part of the postoperative care which is usually part of a package of services of the surgery performed
Modifier -26
Is attached to the procedure to indicate that the physician provided only the professional component
Modifier -32
Used to indicate that the service provided was required by a third party payer, governmental, legislative, or regulatory body
Modifer -50
Is used when the same procedure is performed on a mirror-image part of the body
Modifier -51
Used when more than one procedure is performed during the same surgical episode; one code doesn't describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure
Modifier -58
Used to explain that the procedure or service done during a postoperative period was planned at the time of the orginal procedure
Modifier -78
To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure
Modifier -79
Used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure
Modifier -90
Used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic
Modifier -99
Used to report a procedure or service that has more than one modifier but the third-party payer does not allow the additon of multiple modifiers to the code
Are listed first in the CPT manual because they are used by all the different specialties
Evaluation & Management (E/M) Codes
History
The set of information the physician gathers from the patient
Chief Complaint (CC)
The reason the patient came to see the physician
History of Present illness (HPI)
A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
Review of Systems (ROS)
The inventory of the constitutional symptoms regarding the various body systems
Past, Family and Social History (PFSH)
Consists of the patient's personal experiences with illnesses, surgeries and injuries; information of illnesses predominant in the family; patient's educational background, occupation, marital status, and other factors
List of modifiers are found where in the CPT
Appendix A