25 terms

mod h unit 3

Chief Complaint
The reason that the patient is seeing the physician, usually stated in his or her own words, is known as the:
Established patient
In CPT coding, a patient who was seen on October 1, 2008and then not seen again in the same medical practice until August 30, 2010, classified as a(n)
The time the health care provider spends in direct contact with a patient is called:
Level 1 codes
The AMA 5-digit codes used for reporting services performed by healthcare professionals are:
A patient's medical record must contain sufficient documentation to support the use of:
Modifying terms
A main term can stand alone, or it can be followed by up to three
Special reports
accompany the claim when a rarely used, unusual, variable or new service is performed?
Stand-alone codes.
The type of code that contains the full description of the procedure without additional explanation is the
There are ________ levels of procedural codes
The six sections listed in the main body of the CPT manual called
Category III codes
Evaluation & Management (E&M) list the three key components.
History; examination; complexity of medical decision making
Purpose of CPT coding
Accurately describes professional service(s) performed
Name the three different ways the CPT codes can be displayed.
As a single code; as multiple codes; as a range of codes
Name the four contributing factors that impact the Evaluation & Management (E&M) coding
Contributing factors
Like history-taking there are _____ degrees of patient examination
Time is never a factor when a patient is seen in an
Emergency department
How do you determine complexity of decision making?
diagnostic and treatment options were considered: the amount and complexity of data reviewed; and the amount of risk for complication, morbidity or mortality determine the
Name these symbols:
symbol is used to show that the code has been changed or modified
Symbol representing a code that is a new to the CPT book:
Horizorial triangles
Symbol identifying a change in wording of a new/revised code:
lighting Bolt
Symbol used to indicate codes for vaccines pending FDA approval:
Plus sign
Symbol indicating an add-on code
Circle with line cancel/no symbol
Symbol denoting modifier exempt codes:
Circle with dot
Symbol identifying codes that include conscious sedation: