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Alphanumeric ID + letter at end
(0001T) codes located after Medicine section they archived after 5 yrs. or placement in category I
Horizontal triangles surround revised guidelines & notes:
This symbol is not used for revised code description.
( ; ) semicolon id used to save space in CPT
Some code descriptions are not printed entirely next to code #.
+ Plus symbol ID's add-on codes.
(Appendix D of CPT) procedures commonly, not always, performed at the same time & by the same surgeon.
Circle with slash / throught it:
Forbidden symbol ID's codes that are "not" to be used eith modifier
Unlisted procedure or
assigned when provider performs a procedure or service which no CPT code.
Occur in middle of main clause after semicolon & may or may not be enclosed in parentheses.
Range of codes separted by dash -
a series of codes separated by commas, or combibation of single codes & ranges of codes.
a 2-digit code added to the 5-digit CPT code
reported on claims submitted for provieder office services & procedures.
TOS= Type of Service
Kind of service; Critical care, consultation, initial hospital care, subsequent hospital care (Follow up)
provision of similar services such as hospital inpatient visits, to same patient by more than one provider on same day.
E/M guidelines clarify
when an unlisted service code is reported, special report must be submitted with claim for medical appropriateness.
Description of, nature of, extent of & need for service
Diagnostic & Therapeutic procedures performed
Extent of History
Patient History of Present illness (HPI), Chief Complant (CC) Reviwiew of systems (ROS) & Past/family/ social history (PFSH)
Diagnostic results, impressions, or
diagnostic studies; [rognosis; risks & benefits of options (treatment)
Coordination of Care
Physician makes arrangements with other providers or agencies to procid services to patient.
1. Requested by another physician or source 3-party payer, (ifconsultation is mandated by payer, attach modifier -32 to services code.)
4. requesting physician has documented patient's record the request & need for consultation.
5. opinion, adcice & andy services rendered are documented in patient's record & communicated to requesting physician or source, generally in written report.
Emergtency department services (ED)
Provided in hospital, open 24 hours to provide unscheduled episodic services to patients require immediate medical attention.
Preventive medicine services
Routine examinations , risk management counseling for kids / adults no overt signs or symptoms.
Physical status modifier
added to ea. reported anesthesia code to indicate patient's condition at time anesthesia was asministered.
discontinued outpatient hospital/ambulatory surgery center procedure after anesthesia admin.
" separate procedure code
reported if procedure / service is performed independently of comprehensive procedure / service, is unrelated, distinct from procedure / service performed at same time.
Multiple Surgical Procedures
First code highest level procedure, then the lesser surgeries listed in decending order of expense.
Modifier -51 is added to CPT # for ea. lesser procedure
that does not have the (X or +) symbol in front of code.
Radiological exam of soft tissue & internal structures of breast.
Screening mammography is performed when patient presents without signs & symptoms of breast disease.
Diagnostic mammography includes
assessment of suspected disease & is reported when abnormality is found or suspected.
When the word "complete" is found in the code description, one code is reported to "completely" describe procedure performed.
Radiologic exam vobers the supervision of procedure & interpretation & writing a report describing exam & findings.
exam vobers the use of equipment, supplies provided & employment of radiologic technicians.
Organ or Disease Oriented Panels
Single code #'s assigned to Organ or Disease Oriented Panels, a series of blood chemistry studies
routinely ordered by providers the same time for purpose of investigating a
specific organ or disorder. Compostion of panel is very specific, & no substitutions are allowed.
CPT Medicine Section
Classifies noninvasive or minimally invasive diagnostic & therapeutic procedures & services, Specialty services
1. Nonivasive procedures require no surgical incision or excision, & are not open procedures.
2. Minimally invasive procedures include percutaneous access.
Chemotherapy & Other Highly complex Biologic Admin.
Chemotherapy admin. in addition, cancer treatments, such as surgery & or radiation therapy, is called adjuvant chemotherapy.
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