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unbundling cpt codes

Occurs because: Providers staff unintentionslly reports multiple codes based on misinterpreted coding guidelines; Reporting multiple code is intentional to maximize reimbursment.
also occurs when one service in divinded into its componants parts, and a code fror each componant part is reported as if they were different service.

multiple surgical procedures

two or more surgeries performed during the same operative session., First code highest level procedure, then the lesser surgeries listed in decending order of expense.


are used to report services and procedures performed on patients.
*By providers in office, clinics and private homes.
*When the provider is employed by the health care facitility.
*by a hospital outpatient department.(ambulatory, ER, outpatient labratory)

Unlisted procedure/unlisted service

assigned when the provider performs a procedure for which there is no cpt code

special report

when an unlisted procedure or service code is reported and must accompany the claim to described the nature, extent, and need for the procedure or service aloing with timem effort, and equipment necessary to provide the service.


define terms and explain the assignment of codes for procedures and services located in a particular section., Located at the beginning of each CPT section and should be carefully reviewed before attempting to code. They give instructions on how to code certain sections.

CPT bullet symbol

located to the left of a code number identifies new procedures and services add to CPT

cpt triangle symbola

located to the left of a code identifies a code description that has been revised.

CPT horizontal triangles

surround revised guidelines and notes. this symbol is not used for revised code descriptions.

cpt semicolon symbol

is used to save space in CPT, and some codes descriptions are not printed in their entirety to a code number

cpt + plus symbol

identifies add-on codes for procedures that are commonly, but not always performed at the same time and by the same surgeon as primary procedures.

cpt forbidden symbol

identifies codes that are not to be used with modifier -51, are reported in addition to other codes, not classified as add-on codes

cpt bull's-eye symbol

indicates a procedure that includes moderate (conscious) sedation

cpt flash symbol

indicates codes that classify products that are pending FDA approval but have been assigned a CPT code

cpt # the number (pound) symbol

precedes CPT codes that appear out of numerical order.

cpt index

organized alphabetical main terns printed in boldface,

See term

is a cross-reference that directs coders to an index entry under which codes are listed in italicized type.

Italicized type

type used for cross-reference term

Inferred words

is use to save space in CPT index when referencing subterms


(essential modifiers) qualify the main term by listing alternate sites, etiology, or clinical status

CPT modifers

clarify services and procedures performed by providers

Main terms

are printed in boldface type and are followedby the code number

nonessential modifiers

are supplementary words located in parenthese after a main term.


are supplementary terms that further modify subterms and other qualifiers.

default code

the code located after the main term.

blocked unindented note

is located below a subsection title and contains instructions that apply to all codes in the subsection

indented parenthetical note

is located below a subsection title, code description, or code description that contains an example

Evaluation and Management (E/M)section

located at the beginning of CPT because these codes describe services most frequently provided by physicians


It is what has happens when cancer spreads from one part of the body to another

V codes

are use to report patient visits to a medical facility for a reason other than sickniss or injury, a supplementary health factor is used, not currently ill

coding procedures and services

Step 1: Read the introduction
Step 2: Review guidelines
Step 3: Review the procedure
Step 4: Refer to the CPT index
Step 5: Locate subterms
Step 6: Review descriptions of service
Step 7: Assign the applicable code

new patient

A patient who has not received professional services from a provider (or another provider with the same specialty in the same practice) within the past three years.

established patient

Individual who has received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past 3 years.

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