Chapter 13 (HIT) CPT Procedural Coding
Terms in this set (39)
Healthcare Common Procedure Coding System
Divided into ___ manuals
Level 1 manual?
is the AMA CPT-4
current procedural terminology
Level 1 AMA CPT-4 consist of?
a numeric coding system painted by the AMA
5-digit codes used by physicians to code procedures or services.
Level 2 manual?
is the HCPCS national codes
codes for products, supplies, and services not included in the CPT codes.
How many sections are in the CPT ?
What is the layout of the CPT?
1) Evaluation and management E/M
5) Pathology and Laboratory
What are the sections that follow the 6 first sections?
1) Category I and Category III codes
Where is the alphabetic Index located?
the back of the book
Alphabetic index is organized by?
In the alphabetic index, how do you located the code?
by finding the procedure, the location or condition.
Where is the tabular section located at?
front of the book
In the tabular section, there are 2 types of codes?
alone and Indented
Where are symbols located on the tabular sections?
at the bottom of the pages
What is the code for physician office?
What are section guidelines?
Each section begins with guidelines.
Refer to the guidelines to answer questions
Where are unlisted procedures and special reports listed?
in the guidelines
five-digit numbers beginning with the number 99?
evaluation and management codes
When must a special report be submitted with the claim?
when an unlisted procedure, unusual, variable, or new procedure is done.
When a special report is submitted with the claim... it must contain?
1) concurrent problems
2) complexity of problems
3) final diagnosis
4) time, effort, and equipment necessary to provide the service
What codes are used most frequent ?
what is considered a new patient?
a patient who has not received any medical treatment by the physician or any other physician in the office with the past 3 years.
what is considered an established patient?
a patient who has been previously treated within the past 3 years
what are the key components?
2) physical examination
3) medical decision making (the last of the three)
when determining the key components. History is what?
Subjective information. (what the patients tells the doctor)
chief complaint ( CC)?
reason the patient is seeing the doctor
what are the history levels?
2) expanded problem focused
provider must choose one based on the patients record
review of systems is a systematic way of assessing the body when doing a physical exam.
level depends on how many body systems are examined
medical decision making (MDM)?
number of diagnosis, amount and complexity of data reviewed and risk of complications to the patients
2) coordination of care
3) nature of present problem
only a key component when half (50%) of the visit is spent counseling the patient and/or family.
must be clearly documented
where is the anesthesia section located?
after the E/M codes
5 digit codes begining with 0
divided by anatomic sites and specific type of procedure
organized by body systems.
5 digit codes beginning with 1000 through 6000
generally, surgeries are billed in packages that include:
1) surgical procedure
2) normal, uncomplicated follow-up care
3) digital block or tropical anesthesia
4) preoperative and postoperative visits are generally included
what are CPT modifiers?
two additional digits added to the code to give additional information
where are the CPT modifiers located and their complete definitions?
located on the inside cover of CPT manual and definitions are located in appendix A
5 digit numbers beginning with 9000
divided into sections
2 codes needed for the administration of injections and immunizations