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Chapter 6

Chapter 6 Glossary

Add-on Code CPT code used to report supplemental or additional procedure appended to a primary procedure (stand-alone) code. Add-on codes are recognized by the CPT symbol + used throughout the cpt codebook.
The Centers for Medicare & Medicaid Services (CMS) Agency within the United States Department of Health and Human Services that administer the Medicare program and works in partnership with state governments to administer Medicaid and State Children's Health Insurance Programs.
Current Procedural Terminology (CPT) A code set copyrighted and maintained by the American Medical Asscociation (AMA)
Diagnosis Pointer Field A field on the medical claim form (CMS 1500) that relates the line item to the diagnosis on the base claim.
Global Package The period (0-90 days as determined by the health plan) and services provided for a surgery inclusive of postoperative visits, intraoperative services, post-surgical complications, postoperative visits, post-surgical pain management by the surgeon, & seve
Global Surgery Status Indicator An assigned indicator, which determines classification for a minor or major surgery, based on RVU calculations.
Healthcare Common Procedure Coding System (HCPCS0 Level II HCPCS level II is the national procedure code set for healthcare practitioners, providers, and medical equipment suppliers when filing insurance claims for medical devices, medications, transportation, and other items and services.
Locum Tenens Substitute physician who takes over the professional practice of a physician who is absent for reasons such as illness, pregnancy, vacation, or continuing medical education. When a locum tenens fills in, the regular physician submits the claim with the m
Major Surgery Surgeries classified as major have a global surgical period that includes the day before the surgery, the day of surgery, and any related follow-up visits with/by the physician 90 days after the procedure.
Minor Surgery Surgeries classified as a minor have a global surgical period that includes the preoperative service the day of surgery, surgery, and any related follow-up visits with/by the physician 0-10 days after the surgery.
National Correct Coding Initiative (NCCI) Used by professional coder to determine codes considered by CMS to bundled codes for procedures and services deemed necessary to accomplish a major procedure. This is to promote correct coding methodologies and to control improper assignment of codes that
Resource-Based Relative Value Scale (RBRVS) Physician payment schedule established by Medicare.
Relative Value Units (RVU) CMS reimburses physicians for Medicare services using national payment schedule based upon the resources used in furnishing physician services. RVU's are configured using work based on specialties, practice expense, and physician liability insurance.
Created by: BBracha