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Chapter 7
| Term | Definition |
|---|---|
| The bull's eye symbol means | a procedure includes moderate conscious sedation |
| guidelines define terms and explain the assignment of codes for | procedures/services located in a particular section of the CPT manual |
| procedures/services listed on a claim must be linked to | the ICD-9-Cm (diagnostic) code that justifies the need for the service or procedure |
| modifier -57 would be assigned when | the reported E/M service resulted in the initial decision to perform surgery |
| appendix E contains | a complete list codes that are modifier -51 exempt |
| physician services rendered in office, home, hospital, consultations and other medical services are | listed in the E/M section of the manual |
| category l codes are procedures/services that are identified by | a 5 digit CPT code and descriptor nomenclature (these are codes traditionally associated with the CPT and organized within six sections). |
| pertinent information relates to... | nature, extent, and need |
| you will not find a star as a symbol in the CPT manual. However you will find the following: | triangle, gullet, and horizontal triangles |
| descriptive qualifier clarifies the assignment of a | CPT code |
| category lll codes contain | "emergency technology" temporary codes assigned for data collection |
| Modifiers are two digit | numeric codes |
| The following are some of the sections found in the CPT manual: | Medicine, Pathology and Laboratory, Radiology |
| E/M codes represent services most often provided by | physicians |
| Modifier -25 would be assigned when | a documented E/M services was performed on the same day as another significant, separately identifiable E/M service. |
| Medicine codes describe | specialty services |
| An established patient | has been seen by the physician in the last three years |
| Concurrent care - | services provided by more than one physician on the same day |
| Anesthesia time unit - | 15min. increments |
| Preventative medicine = | routine exams or risk management |
| Unlisted service - | E/M service with no CPT code |
| Key Components = | history, exam and medical decision-making |
| Special report is used with an | unlisted service |
| CPT -4 stands for | Current Procedural Terminology, 4th edition |
| AMA complies the information in the | CPT -4 manual |
| The CPT manual has three distinct categories: | Category l codes Category ll codes Category lll codes |
| Category l codes - | made up of six sections; codes contain five numbers; each section has its own set of guidelines |
| Category ll codes - | contain a set of codes used for performance measurement; made up of four numbers followed by the letter "F"; they are optional and cannot be substituted for category l codes |
| Category lll codes - | temporary codes used for emerging technology; made up of four numbers followed by the letter "T"; if Category lll codes is available, you must use it rather than Category l "unlisted" |
| CPT 4 manual has 14 | appendices |
| Physical Status (P1-P6) is use by | anesthesia providers |
| POS = | place of service codes |
| The six sections in Category l are: | 1. E/M - called the "99" codes for short 2. Anesthesiology 3. Surgery 4. Radiology 5. Pathology & Laboratory 6. Medicine (except anesthesiology) |
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