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Kinn's Chapter 18

TermDefinition
acronyms Abbreviations,such as ECG for electrocardiography
add-on code A code that indicates additional or supplemental procedures carried out in addition to the primary procedure.
Alphabetic Index The reference section of the CPT manual;it is used to help find a code or code range.
bundled codes Codes designating procedures or services that are grouped together and paid for as one procedure or service.
categories Indented one level below a subsection in the CPT coding manual;a category usually refers to a specific anatomic site or procedures and/or services.
Category I code A five-digit primary procedure or service code found in the Tabular Index that is selected when performing insurance billing or statistical research.
Category II codes Special codes that can help providers track revenue and reimbursement.
Category III codes Codes for new or experimental procedure or service.
downcoding A change in the code submitted for reimbursement, usually performed by the insurance company.This change generally occurs because the code submitted does not match in some way the specification of the insurance company.
eponyms Procedures, services, or diagnoses named after people, such as Mohs' micrographic surgery or Crohn's disease.
guidelines The guidelines are found at the begining of each of the six sections of main text of the CPT.They define items that are necessary to appropriately interpret and report the procedure and services found in the section.
Health Care Common Procedural Coding System (HCPCS) Level II codes created to supplement procedures and services not covered in the CPT.
main term The primary or key word or words abstracted from a medical record that are used to begin the code search in the Alphabetic Index.
main text Same as Tabular Index
modifiers Two characters code additions that explain circumstances that alter provided service or provide additional clarification or detail about a procedure or service.
modifying term A key word (or words) selected after the main term has been chosen to help further define or describe the procedure or service.
new patient (NP) A patient who has his first encounter (visit) with a physician or physician group or who has an established patient with a physician or provider but has not been seen in 3 years.
patient status (PS) The state a patient as either new or established; appears in the Evaluation and management section of the CPT.
physical status The physical condition of the patient.
place of service (POS) The place where a procedure or service was performed,which has a specific code.
section One of the six main divisions of the CPT manual.
subcategory A term indented one level below a category; it usually is a procedure or service unique to the specific category.
subsection A term indented one level below a section; it usually describes an anatomic site or organ system (e.g.intergumentary system or cardiology)
Tabular Index The main text of the CPT; it contains the alphanumeric listing of all Category I procedure and service codes and their respective description.
unbundled codes Codes in which the components of procedure are separated and reported separately.
upcoding The deliberate upgrading of a CPT code to the next highest reimbursable code,despite a lack of documentation, so as to receive higher reimbursement.
Created by: mrsdancona
 

 



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