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Stack #4645168
| Question | Answer |
|---|---|
| The CPT Book List | Commonly performed medical procedures and services |
| CPT Codes have how many categories | 3 Categories |
| Category 1 codes are made of | Most numerous has 5 digits with no decimals |
| Category 1 codes have | a descriptor |
| Descriptor | A brief explanation of the procedure |
| Category 2 Codes | Used to track performance measures for a medical goal such as reducing tobacco use |
| Category 3 Codes (Sunsets) | Have a 5 year life span |
| What happens if Category 3 codes aren't revised or replaced by a Category 1 code within 5 years | It will Sunset |
| Sunset | Archived, A temporary code is still needed |
| Category 2 codes are made of | Alphabetic character for the fifth digit |
| CPT | Current Procedural Terminology(Forth Edition) |
| AMA | American Medical Association |
| CPT Codes are | The standard for physician procedures paid to Medicare, Medicaid, and other government medical insurance programs |
| CPT Began in | 1983 |
| What type of code set is CPT? | A Proprietary Code Set |
| Proprietary Code Set | Not available for free to the public (Must be purchased) |
| Provider in CPT | Either a Physician or another type of qualified healthcare professional (Physician Assistant) |
| Who sends suggestions for revisions of the CPT to the AMA | Practicing Physicians, Medical Specialty Societies and State Medical Associations |
| Suggestions of the CPT is reviewed by | The AMA's Editorial Panel |
| The AMA's Editorial Panel includes | Physicians, Reps from AHIP, CMS, AHIMA, AHA and BlueCross BlueShield |
| AHIP | America's Health Insurance Plans |
| CMS | Centers for Medicare and Medicaid Services |
| HCPCS | Healthcare Common Procedure Coding System |
| AHIMA | American Health Information Management Association |
| AHA | American Hospital Association |
| The AMA's Editorial Panel decides | What changes will be made in the annual Revision of the printed reference book |
| Used to determine the CPT Code | Treatment, Service, Procedure |
| Shown on top of the page | Section, Subsection, and Code Number |
| Codes for items that are used in medical practices but not listed in the CPT can be found In the | HCPCS(Healthcare Common Procedure Coding Services |
| Appendix A in the AMA publication of CPT | Modifiers |
| Modifiers | Complete Listing of all modifiers used in CPT with descriptions and in some cases usage |
| Appendix B in the AMA publication of CPT | Summary of Additions, Deletions, and Revisions |
| Summary of Additions, Deletions, and Revisions | Summary of the codes added, revised or deleted in the current version |
| Appendix C in the AMA publication of CPT | Clinical Examples |
| Clinical Examples | Case Examples of the proper use of the codes in the Evaluation and Management Section |
| Appendix D in the AMA publication of CPT | Summary of CPT Add-on Codes |
| Summary of CPT Add-on Codes | List of supplemental codes used for procedures that are commonly done in addition to the primary procedure |
| Appendix E in the AMA publication of CPT | Summary of CPT Codes Exempt from Modifier 51 |
| Summary of CPT Codes Exempt from Modifier 51 | Codes to which the modifier showing multiple procedures cannot be attached because they already include a multiple descriptor |
| Appendix F in the AMA publication of CPT | Summary of CPT Codes Exempt from Modifier 63 |
| Appendix G in the AMA publication of CPT | Summary of CPT Codes that include Moderate (Conscious) Sedation |
| Appendix H in the AMA publication of CPT | Alphabetical Clinical Topics Listing |
| Appendix I in the AMA publication of CPT | Genetic Testing Code modifiers |
| Appendix J in the AMA publication of CPT | Electrodiagnostic Medicine Listing of Sensory, Motor and Mixed Nerves |
| Appendix K in the AMA publication of CPT | Product Pending FDA Approval |
| Appendix L in the AMA publication of CPT | Vascular Families |
| Appendix M in the AMA publication of CPT | Renumbered CPT Codes-Citations Crosswalk |
| Appendix N in the AMA publication of CPT | Summary of Re-sequenced CPT codes |
| Appendix O in the AMA publication of CPT | Multianalyte Assays with Algorithmic Analyses |
| Appendix P in the AMA publication of CPT | CPT Codes That May Be Used for Synchronous Telemedicine Services |
| Appendix Q in the AMA publication of CPT | SARS-CoV2/COVID-19 Vaccines |
| Appendix R in the AMA publication of CPT | Digital Medicine-Services Taxonomy |
| Indented codes use what to Separate The Common Descriptor from The unique Descriptor | Semicolon(;) |
| A Bullet(Solid Circle) indicates | A new Procedure code, Appears only in the first year it is added |
| A Triangle indicates | That the code's descriptor has change. Appears only in the first year the descriptor is revised |
| Facing Triangles indicates | enclose new or revised text other than the code descriptor |
| A plus sign(+) indicates | An add-on Code |
| Add-On Codes Describe | Secondary procedures that are commonly carried out in addition to Primary procedure |
| Add-On Codes usually use the Phrases | Each additional or list separately in addition to the primary procedure |
| A Star Symbol next to a code indicates | Telemedicine Codes |
| Telemedicine Codes | Telecommunication System Services (Video/Audio) |
| A Lighting Bolt Symbol is used with | Vaccine Codes that have been submitted to the FDA and are expected to be approved for use soon, Cannot be used until approved |
| The Index Provides | A Pointer to the correct code range |
| The Main Text us read to | Verify the selection of the code |
| In order to report Telemedicine codes the provider must | Exchange enough information to meet the key components required for a face to face encounter |
| Common Descriptors begin with | A Capital Letter |
| Unique descriptors after the Semicolon | Have no Capital Letter |
| 2nd,3rd&4th Descriptors after the first listing are | Indented |
| Indenting Visually Reinforces | The relationship between the entries and the common descriptor |
| Practice of displaying the codes outside of the Numerical order in favor of grouping them according to the relationships among the code descriptors | Resequencing Codes |
| Modifiers are used to | Communicate special circumstances involved with procedures that have been performed |
| Modifiers are shown by | Adding a space and the two-digit code to the CPT code |
| Step 1 of the coding process | Review complete medical documentation, |
| Step 2 of the coding process | Abstract the medical procedures from the visit documentation |
| Step 3 of the coding process | Identify the main term for each Procedure |
| Step 4 of the coding process | Locate the Main terms in the CPT Index |
| Step 5 of the coding process | Verify the code in CPT main Text |
| Step 6 of the coding process | Determine the need for Modifiers |
| Re-sequenced codes are listed | Twice |
| Step 1 Review complete medical documentation, | Determine which and where service/procedure was performed, Review documentation |
| CPT Modifiers are made of | Two-digit numbers that may be attached to most 5 digit procedure codes |
| Modifiers are used when | Only part of a procedure is done, a procedure has two parts: Technical and profession components, Unusual difficulties occurred |
| Using two or more modifiers with one code will | Provide the best description possible |
| Step 3 Main terms can be based on | Procedure/service, Organ/body part, Condition/disease treated, Common Abbreviations, Eponym, Symptom |
| Step 2 Abstract the medical procedures from the visit documentation | Consider the payer's policies |
| Step 6 Determine the need for Modifiers | Patient's Diagnosis may affect whether a modifier is required, Circumstances involved with procedure/service may require the use of modifiers |
| For Modifier for a two part procedure the PC indicates | The Physician Performed or reported a procedure |
| When coding an office visit | There are for codes to choose from for an office visit with a new patient |
| Step 4 Locate the Main terms in the CPT Index | Locate the procedure in the index at the back of CPT when a code range is listed read the code descriptors for all codes in the range, if Main term cannot be located in the index the insurance specialist reviews the main term with the physician |
| Step 5 Verify the code in CPT main Text | Review possible codes pointed to Check section guideline and noted under the code in & after the code descriptor, Items that cannot be billed separately because that are covered under another broader code are eliminated |
| Step 5 Codes to be reported for each day's services are ranked in order of highest to lowest rate of reimbursement | in order of highest to lowest rate of reimbursement |
| Most Codes in the E/M section are Organized by | The place of service |
| A Few Codes in the E/M section are Organized by | Type of service |
| Any Professional Services | that the established category is used for a patient who had a face-to-face encounter with a Physician |
| Consultation Request and Reports must be | Written documents placed in the Medical record |
| E/M Codes | Evaluation and Management codes |
| E/M Codes Cover | complex process a physician uses to gather and analyze information about a patient's illness |
| E/M Codes are Listed | First in the CPT |
| E/M Codes are often called | The Cognitive Codes |
| Information the Physician received by questioning the patient about the chief complaint and other signs or symptoms | History |
| Coding a routine physical examination under preventive medicine services lab test immunizations and other services use | Medicine and the pathology and laboratory sections |
| Services under the Anesthesia section | General, Supplementation of local, & Regional Anesthesia |
| Anesthesia Coding | The ASA assigns a base unit value to each code, Records time spend with patient during procedure and difficulties like severe systemic disease both add to the value of the service |
| To Justify using a higher level E/M code the provider must | Perform and document specific clinical facts |
| Anesthesia sections Subsections are organized by | Body Sites |
| HPI documentation should have | Location, Quality(Type), Severity, Timing, Context, Modifying Factors and Associated signs and Symptoms |
| 3 Status level codes for patient's physical status when anesthesia service coding | P4- Severe systemic disease is constant Threat to life, P1- normal Healthy Patient, P5 Moribund patient who is not expected to survive without operation |
| Preventive Medicine Services | Used to report routine physical examinations in the absence of a patient complaint |
| Anesthesia codes are reimbursed according to | Time |
| Some private payers require anesthesia services to be reported by procedure codes from the | Surgery section |
| Body- Site subsections | Radiological, Other or Unlisted, Burn Excisions or Debridement, Obstetric |
| Surgery Section Codes are | The largest in CPT |
| Surgery Section Codes are used for | The many hundreds of surgical procedures performed by physicians |
| Separate Procedure Means | The procedure is usually done as an integral part of a surgical package- Usually a larger procedure- but that in some situations it is not |
| Covered under a single code and are included in a complete procedure | Postoperative Care, Use of a Local Anesthetic, Surgery |
| Surgical Package codes include | Written order, Typical Postoperative follow up care & E/M Services subsequent to the decision for surgery on the day before and/or day of surgery |
| Procedures that often use contrast material | MRI Magnetic Resonance Imaging |
| Used to indicate special circumstances involved with surgical procedures | Increased procedural, Preventive & Mandated Services |
| Procedures that often use contrast material | MRI Magnetic Resonance Imaging |
| Used to indicate special circumstances involved with surgical procedures | Increased procedural, Preventive & Mandated Services |
| CLIA Certification two parts | Waived test and provider-performed microscopy & Moderate- Or High-Complexity testing |
| Subsections in medicine section are organized by | Type of service |
| Complete Blood Count Is and example of | Panel of Tests |
| Codes not listed in the E/M section use | the 51 Modifier, Multiple Procedures, May not be used |
| Codes in the Medicine section of the CPT | Therapeutic, Evaluation, Diagnostic |
| Level 2 E codes cover | DME |
| DME | Durable Medical Equipment |
| PA | Surgical or other invasive procedure on the wrong body part |
| PB | Surgical or other invasive procedure on the wrong patient |
| PC | Wrong Surgery or other invasive procedure on a patient |
| Related to Categorizing codes without permanent national codes | All Payers use these miscellaneous codes to bill for item or services that do not have permanent national codes |
| Related to Categorizing codes without permanent national codes | Some Codes are Miscellaneous or not elsewhere classified |
| Related to Categorizing codes without permanent national codes | Many of the miscellaneous codes are given permanent national status in the updating process |
| to assign HCPCS Level 2 codes | First look up the name of the supply or item in the index, index is arranged alphabetically with the main term in bold verify in the tabular list section |
| Other way to assign HCPCS Level 2 codes | Table of drugs presents drugs in alphabetical order, followed by dosage |
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