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MC109
| Question | Answer |
|---|---|
| add-on code | reported with its primary procedure code and cannot be reported alone; modifiers 50 (bilateral procedure) and 51 (multiple procedures) are not reported with add-on codes. |
| CPT appendices | located after CPT category III codes and provide additional guidance for proper code assignment. |
| CPT category I codes | traditional five-character CPT codes and descriptions for procedures or services, which are organized within one of six sections. |
| CPT category II codes | optional CPT "performance measurements" alphanumerical tracking codes that contains a letter in the last field. |
| CPT category III codes | temporary "emerging technology" alphanumerical codes that contain a letter in the last field, are reported for data collection purposes, and ate archived after five years if a CPT category I code isn't created. |
| CPT instructional notes | appear throughout CPT sections to clarify the assignment of codes. |
| Descriptive qualifiers | terms that clarify the assignment of a CPT code by altering its description; may be located in the code description, parentheses, or after a semicolon. |
| functional modifier | pricing or payment modifier that a third-party payer considers when determining reimbursement. |
| guidelines | define terms and clarify the assignment of codes for procedures and services that are located in a particular section of the CPT. |
| inferred words | save space in the CPT index when referencing subterms |
| Informational modifier | clarifies aspects of the procedure or service provided for the payer. |
| National Correct Coding Initiative (NCCI) program | implemented by the Centers for Medicare & Medicaid Services (CMS) to promote national correct coding methodologies and to control the improper assignment of Medicare Part B claims. |
| Notice of Exclusions from Medicare Benefits (NEMB) | document signed by patient prior to undergoing a procedure or service that is not covered by Medicare. |
| payment modifier | pricing or payment modifier that a third-party payer considers when determining reimbursement. |
| pricing modifier | pricing or payment modifier that a third-party payer considers when determining reimbursement. |
| range of codes | code numbers separated by a dash or a series of codes separated by commas in the CPT index |
| single code | single code number listed in the CPT index |
| special report | document that must accompany the claim to describe the nature, extent, and need for the procedure or service code is reported. |
| statistical modifier | clarifies aspects of the procedure or service provided for the payer. |
| telemedicine | provision of remote medical care an interactive audio and video telecommunications system that permits real-time communication between provider, at the distant site, and patient, at originating site, as an alternative to in-person face-to face encounters |
| unlisted procedure | code assigned when the provider performs a procedure or service for which there is no CPT code |
| unlisted service | same as unlisted procedure |
| National Correct Coding Initiative (NCCI) | implemented by the Centers for Medicare & Medicaid Services (CMS) to promote national correct coding methodologies &to control improper assignment of codes that results in inappropriate reimbursement of Medicare Part B claims, |
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