Category 1
Terms that serve as the means to report/indicate a service or procedure performed has been altered by some specific circumstance but not changed in its definition is called.
What is a modifier?
A patient who has not received professional services from a group in the past three years is known as
What is a new patient?
The code range 99201-99499 are
What is evaluation and management codes?
A pre-printed form that designates what services and/or procedure are performed and at what level of acuity those services should be billed.
What is an encounter form?
An element identified one level below a section, unique to a specific category.
What are subcategories?
A five-digit primary procedure or service code, found in the tabular index that is selected when performing insurance billing or statistical research is called a
What is a category I code?
The name or term for something that is based upon the name of a person, place or thing.
What is an eponym?
These nonspecific codes have been provided for instances where an accurate code cannot be found.
What are unlisted procedures and services?
The major factor to be considered when selecting an E/M code.
What are key components?
These are found at the beginning of each section of the coding manual, specific definitions of items that must be read to appropriately interpret and report the procedure/services contained in that section.
What are guidelines?
Codes in which the components of a procedure are separated and reported separately are called
What is an unbundled code?
Abbreviations such as ECG or EKG are called these.
What are acronyms?
These are additional components that can be considered when selecting an E/M code. Time, nature of presenting problem, counseling, and coordination of care.
What are contributing factors?
Level II codes, created by CMS to report supplies, materials, injections, and certain procedures/services not defined in the CPT manual.
What are HCPCS?
Codes that are used on professional claims to specify where the service was rendered.
What are place of service (POS) codes.
A medical professional qualified by education, training, licensure or regulation and facility to perform a service within the scope of practice and report that professional service are known as
What are providers?
The physical condition of the patient is known as
What is the physical status?
This is a practice of third-party payers in which the benefits code has been changed to a less complex or lower cost procedure than what was reported.
What is down coding?
What are main terms?
Deliberate increase in CPT code despite lack of documentation to the next highest reimbursable code to receive higher reimbursement.
What is upcoding?
CPT codes of several services or procedures that are directly related to the specific procedure and are paid as one are known as
What are bundled codes?
A set of supplemental codes that can be used for performance measurement.
This is the numerical listing of procedures performed in a medical practice; a standardized identification of procedures published by the American Medical Association (AMA).
What is Current Procedural Terminology (CPT)?
These are indented one level below a section, usually to describe an anatomic site, organ, or system.
What are subsections?
“Mental effort” put forth with a patient during an encounter.
What is medical decision making?