Uses
What are codes used for?
Diagnostic Codes
Represent the physicians diagnosis
CPT
Current Procedural Terminology
CPT Codes
5 numbers long
What is the main term?
The most general term in a diagnosis
What is the CPT data used for?
Reimbursement; used by medical providers to report the procedures they performed
Procedural Codes
Represent the specific actions taken in response to the diagnosis
CMS
Centers for Medicare and Medicaid Services
ICD-10-CM
3-7 characters long
Eponym
Diseases, procedures, or syndromes names after a person
What is the purpose of coding?
Communicate with insurance carriers; keep statistical data within the office
Primary Diagnosis
The most significant condition treated by the physician
AMA
American Medical Association
How many digits can be added to CPT codes using a modifier?
2 extra digits
When entering a code, do not disregard the...
Zeros
What are essential modifiers
Modify the main term by describing the site of a diagnosis, its cause, or its specific type
Secondary Diagnosis
The one that coexists with the primary condition and may affect its treatment
HCPCS
Healthcare Common Procedural Coding System
How many digits and modifiers do procedural codes have?
Two-digit modifiers may be added after five-digit codes
What is downcoding?
Code will be reduced to its most basic form, and reimbursement will be made at the lowest possible level
What are nonessential modifiers?
Appear in parenthesis directly after main terms. May give alternate terminology or help to add specificity
Name two examples of types of codes found in Chapter 21
Vaccinations and screenings
ICD-CM
International Classification of Diseases/Clinical Modification
What four parts is the CPT-4 divided into?
Introduction, 6 main sections, 13 appendices (A-L), index
What are the 6 main sections?
Evaluation and management (E&M), anesthesia, surgery, radiology, pathology and laboratory, medicine