Key Terms
A book with the most commonly used system of procedure codes. It is the HIPAA-required code set for physicians’ procedures.
What is Current Procedural Terminology (CPT)?
A code indicating procedures that are usually carried out in addition to another procedure. Add-on codes are used together with the primary code.
What is an add-on code?
Coding to a higher level of service than that provided to obtain higher reimbursements.
What is upcoding?
1. The extent of the patient history taken.
2. The extent of the examination conducted.
3. The complexity of the medical decision making.
What are the Key Factors in Determining Level of Service?
The period of time that is covered for follow-up care of a procedure or surgical service.
What is global period?
A coding system developed by the Centers for Medicare and Medicaid Services that is used in coding services for Medicare patients.
What is Healthcare Common Procedure Coding System (HCPCS)?
One or more 2-digit codes assigned to the 5-digit main code to show that some special circumstance applied to the service or procedure that the physician performed.
What are modifiers?
Meeting of two or more physicians or surgeons to evaluate the nature and progress of disease in a particular patient and to establish diagnosis, prognosis, and/or therapy.
What is consultation?
The most complex of the histories.
What is Comprehensive?
In 2021, the Justice Department recovered more that $5 billion in these cases.
What are Healthcare Fraud Cases?
Patient that, for CPT reporting purposes, has not received professional services from the physician within the past 3 years.
What is a new patient?
Blue Triangle.
What is Code description has changed since last revision.
The insurance carrier bases reimbursement on a code level lower than the one submitted by the provider.
What is downcoding?
Exam of the affected body area or organ system and any other symptomatic or related BA or OS.
What is Expanded problem-focused-limited exam?
Find the services listed on the super bill and/or in the patient's record.
What is the first step in locating a CPT Code.
Code that represents a medical procedure, such as surgery and diagnostic tests, and medical services, such as an examination to evaluate a patient’s condition.
What is a procedure code?
Red Dot.
What is new code since last revision?
Use of several Current Procedural Terminology codes for a service when one inclusive code is available.
What is unbundling?
There are multiple diagnoses and management options with a moderate amount or complexity of data to review.
What is Moderate complexity MDM.
A 5-digit code representing the service provided to the patient.
What is a CPT Code?
Care provided to unstable, critically ill patients. Constant bedside attention.
What is critical care?
Lightning Bolt.
What is FDA approval pending?
Care being provided by more than one physician, such as with specialists.
What is concurrent care?
The time licensed practitioner uses to coordinate patient care with other healthcare agencies such as home care or nursing home care.
What is Coordination of Care?
Codes that cover many supplies such as sterile trays, drugs, and durable medical equipment; also referred to as national codes. They also cover services and procedures not included in the CPT.
What are HCPCS Level II Codes?