Chapter 5 Procedural Coding: CPT and HCPCS – Flashcards
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Current Procedural Terminology (CPT)
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contains the standardized classification system for reporting medical procedures and services.
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Fragmented billing
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Incorrect billing procedure in which procedure are unbundled and separately reported
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Panel
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Single code gathering laboratory tests frequently done together
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level II
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HCPCS national codes
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Durable medical equipment (DME)
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Reusable physical supplies ordered by the provider for home use.
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Healthcare Common Procedure Coding System (HCPCS )
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Procedure codes for Medicare claims
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Never event
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Situation for which a policy never pays a provider
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Level II modifiers
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HCPCS national code set modifiers
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Category I codes
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procedure codes found in the main body of CPT
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Category II codes
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optional CPT codes that track performance measures
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Category III codes
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temporary codes for emerging technology services and procedures
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section guidelines
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usage notes at the beginning of CPT sections
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unlisted procedure
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service not listed in CPT
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special report
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note explaining the reasons for a new, variable, or unlisted procedure or service
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add-on-code
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procedure performed and reported in addition to a primary procedure
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primary procedure
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most resource-intensive CPT procedure during an encounter.
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resquenced
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CPT procedure codes that have been reasigned to another sequence.
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modifier
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number appended to a code to report particular facts
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technique component (TC)
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reflects the technician's work and equipment and supplies used in performing it.
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professional component (pc)
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represents a physician's skill, time and expertise used in performing it.
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E/M codes (evaluation and management codes)
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codes that cover physician's services performed to determine the optimum course for patient care.
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consultation
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service in which a physician achieves a requesting physician about a patient's condition and care.
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key component
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factor documented for various levels of evaluation and management services.
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outpatient
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patient who receives healthcare in a hospital setting without admission.
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physical status modifier
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code used with anesthesia codes to indicate a patient's health status.
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surgical package
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combination of services included in a single procedure code
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global surgery rule
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combination of services included in a single procedure code
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global period
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day surrounding a surgical procedure when all services relating to the procedure are considered part of the surgical package.
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separate procedure
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descriptor used for a procedure that is usually part of a surgical package but may also be performed separately.
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bundling
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using a single payment for 2 or more related procedure codes.
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unbundling
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incorrect billing practice of breaking a panel or package of services / procedures into component parts.
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Discuss the purpose of the HCPCS code set and its modifiers.
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HCPCS code set provides a coding system for specific products, supplies, and services that patients receive in the delivery of their care.
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Identify the correct structure of Category II codes in CPT?
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4 digits followed by an alphabetical character.
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When a physician asks a patient questions to obtain an inventory of constitutional symptoms and of the various body symptoms, the results are documented as the?
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review of systems.
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Temporary codes are what type of HCPCS codes?
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Q codes.
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The examination that the physician conducts is categorized as?
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problem-focused, expanded problem-focused, detailed or comprehensive
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The 3 key factors in selecting an Evaluation and Management code are?
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history, examination, and medical decision making.
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CPT code 99382 is an example of?
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preventive medicine service code.
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Anesthesia codes generally include?
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preoperative evaluation and planning, normal care during the procedure, and routine care after the procedure
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Surgery code generally include?
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all aspects of the operation including preparing the patient for the surgery performing the operation and normal additional procedure, as well as as normal, uncomplicated follow up.
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When a Surgery section code has a plus sign next to it?
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it cannot be reported as a stand-alone code.
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When a panel code from the Pathology and Laboratory section is reported?
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all the listed tests must have been performed.
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List the 6 steps in the procedural coding process?
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Step 1 Review complete Medical Documentation Step 2 Abstract Medical Procedure from visit documentation Step 3 Identify main term with a each procedure Step 4 locate main term in CPT index Step 5 Verify code in CPT main index Step 6 Determine need for modifiers
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List the 3 key components used to select E/M codes? and the 4 levels each component has?
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3 Key components: A. (1) History Physician documented #1 problem focused #2 expanded problem focused #3 detailed #4 comprehensive B. (2) Examination documented #1 problem focused #2 expanded problem focused #3 detailed #4 comprehensive C. (3) Medical Decision documented #1 straight forward #2 low complexity #3 moderate complexity #4 high complexity
