CBCS Study Guide 2024

Medical Billing & Coding as a Career - *Claims assistant professional or claims manager, *Coding Specialist, * Collection Manager, *Electronic Claims Processor, *Insurance Billing Specialist, * Insurance Coordinator, *Insurance Counselor, *Medical Biller, *Medical & Financial Records Manager, * Billing & Coding Specialist What are Medical Ethics? - Standards of conduct based on moral principle. They are generally accepted as a guide for behavior towards pt's, dr's, co-workers, the gov, and ins co's. What does acting within ethical behavior boundaries mean? - carrying out one's responsibilities w/ integrity, dignity, respect, honesty, competence, fairness, & trust. Compliance regulations: - Most billing-related cases are based on HIPPA and False Claims Act Health Insurance Portability & Accountability Act (HIPAA) - Enacted in 1996, created by the Health Care Fraud & Abuse Control Program-enacted to check for fraud and abuse in the Medicare/Medicaid Programs and private payers What are the 2 provisions of HIPPA? - Title I: Insurance Reform Title II: Administrative Simplification What is Title I of HIPPA? - Insurance Reform-primary purpose is to provide continuous ins coverage for worker & their dependents when they change or lose jobs. Also *Limits the use of preexisting conditions exclusions *Prohibits discrimination from past or present poor health *Guarantees certain employees/indv the right to purchase new health ins coverage after losing job *Allows renewal of health ins cov regardless of an indv's health cond. that is covered under the particular policy. What is Title II of HIPPA? - Administrative Simplification-goal is to focus on the health care practice setting to reduce administrative cost & burdens. Has 2 parts- 1) development and implementation of standardized health-related financial & administrative activities electronically 2) Implementation of privacy & security procedures to prevent the misuse of health info by ensuring confidentiality What is the False Claims Act (FCA)? - Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection w/ a claim. Also protects & rewards whistle-blowers. What is the National Correct Coding Initiative (NCCI)? - Developed by CMS to promote the national correct coding methodologies & to control improper coding that lead to inappropriate payment of Part B health ins claims. How many edits does NCCI include? - 2: 1)Column 1/Column 2 (prev called Comprehensive/Component) Edits Column 1/Column 2 edits (NCCI) - Identifies code pairs that should not be billed together b/c 1 code (Column 1) includes all the services described by another code (Column 2) Mutually Exclusive Edits (NCCI) - ID's code pairs that, for clinical reasons, are unlikely to be performed on the same pt on the same day What are the possible consequences of inaccurate coding and incorrect billing? - *delayed processing & payment of claims *reduced payments, denied claims *fine and/or imprisonment *exclusion from payer's programs, loss of dr's license to practice med Who has the task of investigate and prosecuting health care fraud & abuse? - The Office of Inspector General (OIG) Fraud - knowingly & intentionally deceiving or misrepresenting info that may result in unauthorized benefits. It is a felony and can result in fines and/or prison. Who audits claims? - State & federal agencies as well as private ins co's What are common forms of fraud? - billing for services not furnished, unbundling, & misrepresenting diagnosis to justify payment Abuse - incidences or practices, not usually considered fraudulent, that are inconsistent w/ the accepted medical business or fiscal practices in the industry. What are examples of Abuse? - submitting a claim for services/procedures performed that is not medically necessary, and excessive charges for services, equipment or supplies. What is a method use to minimize danger, hazards, & liabilities associated w/ abuse? - Risk Management Patient Confidentiality - All pt's have right to privacy & all info should remain privileged. Only discuss pt info when necessary to do job. Obtain a signed consent form to release medical info to ins co or other individual. When may providers use PHI (Protected Health Information) w/o specific authorization under the HIPPA Privacy Rule? - When using for TPO, Treatment (primarily for the purpose of discussion of pt's case w/ other dr's) Payment (providers submit claims on behalf of pt's) & Operations (for purposes such as training staff & quality improvement) What is Employer Liability? - Means physicians are legally responsible for their own conduct and any actions of their employees (designee) performed w/in the context of their employment. Referred to as "vicarious liability. A.K.A "respondent superior"-"let the master answer". Means employee can be sued & brought to trial What is Employee Liability? - "Errors & Omissions Insurance"-protection against loss of monies caused by failure through error or unintentional omission on the part of the indv or service submitting the claim. ****Some dr's contract w/ a billing service (clearinghouse) to handle claims submission, & some agreements contain a clause stating that the dr will hold the co harmless from "liability resulting from claims submitted by the service for any account", means dr is responsible for mistakes made by billing service, errors & omissions is not needed in the instance. ******However, if dr ever asks the ins biller to do the least bit questionable, such as write of pt's balances for certain pt's automatically, make sure you have a legal document or signed waiver of liability relieving you of responsibility for such actions. What is a Medical Record & what is it comprised of? - documentation of the pt's social & medical history, family history, physical exam findings, progress notes, radiology & lab results, consultation reports and correspondence to pt- Is the foremost tool of clinical care and communication. What is a medical report? - part of the medical record & is a permanent legal document that formally states the consequences of the pt's exam or treatment in letter or report form. IT IS THIS RECORD THAT PROVIDES INFO NEEDED TO COMPLETE THE INS CLAIM FORM. Reasons for Documentation - Important that every pt seen by dr has comprehensive legible documentation about pt's illness, treatment, & plans for following reasons: Retention Of Medical Records - Is governed by state & local laws & may vary from state-to-state. Most dr are required to retain records indefinitely, deceased pt records should be kept for @ least 5 years -algia - pain -emia - blood condition -itis - inflammation -megaly - enlargement -meter - measure -oma - tumor, mass -osis - abnormal condition -pathy - disease condition -rrhagia - bursting forth of blood -rrhea - discharge, flow -sclerosis - hardening -scopy - to view -centesis - surgical puncture -ectomy - removal, resection, excision -gram - record -graphy - process of recording -lysis - separation, breakdown, destruction -pexy - surgical fixation -plasty - surgical repair -rrhapy - suture -scopy - visual examination -stomy - opening -therapy - treatment -tomy - incision, to cut into a, an - without ante - before anti - against brady - slow dys - painful, difficult endo - inside, within epi - upon, above ex - out, out of hemi - half, partial hypo - below, deficient infra - below inter - between neo - new oligo - scanty, little pan - all para - beside per - through poly - many pre - before, in front of pseudo - false sub - under supra - above, beyond tetra - four arth - cartilage cephal - head cardi - heart cholecyst - gall bladder chondro - cartilage colp - vagina derm - skim enter - intestine episi - vulva gastro - stomach gloss - tongue hepato - liver hyster - uterus lapar - abdomen lact - milk lith - stone mast - breast myo - muscle nat - birth oophor - ovary oste - bone pneum - lung rhin - nose salping - fallopian tubes stomat - mouth Anterior, Ventral - front surface of the body Posterior, Dorsal - back side of the body Superior - above another structure Inferior - below another structure Proximal - near the point of attachment to the trunk Distal - far from the point of attachment to the trunk Medial - pertaining to the middle of the body Lateral - pertaining to the side Frontal, Coronal - Vertical plane dividing the body into anterior & posterior portions Sagittal - vertical plane dividing the body into right & left sides Transverse, Cross-sectional - Horizontal plane dividing the body into upper & lower portions Anatomy & Physiology - A professional medical coder must have knowledge of anatomy & physiology so that coding assignment is quick & accurate. What is the 1st body system for which medical procedures are described in the CPT manual? - The Integumentary System (the skin and it's accessory organs) Integument means covering. It is a complex system of specialized tissues containing glands, nerves and blood vessels. How much area does the skin cover? - an area of 22 sq ft (an average adult). It is the largest organ of the body What is the main function of the skin? - To protect the deeper tissues from excessive loss of minerals, heat & water. It also provides protection form diseases by providing a barrier. It accomplishes its diverse functions w/ assistance from the hair, nails and glands. SEBACEOUS (OIL) GLANDS & SUDDORIFERIOUS (SWEAT GLANDS) - produce secretions that allow the body to be moisturized or cooled. How many layers to the skin? - 3;1) Epidermis (thin, cellular membrane layer that contains keratin) 2) Dermis (dense, fibrous, connective tissue that contains collagen) 3) Subcutaneous layer (thicker & fatter tissue) Hair - composed of tightly fused meshwork of cells filled w/ hard protein called karatin. Has its roots in the dermis & together w/ their coverings, is called HAIR FOLLICES. Main function is to assist in regulating body temp. Holds heat when body is cold by standing on end & holding a layer of air as insulation. Nails - cover & protect the dorsal surface of the distal bones of the fingers & toes. Part that is visible is nail body, nail root is under skin @ the base of the nail and nail bed is the vascular tissue under the nail that appears pink when the blood is oxygenated or blue/purple when it is oxygen deficient. What is the moon like white area of the nail called? - lunula What is the eponychium? - the cuticle at the lower part of the nail sometime referred to as such SEBACEOUS GLANDS - located in the dermal layer of the skin over the entire body, expect for palm of hands and soles of feet. Secrete oily substance called SEBUM. SEBUM CONTAINS LIPIDS THAT HELP LUBRICATE THE SKIN & MINIMIZE WATER LOSS. It is the overproduction of sebum during puberty that contributes to acne in some people SUDDORIFEROUS GLANDS - sweat glands that are tiny, coiled gland found on almost all body surfaces. They are most numerous in the palms and soles of feet. Coiled sweat glands originate in the dermis and straighten out to extend up through the epidermis. Tiny opening at surface is called a PORE. How many types of sweat glands? - 2;1) eccrine sweat glands (most common) 2) apocrine sweat glands (secrete orderless sweat) What organ secretes hormones? - the adrenal glands, they secrete epinephrine & steriods Albino - deficient in pigment (melanin) Collagen - structural protein found in the skin & connective tissue Melanin - major skin pigment Lipocyte - a fat cell Macule - discolored, flat lesion (freckles,, tattoo marks) Polyp - benign growth extending from the surface of the mucous membrane Fissure- - groove or crack like sore Nodule - solid, round or oval elevated lesion more than 1 cm in diameter Ulcer - open sore on the skin or mucous membrane Vesicle - small collection of clear fluid; blister Wheal - Smooth, slightly elevated, edematous (swollen) area that is redder or paler than the surrounding skin Alopecia - absence of hair form areas where it normally grows Gangrene - death of tissue associated w/ the loss of blood supply Impetigo - bacterial inflammatory skin disease characterized by lesion, pustules, and vesicles Multigravida - a pregnant woman who has had at least one previous pregnancy The Musculoskeletal System - includes bones, muscles & joints. Acts as a framework for the organs, protects many of those organs, and also provides the body w/ the ability to move What are bones connected to one another by? - by fibrous bands of tissues called LIGAMENTS What are muscles attached to the bone by? - tendons What is the fibrous covering of muscles called? - the fascia and the aricular cartilage, covers the end of many bones and serves as a protective function. Bones - complete organs made up of connective tissue called OSSEOUS. Inner core of bones is comprised of HEMATOPOIETIC tissue. This is where the red bone marrow manufactures blood cells. Other parts of the bones are storage areas for minerals necessary for growth, ie; calcium and phosphorous How are bones categorized? - as belonging to either the AXIAL SKELETON or the APPENDICULAR SKELETON. Axial Skeleton - consist of the skull, rib cage & spine Appendicular Skeleton - made up of the shoulder, collar, pelvic, arm & legs Long Bones - typically very strong, are broad at the ends and have large surfaces for muscle attachment. IE: HUMERUS & FEMUR. Short Bones - are small w/ irregular shapes, they are found in wrist and ankle Flat Bones - are found covering the soft body parts, IE; SHOULDER BLADES, RIBS AND PELVIC BONES Sesamoid Bones - small, rounded bones that resemble a sesame seed. they are found near joints and increase the efficiency of muscles near a joint. IE, KNEE CAP Skull - made up of 2 parts, the cranium and the facial bone Cranium - includes following bones *Frontal Bone- forms the anterior part of the skull & forehead *Parietal Bone- Forms the sides of the cranium *Occipital Bone- forms the back of the skull, there is a large hole at the ventral surface in this bone, called the foramen magnum, which allows the brain communication w/ the spinal cord *Temporal Bone- forms the 2 lower sides of the cranium *Ethmoid Bone- forms the roof of the nasal cavity *Sphenoid Bones- anterior to the temporal bones Zygoma - cheekbone Lacrimal Bones - paired bones at the corner of each eye that cradle the tear ducts Maxilla - upper jaw bone Mandible - lower jaw bone Vomer - bone that forms posterior/inferior part of the nasal septal wall between the nostrils Palatine bones - Make up part of the roof of the mouth Spinal/Vertebral Column - is divided into 5 regions from the neck to the tailbone. There are 26 bones in the spine & are referred to as the VERTABRAE Cervical - Neck Bones Thoracic - Upper Back Lumbar - Lower Back Sacral - Sacrum Coccygeal - Coccyx (tailbone) Rib Cage - There are 12 pairs of ribs. The 1st 7 pairs join the sternum anteriorly through the cartilaginous attachments called COSTAL CARTILAGE. The TRUE RIBS #'s 1-7 attach directly to the sternum in the front of the body. The FALSE RIBS, #'s 8-10 are attached to the sternum by cartilage. Ribs 11 & 12 are FLOATING RIBS, b/c they are not attached at all Upper Appendicular Skeleton - includes the shoulder girdle which is made up of the SCAPULA, CLAVICLE, & UPPER EXTREMITIES Scapula - or shoulder blades are flat bones that help support the arms Clavicle - or collarbone, is curved horizontal bones that attach to the upper sternum at one end, these bones help stabilize the shoulder Humerus - upper arm bone Ulna - lower medial arm bone Radius - lateral lower arm bone (in line w/ the thumb) Carpals - Wrist bones, there are 2 rows of 4 bones in the wrist Metacarpals - the 5 radiating bones in the fingers. These are the bones in the palm of the hand. Phalanges - finger bones, each finger has 3 phalanges, except for the thumb. The 3 phalanges are the proximal, middle and a distal phalanx. The thumb has a proximal and distal Lower Appendicular - can be divided into the pelvis and the lower extremities Pelvis - superior & widest bone Ischium - lower portion of the pelvic bone Pubic Bone - lower anterior part of the bone Femur - thighbone Patella - kneecap Tibia - shin Fibula - smaller, lateral leg bone Malleolus - ankle Tarsal - hind foot bone Metatarsal - midfoot bone Phalanx - toe bones, 14 in all (2 in great toe, 3 in each of the other toes) Joints - parts of the body where 2 or more bones of the skeleton join. Different joints have different ROM (range of motion), ranging from no movement at all to full range of movement No ROM - most synarthroses are immovable joints held together by fibrous tissue Limited ROM - amphiathroses are joints joined together by cartilage that is slightly moveable, such as the vertebrae of the spine or the pubic bone Full ROM - diathroses are joints that have free movement, Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints (synovial joints) Synovial Joints - free moving joints, are surrounded by joint capsules. Many of the synovial joints have BURSAE-SACS OF FLUID THAT ARE LOCATED BETWEEN THE BONES OF THE JOINT AND THE TENDONS THAT HOLD THE MUSCLES IN PLACE. Muscles - Muscle is tissue comprised of cells. Have the ability to contract & relax. What are the 3 different functions of the human muscles? - 1) allow the skeleton to move 2) responsible for movement of organs 3) to pump blood to the circulatory cystem How are muscles attached to bones? - by strong, fibrous bands of connective tissues called tendons. Extension - to increase the angle of the joint Flexion - to decrease the angle of the joint Abduction - movement away from the midline Adduction - movement towards the midline Supination - turning the palm or foot upward Pronation - turning the palm or foot downward Dorsiflexion - raising the foot, pulling the toes toward the shin Plantar Flexion - lowering the foot, pointing the toes away form the shin Eversion - turning outward Inversion - turning inward Protraction - moving a part of the body forward Retraction - Moving a part of the backward Rotation - revolving a bone around its axis Fractures - broken bone, most occur as a result of trama, however some disease such as cancer or osteoporosis can also cause spontaneous fractures. Can be classified as simple or compound. Simple fractures don't rupture the skin as compound fractures split open the skin allowing for an infection to occur. Communicated Fracture - the bone is crushed and/or shattered Compression Fracture - the fractured area of the bone collapses on itself Colles Fracture - the break of the distal end of the radius at the epiphysis often occurs when the pt has attempted to break his/her fall Complicated Fracture - the bone is broken and the ends are driven into each other Hairline Fracture - a minor fracture appears as a thin line on x-ray; and may not extend completely through the bone Greenstick Fracture - the bone is partially bent & partially broken, this is a common fracture in children b/c their bones are still soft Pathologic Fracture - any fracture occurring spontaneously as a result of disease Salter-Harris Fracture - a fracture of the epiphyseal plate in children Sprains, strains and dislocation/subluxation - SPRAIN is a traumatic injury to the joint involving the soft tissue, soft tissue includes the muscles, ligaments and tendons. Strain - lesser injury, usually this is a result of overuse or overstretching Dislocation - is when the bone is completely out of place Subluxation - bone is partially out of joint Evaluations & Management Review - The E&M section include codes that pertain to the nature of the physicians work. Codes depend on type of service, pt status, and place where service was rendured. The E&M section is divided into broad categories such as office visit, hospital visits, and consultations Basic Format of the levels of E&M services - 1) a unique code # is listed 2) the place & type of service is specified 3) the content of the service is defined 4) the nature of the presenting problem(s) usually associated w/ a given level is (are) described 5) time is typically specified in the descriptor of the code New Patient - defined as one who has not received medical services w/in the last 3 years Established Patient - defined as someone who has recieved medical services w/in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice Chief Complaint - brief statement describing the symptom, problem, diagnosis, or condition that is the reason the pt seeks medical care How many Volumes to ICD manual? - 3; *Volume 1- Disease: Tabular List *Volume 2- Disease: Alphabetic Index *Volume 3- Procedures: Tabular list and Alphabetic Index Volume 1-Index to Diseases, Tabular List - contains the disease and condition codes and the descriptions, also contains the V codes and E codes Volume 2-Index to Diseases, Alphabetic Index - the is the alphabetic index of Volume 1; use this first then volume 1 to confirm codes Volume 3-Procedures - contains codes for surgical, therapeutic, and diagnosis procedures, used primarily in hospitals Which volume(s) are used in the inpatient and outpatient settings (physician office)? - Volume's 1 & 2 How to ensure you have chosen the correct code? - First locate the code in the alphabetic index (Volume 2) then cross-reference this code in the Tabular List (Volume 1) What are V codes? - Supplementary Classification of Factors Influencing Health Status and Contact of Health Services-supplementary classification code used to identify health care encounters that occur for reasons other that illness or injury or to indentify pt's whose illness is influenced by special circumstances or problems. Can be found in both Volume 1 & Volume 2 What are circumstances when V codes are used? - *When a person who is not currently sick encounters health services for some specific reason such as to act as an organ donor or receive a vaccination. (IE; V59.3 is the code for donor of bone marrow) *When a person w/ a resolving disease or chronic condition presents for specific treatment of that disease or condition. (IE; V56.0 is used for extracorporeal dialysis) *When a circumstance may influence the pt's health status but is not a current illness (IE; V16.3 is used for family history of coronary artery disease) *To indicate the birth status of a newborn (IE; V30.0 is uused for a newborn male born in the hospital by c-section) What are E codes? - Supplementary Classification of External Causes of Injury and Poisoning-supplementary classification codes used to describe the reason of EXTERNAL CAUSE of injury, poisoning and other adverse effects. Can be found in both Volumes ! & 2. What codes are used to classify environmental events, circumstances, and conditions as the cause of injury, poisoning & other adverse effects and capture how the injury or poisoning happened, the intent and the place where the event happened? - E codes When is the ICD manual updated - Annually, Usually in October How many chapters does the Tabular List(Volume 1) contain? - 17; based on either body system or cause or type of disease What do the codes range from? (ICD-Volume 1) - 001-999 Chapters - are the main division on the ICS-9-CM, they are divided into secctions Sections - composed of a group of 3 digit categories representing a group of conditions or related conditions, they are divided into categories Categories - are composed of 3 digit codes representing a single disease or condition. the 3 digit code is used only if it is not further subdivided. There are about 100 category codes and most requires a 4th digit (subcategory code) Ex; 242 Subcategories - provide a 4th digit code (one digit after the decimal point) which is more specific that category code (3 digit) in terms of causes, site, manifestation of the condition. This must be used in available. Ex; 242.0 Subclassification - provides a 5th digit code which gives the highest specificity of description to a condition. Use of it is mandatory when available. A code not reported to the full # of digits required is invalid ex; 242.01 Level of detail in coding - a category code is used only if it is not further subdivided. Where subcategory and subclassifaction codes are provided, their assignment is mandatory. A code is invalid if it has not been coded to the level of specificity required for that code. Sequencing the diagnosis - the diagnosis, condition, or other reason for the encounter or visit shown in the medical record to be chiefly responsible for the services provided is listed first. Coexisting conditions that were treated or medically managed or influenced by the pt during the encounter are listed as additional codes. (Conditions that were previously treated and no longer exist are not coded.) If personal history or family history has an impact on current care or influence treatment, history code may be assigned as a secondary code Alphabetic Index (Volume 2) - Everything in the Index is listed by condition-that is, diagnosis, signs, symptoms, and conditions such as pregnancy or admission Nonessential Modifers - the main term may be followed by these in paranthesis, their presence or absences does not have an effect on the the selection of the code listed for the main term Essential Modifiers - Terms indented two spaces to the right below the main term called subterms. Are essential modifiers b/c they have bearing on the right selection of the code. Hypertension table - found in the Index under the main term "Hypertension" and it contains a list of conditions that are due to or associated with hypertension. The Table classifies the conditions as: -Malignant; an accelerated sever form of hypertension w/ vascular damage and a diastolic pressure of 130mmHg -Benign; Mild or controlled hypertension & no damage to the vascular system or organs -Unspecified; This is not specified as benign or malignant in the diagnosis or medical record Neoplasm Table - this is located in the Index under the main term "Neoplasm" and is organized by anatomic site. Each site has 6 columns w/ 6 possible codes determined by whether the neoplasm is malignant, benign, of uncertain behavior or of unspecified nature Malignant - further classified as to primary, secondary or carcinoma in situ Primary Malignancy - the original cancer site. Malignant tumors are considered primary unless documented as secondary or mastastic Secondary Malignancy - cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body Carcinoma (Ca) in Situ - cancer that is localized and has not spread to adjacent tissues or distant parts of the body Benign - noninvasive, non-spreading, nonmalignant Uncertain Behavior - uncertain whether benign or malignant, borderline malignancy Unspecified Nature - a neoplasm is identified; however, no nature of the tumor is documented in the diagnosis of the medical record Choose the code that represents the current status of the neoplasm - a neoplasm code is assigned if the tumor has been removed and pt is still receiving chemotherapy tx or radiation. A V code is assigned if the tumor is no longer present or if the patient is not receiving treatment, but is returning for follow-up care 3 sections to Alphabetic Index - Section 1) Index to diseases Section 2) Table of drugs and chemical Section 3) Index to External Cause of Injury (E Codes) Section 1: Index to diseases - each term is followed by the code or codes that apply to that term Section 2: Table of Drugs and Chemicals - contains a list of drugs & chemicals w/ the corresponding poisoning code and E codes. The E codes are used to explain the circumstances surrounding the poisoning which may be: -Accident: Poisoning was due to accidental overdose, wrong substance taken, accidents in use of drugs and biologicals, external causes of poisoning classifiable to 980-989 -Therapeutic Use: instances when a correct substance properly taken is the cause of an adverse effect -Suicide Attempt: the poisoning was self-inflicted -Assault: poisoning was inflicted by another person w/ intent to kill or injury -Understand: poisoning cannot be determined whether intentional or accidental Section 3: Index to External Cause of Injury (E codes) - this is the index for the E codes. It classifies in alphabetical order, environment events and other conditions as the cause of injury and other adverse effects. Health Care Financing Administration Common Procedure Coding System - HCPCS Reference Manual Who assigns NPI#'s & what are they? - The CMS assigns a standard unique identifier known as National Provider Identifier (NPI). Who developed HCPCS & What is it? - The CMS developed Healthcare Common Procedure Coding System (HCPCS) which is a collection of codes for procedures, supplies, products, and services that may be provided to Medicare/Medicaid beneficiaries and also to those enrolled in a private health ins program. Codes are divided into 2 levels: Level I Codes - Consist of codes found in the CPT manual. They have five position numeric codes used to report physicians services rendered to patients. Level II Codes (National Codes) - codes formulated thru the joint efforts of the CMS, the health insurance association of america, and the bcbs are five position alpha-numeric codes for physician and non-physician services not found in the cpt(level 1), start w/ a letter followed by 4 #'s and make up more than 2,400 5 digit alphanumeric codes divided into 22 sections, each covering a related group of items. Most of these items are supplies, materials or injections that are covered by medicare. Some codes are for physicians & non-physician services not found in the CPT (Level I) Ex; E section is for the Durable Medical Equipment category which covers reusable medical equipment ordered by the physician for use in the home, such as wheelchairs or portable oxygen tanks. Level III Codes - codes that were used locally or regionally have been eliminated by the CMS since the implementation of the HIPPA. Some of the codes are now in the Level II CPT - Current Procedural Terminology- codes from CPT code book used to report services and procedures by dr's. The CPT coding system uses a 5 digit numeric system for coding services rendered by dr's. Some codes use a 2 digit modifier to five a more accurate description of the services rendered