CPT-Current Procedural Terminology

Appendix A - answer-Detailed list of modifiers. Appendix B - answer-List of all annual CPT coding changes. Consultations - answer-When an MD needs advice on a particular patient. The doctor they are seeking the advice from is the consultant. Not the same as a referral. CPT appendices - answer-Contains five appendices that are located between the Medicine section and the Index. The content changes annually CPT Appendices - answer-CPT contains five appendices that are located between the medicine section and the index, content changes annually. CPT Index repesented by a series of codes separated by a dash - answer-Must be coded within the range of code numbers within the dash CPT Index two digit codes separated by a comma - answer-Must be coded with multiple code numbers, when it shows two code numbers. CPT Index with single digit code - answer-Must be coded with a single code number, when it shows only one code number. CPT organizes Category 1 procedures within how many sections? - answer-Category 1 procedures are organized within six sections, note that the Index is considered as the 7th and last category located in the back of the book, and is in alphabetical order. CPT sections - answer-CPT organizes category 1 procedures and services within six sections, including the Index as the seventh section. It consists of Evaluation and management (), Anesthesia (0), Surgery (-largest section), Radiology (), Pathology and laboratory (), Medicine (). Index ( toward the end of the book, organized by main terms. CPT symbol- A code description has been changed - answer-Represented by a triangle symbol. CPT symbol- Add on codes - answer-Represented by + sign CPT symbol- New services and procedures added to the CPT manual - answer-Represented by a bullet symbol. CPT symbol-Codes not to be used with modifier-51 - answer-Represented by a circle with a line across it as the symbol. CPT symbol-Procedure that includes a conscious sedation. - answer-Represented by a bull's eye symbol. CPT symbol-Used around revised guidelines and notes - answer-Represented by two horizontal triangles <> CPT use is for - answer-reports services and procedures performed on patients. CPT was published in what year and by whom? - answer-AMA first published CPT in 1966 CPT-Current procedural terminology - answer-Is a listing of descriptive terms and identifying codes for reporting medical services and procedures. Published in 1966 by AMA. It provides a uniform language that describes medical, surgical, and dx svcs. to facilitate communication among providers, patients, and insurers. Critcal care service - answer-determined by the amount of time the MD spends with the patient. Define Medical neccessity - answer-To establish why a procedure was requested in order to be coded and billed. Define referral - answer-Is a permission tha the insurance company needs to authorized payment for the visit, this authorization gets faxed to the specialist for payment for the encounter with the patient. Definition of a modifier - answer-two digit number added to the end of a code to give more information about the procedure. Emergency department services - answer-used for new or established patient who receive care in the E/m dpt. . These codes will bring high reimbursement. Established office visits - answer-code used for patients seen within 3 years. 99211 code is used when patient received servie from someone other than MD (nuse, MA), usually less than 5 minutes in duration. Two of the three criteria must be met. Evaluation & Management - answer-codes for broad categories such as office, hospitals and consultation visits. First section of the CPT manual. Give code categories for Anesthesia - answer- Give code categories for Evaluation and management - answer- Give code categories for Medicine - answer- Give code categories for Radiology - answer- Give code categories for Surgery - answer- (largest section-coded by body systems) Give code category for Pathology and Laboratory - answer- Guidelines - answer-Located at the beginning of each CPT section and should be carefully reviewed before attempting to code. They give instructions on how to code certain sections. HCPS (hicks picks)/Healthcare common procedure - answer-Created by medicare 1983. Also CPT codes required by Medicare, and are found in a different book Hospital inpatient services - answer-one who has been formally admitted to an acute care facility. Hospital observation services - answer-a patient who does not need care as intensive as an inpatient but must remain in the hospital for a short period of time. Patient is NOT ADMITTED. Key components in selecting a level fo Evaluation and Management services - answer-History, Physical exam or examination, and medical decision making Name CPT Sections - answer-Evaluation & Management (), Anesthesia (), Surgery (-Lgst. sec.), Radiology (), Pathology & Laboratory (), Medicine () New patient office visits - answer-When coding a new patient all three criteria must apply to use code. Patient has not ever see the MD before or not in the past 3 years. MD must spend more time with the patient so it will increase reimbursement. Subsequent hospitl care - answer-Patient received follow up care while in the hospital. Used to code for daily hospital visits hile patient is hospitalized. Superbill - answer-Is a financial document, it represents what the MD charges for each procedure and must be backed up by the list of charges being billed. Three factors of Evaluation and Management codes - answer-Place of service-setting in which services are provided. Type of service-reason service is requested. Patient status-new patient, established patient (seen in last three years, if more than three years, patient is considered as a new patient), outpatient (ambulatory), and inpatient (somewhere in the hospital). Unlisted Procedures and Services - answer-a code assigned when there is a procedure performed for which there is no CPT code. A special report must accompany the claim to describe the procedure so MD can be reimbursed. What is an initial inpatient cosultation? - answer-consultant services used in the hospital setting. What is an office consultation? - answer-used to code services provided in an office. What will you look for to determine the type of code to be selected in the Medical Decision Making, profile? - answer-Determined by: number of possible DX, amount of data to review, and risk of complications. Based on the Straightforward, low, moderate or high medical decision. What will you look for to determine the type of code to be selected, in the history profile? - answer-Subjective info given by patient. It incudes problem focused, expanded problem focused, detailed and comprehensive history that was done. What will you look for to determine the type of code to be selected, in the Physical exam/examination profile? - answer-Objective findings of MD. It includes problem focused, expanded problem focused, detailed, and comprehensive examination. When a code is not found use code number - answer-99999, submit with a report t