Billing And Coding Flashcards
Who developed the CPT codes?
American Medical Association
What does CPT stand for?
Current procedural terminology
When were the CPT codes developed?
1966
Why were the CPT codes developed?
To give a common language to physicians, patients, people who look at demographics of different patient populations, insurance companies and Medicare. It is a way of figuring out who is doing what as a function of geography.
What is an RVU?
A relative value unit that involves a method of deciding how much a given procedure is worth based on amount of time it takes, amount of expertise it takes to interpret, and equipment required.
No RVU associated with HCPCS
What are the requirements for a new CPT code?
- Unique
- Universal
- Non-investigational (equipment must be FDA approved)
- Support for procedure in literature
What is HSPCS?
Health Care Financing Administration Common Procedure Coding System
Why was HCPCS developed?
To meet the needs of Medicare and Medicaid
V codes
Used for instances other than injury or disease. All hearing stuff is under the vision section which is why they are called V codes. Part of HCPCS and ICD-9
Balance billing
When you bill, here is what I want to bill, here is what insurance paid, this is the balance here, and I’m going to send it to the patient. Can’t have patient pay X amount and the difference between X and Y also.
ILLEGAL
Upgrade/cost share
Let the patient know that the hearing aids cost X amount and that insurance will pay Y amount so you can have the patient pay X-Y.
LEGAL
21 modifier
- Used most often
- Indicates a prolonged evaluation
52 modifier
- Reduced procedure
- Part of procedure wasn’t completed (only tested right ear)
53 modifier
- Couldn’t finish procedure
- i.e ABR on child who wakes up during test and doesn’t fall back asleep
51 modifier
If procedure was done more than once on a give date of service as separate events
