ch.19 Flashcards
Add-on Code
a code indicating procedures that are usually carried out in addition to another procedure. Add-on codes are used with the primary code.
Bundled Codes
when healthcare services that are usually separate are considered as a single entity for purposes of classification and payment.
Concurrent Care
care being provided by more than one physician, such as with specialists.
Consultation
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 therapy.
Counseling
provision of advice and instruction by a healthcare professional to patients.
Critical Care
care provided to unstable, critically ill patients. Constant bedside attention is needed in order to code critical care.
Current Procedural Terminology
a book with the most commonly used system of procedure codes. It is the HIPAA-required code set for physicians’ procedures.
Down Coding
the insurance carrier bases reimbursement on a code level lower than the one submitted by the provider.
E/M Code
evaluation and management codes that are often considered the most important of all CPT codes. The E/M section guidelines explain how to code different levels of services.
Established Patient
a patient who has seen the physician within the past 3 years. This determination is important when using E/M codes.
Global Period
the period of time that is covered for follow-up care of a procedure or surgical service.
HCPCS Level II Codes
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.
Healthcare Common Procedure Coding System
(HCPCS) a coding system developed by the Centers for Medicare and Medicaid Services that is used in coding services for Medicare patients.
Modifier
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.
New Patient
patient that for CPT reporting purposes has not received professional services from the physician within the past 3 years.
