Chapter 8 Flashcards
CPT codes are used by: (5)
Physician's offices and clinics Hospitals Rehab units Ambulance services Long-term care facilities
CPT forms… (paragraph)
…the basis for a universal communication system that ensures accuracy and clarity when the procedures and services delivered within the health care system are described
Six main divisions in Category I of the CPT manual
- Evaluation and Management (E/M)
- Anesthesia
- Surgery
- Radiology
- Pathology and Laboratory
- Medicine
The universal paper form
CMS-1500
Services that are reported electronically by the CMS-1500
Outpatient services
Appendix A
Modifiers
Appendix B
Additions, Deletions, Revisions
Appendix C
Clinical Examples, E/M Codes
Appendix D
Add-on Codes
Appendix E
-51 Exempt Codes
Appendix F
-63 Exempt Codes
Appendix G
Include Moderate Conscious Sedation
Which appendix gives coders examples of how to apply E/M codes?
Appendix C
One subsection of E/M is…
…Office or Other Outpatient Services
What indicates that a portion of text has been changed?
right- and left- facing triangles surrounding the parenthetical note below the code description
An add-on code: (3)
- May only be used with another specific code
- Is never used alone
- Requires no reduction for multiple services
Where is the full list of add-on codes listed?
Appendix D
What is the purpose of an add-on code?
Additional code to show the furthest extent of the procedure
-51 Exempt Codes are services…
typically exempt from multiple procedure reductions
When is a modifier -51 used?
When multiple surgeries are performed on the same day during the same surgical session
Modifier -51 should not be used with…
…add-on codes
Symbol: plus (+) sign
add-on code
Symbol: circle with a line through it
“-51 may not be used with these codes”
Why is evaluation and management section listed first?
Procedures and services listed in the E/M section are frequently used
How is the CPT categorized?
Sections
Subsections
Subheadings
Categories
The surgery section is subdivided by…
…body systems
Subdivisions may be categorized by:
Anatomy: knee or shoulder Procedure: incision or excision Condition: fracture or dislocation Description: cast or strap Surgical approach: anterior cranial fossa or middle cranial fossa
Where do guidelines appear in the CPT manual?
At the start of each section of the CPT
Where do notes appear in the CPT?
Throughout and are listed before and after the codes that they reference
What are notes?
Special instructions that must be followed for coding to be accurate
Notes are a…
…must-reading for the coder
Two types of codes used in the CPT manual
Stand-alone
Indented codes
Codes which have a complete, full descriptions attached to them
Stand-alone
Codes that are listed under related stand-alone codes.
Indented
Descriptions for these codes depend on information in the code that precedes them
Indented
Words before the semicolon applies to ___ indented codes that follow
all
What divides the portion of the description that is related to all indented codes that follow it from the portion that pertains specifically and only to the current code
semicolon
How does each surgeon bill the procedure?
modifier -62
Medicare requires documentation of medical necessity when modifier ___ is used
-25
Modifiers are placed…
…M1 and/or M2 of the EHR
List modifiers in _______ order on the claim form
descending
Unlisted procedures may be coded as…
“unlisted” of no specific Category I or III code describes the procedure
Medicare requires unlisted codes to be accompanied by…
a special report
Codes that are used to indicate an unlisted service
99
Where are codes for unlisted services found?
At the end of each subsection and are categorized either by body area or type of procedure
Codes that report the latest technology and temporary codes for up to five years
Category III
Category III codes are listed…
immediately before Appendix A
Format for the Category III codes
4 numbers and one letter
Category III codes are published…
each January and July on the AMA website and then in the next edition of the CPT
What must accompany claims for unlisted Category I and Category III codes to explain the need for the service provided
Written reports
A special (written) report must state the following details about the procedure: (7)
- Nature
- Extent
- Need
- Time
- Effort
- Equipment used
- Photos and medical journal (if relevant)
Used to locate the service/procedure terms and codes
The index
What is the purpose of using the Index in the back of the CPT manual?
It speeds up the process of locating the term or code
The index is organized…
Alphabetically
How are entries coded?
May be single, multiple, or a range of codes. Depends on the entry noted in the Index
Methods of locating codes in the CPT: (6)
Service or Procedure: repair, excision Anatomical Site: median nerve, elbow Condition or Disease: cleft lip, clot Synonym: toe and interphalangeal joint Eponym: Jones procedure, Heller operation Abbreviation: ECG, PEEP
Used to cross-reference terms
“see”
See means
Look here for the code
