AMA110 Chapter 19

Blue Triangle

Indicates that the code description has changed since the previous edition of the CPT manual

Bull's-Eye

denotes moderate (conscious) sedation and means it is understood that conscious sedation is necessary for the procedure performed and so is included in the procedure; it cannot be billed separately.

Appendix G

Lists all codes that include moderate (conscious) sedation.

Red dot

Appears next to codes that are new since the previous edition of the CPT.

The # Sign

Used to note codes that are out of numeric sequence.

Circle with diagonal line

Modifier 51 exempt

Appendix E

Lists the modifier 51 exempt codes.

Lightning bolt

Used to denote vaccines pending FDA approval.

Triangles pointing toward each other

Denote new or revised text information. You may also see them used for the out-of-sequence coding information.

Appendix K

Lists the vaccines affected by this symbol.

Procedural coding

The translation of medical terms for procedures and services provided to patients into code numbers selected from standardized procedural coding systems.

How many digits does a CPT code have?

CPT codes are 5-digit numeric codes

HCPCS

Health Care Common Procedure Coding System

Why was HCPCS developed

Developed for use in coding services for Medicare patients.

What are HCPCS Level 1 codes?

CPT Codes

How would you describe the HCPCS Level II codes?

National codes issues by CMS that cover many supplies and durable medical equipment. HCPCS Level II codes have five characters, either numbers, letters, or a combination of both.

Fraud

An act of deception used to take advantage of another person or entity.

What do modifiers to a CPT code indicate?

The two-digit modifiers indicate that one or more special circumstance applies to the service or procedure the physician performed.

What is the maximum number of modifiers which can be used per CPT code?

A maximum of three modifiers can be assigned for a CPT code.

What are the most frequently used CPT Codes?

The evaluation and management (E/M) codes are used so frequently that they are placed in the front of the CPT manual for easy reference.

How often are the CPT codes updated?

The CPT manual is updated yearly, and new codes are used for services beginning January 1 of each New Year.

Code linkage

The analysis of the connection between the diagnostic and procedural information on a claim and is done by insurance companies to evaluate the medical necessity of the reported charges.

New patient

The general rule of thumb is that if a patient has not been seen in the practice within three years, he or she is considered a new patient.

Add-on codes

Describe procedures done in addition to a main procedure.

Appendix D

Contains a complete listing of all add-on codes in the manual.

Appendix A

The place in the CPT manual where you would find information about the proper use of modifiers.

How many codes are required for an injection of a vaccine?

Two codes are required; one for giving the injection, and one for the particular vaccine that is given.

Indented codes

Means that you refer back to the previous code description, reading the information prior to the semicolon and adding the indented code information after the colon to complete the description.

Bundled codes

Consist of any code that includes more than one procedure in its description.

Concurrent care

Similar care being provided by more than one physician

Critical care

Provided to unstable, critically ill patients.

Downcoding

Reimbursement is based on a code level lower than the one submitted by the provider.

Unbundling

Breaking a bundled code into its component parts for higher reimbursement and is not allowed.

Upcoding

Coding a procedure or service at a higher level to receive greater reimbursement. Code creep, overcoding, and overbilling - fraudulent practices when done knowingly or repeatedly