acronyms
Abbreviations,such as ECG for electrocardiography
add-on code
A code that indicates additional or supplemental procedures carried out in addition to the primary procedure.
Alphabetic Index
The reference section of the CPT manual;it is used to help find a code or code range.
bundled codes
Codes designating procedures or services that are grouped together and paid for as one procedure or service.
categories
Indented one level below a subsection in the CPT coding manual;a category usually refers to a specific anatomic site or procedures and/or services.
Category I code
A five-digit primary procedure or service code found in the Tabular Index that is selected when performing insurance billing or statistical research.
Category II codes
Special codes that can help providers track revenue and reimbursement.
Category III codes
Codes for new or experimental procedure or service.
downcoding
A change in the code submitted for reimbursement, usually performed by the insurance company.This change generally occurs because the code submitted does not match in some way the specification of the insurance company.
eponyms
Procedures, services, or diagnoses named after people, such as Mohs' micrographic surgery or Crohn's disease.
guidelines
The guidelines are found at the begining of each of the six sections of main text of the CPT.They define items that are necessary to appropriately interpret and report the procedure and services found in the section.
Health Care Common Procedural Coding System (HCPCS)
Level II codes created to supplement procedures and services not covered in the CPT.
main term
The primary or key word or words abstracted from a
medical record that are used to begin the code search in the Alphabetic Index. A main term can identify a procedure or servie performed; an organ or anatomic site; a condition, illness, or injury;or an ep
main text
See Tabular Index
modifiers
Two characters code additions that explain circumstances that alter provided service or provide additional clarification or detail about a procedure or service.
modifying term
A key word (or words) selected after the main term has been chosen to help further define or describe the procedure or service.
new patient (NP)
A patient who has his first encounter (visit) with a physician or physician group or who has an established patient with a physician or provider but has not been seen in 3 years.
patient status (PS)
The state a patient as either new or established; appears in the Evaluation and management section of the CPT.
physical status
The physical condition of the patient.
place of service (POS)
The place where a procedure or service was performed,which has a specific code.
section
One of the six main divisions of the CPT manual.
subcategory
A term indented one level below a category; it usually is a procedure or service unique to the specific category.
subsection
A term indented one level below a section; it usually
describes an anatomic site or organ system (e.g.intergumantary system or cardiology)
Tabular Index
The main text of the CPT; it contains the alphanumeric listing of all Category I procedure and service codes and their respective description.
unbundled codes
Codes in which the components of procedure are separated and reported separately.
upcoding
The deliberate upgrading of a CPT code to the next highest reimbursable code,despite a lack of documentation, so as to receive higher reimbursement.