acronyms
abbreviations, such as ECG.
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 and 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 preforming insurance billing or statistical research
Category II Codes
special codes that can help providers track revenue and reimbursements
Category III Codes
codes for a 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 specifications of the insurance company.
eponyms
procedures, services, or diagnoses named after people, such as Mohs' micrographic surgery of Crohn's diseas
guidelines
found in the beginning of each of the six sections of the main text of the CPT. They define items that are necessary to appropriately interpret and report the procedures and services found in the section.
main term
primary or key word or words abstracted from a medical record that are used to begin the code search in the Alphabetic Index. Can identify a procedure or service performed; an organ or anatomic site; a condition, illness, or injury; or an eponym, abbrevia
main text
see Tabular Index
modifiers
two character code additions that explain circumstances that alter a provided service or provide additional clarification or detail about a procedure or service.
modifying term
a key word(s) selected after the main term has been chosen to help further define or describe the procedure or service
new patient
NP, Individual who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice within the past 3 years.
patient status
PS, the state of 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 on 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. integumentary system
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 a procedure are separated and reported separately
upcoding
deliberate upgrading of a CPT code to the next highest reimbursable code, despite a lack of documentation, so as to receive higher reimbursements.