Chapter 6 - Introduction To CPT, Surgery Guidelines, HCPCs, And Modifiers Flashcards
(63 cards)
Category I CPT codes
5 numeric digits for each code. These codes are commonly used for medical services, procedures and professional services.
Category II CPT codes
Optional performance measurement tracking codes designed to minimize administrative burden because they facilitate data collection about quality of care. Listed near the back of the CPT book. Alphanumeric codes with the letter F in the last position. Can be reported in addition to category I codes
Category III CPT codes
Temporary codes for emerging technology, services or procedures. Alphanumeric with T in the last position. Can stand alone if a category III code fully represents a case
; semicolon and indented procedure
Used so the common portion of a procedure so it doesn’t have to be listed each time. Everything before the ; is common to the procedure. Indented portion is specific to each code. No need to report main common portion when using an indented code
+ Add On Code
Never reported alone and always accompany a primary code. Never reported with modifier 51.
🚫 Forbidden symbol means
Code is exempt from the use of modifier 51
⚡️ lightning bolt symbol identifies
Vaccines pending FDA approval.
pound sign identifies
Codes that have been resequenced and are out of numerical order.
Each -
Each separate instance. Added to a primary code for each separate instance of a procedure.
Each additional -
Each instance, above and beyond the first code, up to the amount given is reported with this code. No modifier 51 used
Included when performed -
Indicates a procedure, when performed, is not reported separately because it is considered included in the base procedure
Part thereof -
Typically seen in add on codes. Part of or up to the number or percentage listed. If over that number another code is used
Separate procedure -
When performed alone the separate procedure is reported. If reported with another procedure or service on the same patient, during the same encounter, and is related, it may be considered inclusive and the procedure is not reported separately.
Single or multiple -
Indicates the code is only reported once
Units -
Number of times a single CPT code is reported
Separate procedure
When a service or procedure is designated as separate procedure it is performed alone, or is considered unrelated to another procedure provided during the same visit.
Unilateral or bilateral
Modifier for bilateral not necessary as the procedure can be used for unilateral or bilateral
Resource based relative value scale (RBRVS)
System to reimburse physicians based on the CPT code submitted. Each CPT code has a Relative Value Unit assigned when multiplied by the conversion factor and geographic region adjustment creates the reimbursement rate
Relative Value Unit
Assigned to each CPT code. Considers three things. Physician work, practice expense, and professional liability / malpractice insurance
Steps for coding multiple procedures
- Select all procedure codes
- Check codes against NCCI and the mutually exclusive table for bundling and eliminate and bundled codes. If documentation supports a modifier to report a bundled code append modifier to the column 2 code
- Check RVU’s for remaining codes and sequence by RVU, highest to lowest
Place Of Service codes
Two digit codes placed on all claims to denote the setting where the service was provided. Found in the front of the CPT book
CPT category 1 publish and effective dates
Published late summer / early fall and effective Jan 1 of the next year
CPT category II publish and effective dates
Released three times yearly then effective three months after being released
CPT category III codes publish and effective dates
Published Jan 1 and July 1. Effective 6 months after they are published
