CPT stands for current procedural terminology. It provides ervices and procedure codes reported on insurance claims.
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Overview of CPT
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CPT provides a list of identifying and descriptive codes for procedures and service. CPT coding is the uniform language that describes surgical procedures and services. CPT codes are used to report services and procedures. CPT codes are linked with ICD-9 codes. CPT codes are used to justify need for service or procedure.
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CPT Supports electronic data
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Exchange (EDI), computer based patient. Record (CPR), electronic medical. Record (EMC), reference/research database.
Category 2 contains performance measurement tracking codes in an alphanumeric identifier with a letter in the last field. (EX: 4246C)
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Category 3
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Category 3 contains emerging technology and temporary codes assigned for data purposes.
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CPT's 6 Sections
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Evaluation and Management (E/M) Anesthesia Surgery Radiology Pathology and Laboratory Medicine
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CPT Symbols
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Bullets Triangles Horizontal Triangles Plus Sign Circle with line through it Bull's-Eye
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Horizontal Triangles
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Horizontal triangles are used to save space in CPT and code descriptions that are not printed in their entirety next to a code number. They surround revised guidelines and notes. They are NOT used for revised coding descriptions.
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Plus Sign
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A plus signs identifies add-on codes, for procedures that are performed at the same time and by the same surgeon.
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Circle with Line Through It
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A circle with a line through it identifies codes that are not used with a modifier.
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Bulls-eye
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A bulls-eye indicates a procedure that includes moderate sedation.
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Unlisted procedures/services
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Codes are assigned when a procedure or service is performed by a provider for which there is no CPT code.
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Special report
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When an unlisted procedure or service code is reported a special report is created.
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Narrative document
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A narrative document must accompany claim to describe nature and extent of the need of service or procedure.
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Modifiers
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CPT modifiers are used to clarify services and procedures performed by providers. A list of all CPT modifiers with a brief description is located insider the front cover of the coding manual.
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Coding Surgeries Correctly
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Three questions must be asked: What body system was involved? What anatomic site was involved? What type of procedure was performed?
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Coding E/M Correctly
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E/M codes are based on these three components: Extent of personal, family, and social history. Extent of examination. Complexity of medical decision making.
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E/M categories
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E/M is categorized according to these four types: Problem focused examinations. Expanded problem focused examination. Detailed examination. Comprehensive examination.
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History and Examination
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History and examination is determined by these 4 complexities: Straightforward. Low complexity. Moderate complexity. High complexity.
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Physician Status Modifiers
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Each status modifier reported with an anesthesia code to indicate the patient's condition at the time anesthesia was administered.
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Nation Correct Coding Initiative (NCCI)
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NCCI was created to encourage national correct coding, methodologies, and manage the improper assignment of codes. NCCI was implemented by The Center for Medicare and Medicaid Services.
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Incorrect Coding
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Incorrect coding results in inappropriate repayment of Medicare part B claims.
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Cards in this guide (27)
CPT
CPT stands for current procedural terminology. It provides ervices and procedure codes reported on insurance claims.
Overview of CPT
CPT provides a list of identifying and descriptive codes for procedures and service. CPT coding is the uniform language that describes surgical procedures and services. CPT codes are used to report services and procedures. CPT codes are linked with ICD-9 codes. CPT codes are used to justify need for service or procedure.
CPT Supports electronic data
Exchange (EDI), computer based patient. Record (CPR), electronic medical. Record (EMC), reference/research database.
Category 2 contains performance measurement tracking codes in an alphanumeric identifier with a letter in the last field. (EX: 4246C)
Category 3
Category 3 contains emerging technology and temporary codes assigned for data purposes.
CPT's 6 Sections
Evaluation and Management (E/M) Anesthesia Surgery Radiology Pathology and Laboratory Medicine
CPT Symbols
Bullets Triangles Horizontal Triangles Plus Sign Circle with line through it Bull's-Eye
Horizontal Triangles
Horizontal triangles are used to save space in CPT and code descriptions that are not printed in their entirety next to a code number. They surround revised guidelines and notes. They are NOT used for revised coding descriptions.
Plus Sign
A plus signs identifies add-on codes, for procedures that are performed at the same time and by the same surgeon.
Circle with Line Through It
A circle with a line through it identifies codes that are not used with a modifier.
Bulls-eye
A bulls-eye indicates a procedure that includes moderate sedation.
Unlisted procedures/services
Codes are assigned when a procedure or service is performed by a provider for which there is no CPT code.
Special report
When an unlisted procedure or service code is reported a special report is created.
Narrative document
A narrative document must accompany claim to describe nature and extent of the need of service or procedure.
Modifiers
CPT modifiers are used to clarify services and procedures performed by providers. A list of all CPT modifiers with a brief description is located insider the front cover of the coding manual.
Coding Surgeries Correctly
Three questions must be asked: What body system was involved? What anatomic site was involved? What type of procedure was performed?
Coding E/M Correctly
E/M codes are based on these three components: Extent of personal, family, and social history. Extent of examination. Complexity of medical decision making.
E/M categories
E/M is categorized according to these four types: Problem focused examinations. Expanded problem focused examination. Detailed examination. Comprehensive examination.
History and Examination
History and examination is determined by these 4 complexities: Straightforward. Low complexity. Moderate complexity. High complexity.
Physician Status Modifiers
Each status modifier reported with an anesthesia code to indicate the patient's condition at the time anesthesia was administered.
Nation Correct Coding Initiative (NCCI)
NCCI was created to encourage national correct coding, methodologies, and manage the improper assignment of codes. NCCI was implemented by The Center for Medicare and Medicaid Services.
Incorrect Coding
Incorrect coding results in inappropriate repayment of Medicare part B claims.
If a QIO provider renders a covered service that costs $100 and bills Medicare for the service and Medicare allowed $58, the provider would bill this amount to the patient:
Identify this acronym:OIG
Identify this acronym:RBRVS
A(n) (Blank) (three words), usually an insurance co., handles the daily operations for Medicare, including paper work, claims, and payments.