Ch 19 Procedure Coding
Bundled codes
Any code that includes more than one procedure in its description
Procedure Code
Codes that represent medical procedures such as surgery, diagnostic tests, as well as medical services; like physical examinations to evaluate a patient's condition
Add-on codes (+)
Codes used to describe procedures done in addition to a "main" procedure
Upcoding
Coding a procedure or service at a higher level than that provided to receive a higher level of reimbursement
Concurrent care
Similar care being provided by more than one physician
Healthcare Common Procedure Coding System (HCPCS)
Developed by CMS for use in coding services for Medicare patients
E/M code
Evaluation and Management codes that are often considered the most important of all CPT codes. The E/M section guidelines explain how to code different levels of services
Existing patient
If a patient has been seen by a physician of the same speciality in the same practice within 3 years
New patient
If the patient has not been seen in the practice within the last 3 years
Consultations
Meeting of 2 or more physicians or surgeons to evaluate the nature and progress of a disease in a particular patient and to establish diagnosis, prognosis, or therapy
HCPCS Level II Codes
National codes and cover many supplies, such as sterile trays, drugs, injections, and durable medical equipment
Modifiers
One or more 2 digit codes assigned to the 5 digit main code to show that some special circumstance applied to the service or procedure that the physician performed
Critical care
Provide to unstable, critically ill patients
Counseling
Provision of advice and instruction by a healthcare provider
Current Procedural Terminology (CPT)
Reference Manual published by the American Medical Association. (AMA)
Downcoding
Term used when the insurance carrier bases reimbursement on a code level lower than one submitted by the provider
Panel
Tests frequently ordered together that are organ or disease oriented
Global period
The period of time that is covered for follow-up care of a procedure or surgical service
Unbundling
Use of several Current Procedural Terminology (CPT) codes for a service when one inclusive code is available