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