Medical Coding (CCMA)

Add-on codes

A code that is always assigned in addition to the primary procedure or service, designated with the + symbol

Bundle

When two or more medical services are grouped together and billed as one—rather than billing each service separately

Category

The first three characters of an ICD-10-CM code, which designates the general condition or disease type

Combination code

A single ICD-10-CM code is used to represent either two or more diagnoses OR a diagnosis plus a complication or symptom

Comorbidity

A condition that exists along with the primary diagnosis of a patient

Concurrent care

When similar care is being provided to a patient by more than one provider

Contributory factors

Extra elements that can influence how a medical visit is coded and help determine how complex or intense a visit was (ie: counseling, coordination of care, nature of presenting problem)

Conventions

The standard guidelines that everyone follows when reading, interpreting, and assigning codes that help make coding consistent and accurate across the board

Coordination of care

The time a licensed provider spends setting up patient care with other health care agencies (ie: home care or nursing home care)

Current Procedural Terminology (CPT)

A standardized numerical identification of procedures published by the American Medical Association

Downcoding

When an insurance company or payer changes a medical claim to a lower-level (less expensive) code than what the healthcare provider originally billed, usually if they decide that documentation does not support the higher-level service billed

E/M codes

CPT code relating to the evaluation and management of the patient; related to medical services as opposed to surgical services

Global period

A specific time frame after a surgical procedure during which all of the routine followup care related to that surgery is considered a part of the original procedure and should not be billed separately

HCPCS Level II codes

Alphanumeric codes used to identify medical supplies and equipment not covered by CPT for billing

Healthcare Common Procedure Coding System (HCPCS)

Coding system that consists of two levels: Level I (CPT) and Level II (non-CPT)

International Classification of Diseases (ICD)

A comprehensive list of codes describing the disease or condition presented by a patient

Key components

The history, examination, and medical decision-making that provide the framework for the level of service provided for billing purposes

Laterality

Specifying whether the condition occurs on the left, right, or bilaterally

Modifiers

Coding markers that inform third-party payers that circumstances for that particular code have been altered

Morbidity

The frequency of the appearance of complications following a surgical procedure or other treatment

Sequela

A pathological condition resulting from prior injury, disease, or attack

Surgical package

Procedures found in CPT that may include preoperative exam and testing, the surgical procedure itself (including local or regional anesthesia if used), and routine follow-up care for a set period of time

Tabular list

The main part of the ICD-10-CM code book where all the diagnosis codes are organized numerically and by chapter

Unbundling

• Reporting multiple procedure codes for services when only one code is appropriate

• Considered fraudulent billing and could result in stiff penalties and fines if found to have been done intentionally

Upcoding

Reporting a higher-level code than is appropriate for the service that was rendered