Glossary CPT, HCPCS 2, MODIFIERS

Add-on Code

Code used to report a supplemental or additional procedure appended to a primary procedure (stand-alone) code. Recognized by the CPT “+” used throughout the code book.

The Centers for Medicare & Medicaid Services (CMS)

The agency WITHIN the U.S. dept of Health & Human Services (HHS) that administers the Medicare program and works in partnership with STATE governments to administer Medicaid and state Children’s Health Insurance Programs (CHIPS)

Current Procedural Terminology (CPT)

A code set copyrighted and maintained by the AMA

Global Package

The PERIOD (0-10 days, or 0-90 days as determined by the health plan) and SERVICES provided for a surgery INCLUSIVE of preoperative visits, intraoperative services, post-surgical complications, post-op visits, post-surgical pain management by the surgeon, and several miscellaneous services as defined by the health plan, REGARDLESS of setting (in a hospital, an ASC, or physician office)

Global Surgery Status Indicator

An assigned payment indicator, which determines classification for a minor or major surgery, based on RVU calculations

Healthcare Common Procedure Coding System (HCPCS) Level II

The national procedure code set for healthcare practitioners, providers, and medical equipment suppliers when filing insurance claims for medical devices, medications, transportation services, and other items/services

Major Surgery

Surgeries classified as major have a global surgical period that includes the day before the surgery, the day of surgery, and any related follow-up visits with the provider 90 days after the procedure

Minor surgery

Have a global surgical period that includes the preoperative service the day of surgery, surgery, and any related follow-up visits with the provider 0-10 days after the surgery

Resource-Based Relative Value Scale (RBRVS)

The physician payment schedule established by Medicare

Relative Value Units (RVU)

CMS reimburses physicians for Medicare services using a national payment schedule based on the resources used in furnishing physician services. RVUs are configured using work based on specialties, practice expense, and physician liability insurance

National Correct Coding Initiative (NC I)

Used by professional coders to determine codes considered by CMS to be bundled codes for procedures and services deemed NECESSARY to accomplish a major procedure. This is to PROMOTE correct coding methodologies and to control improper assignment of codes that results inappropriate reimbursement

Substitute physician

Substitute physicians who takes over the professional practice of a physician who is absent for reasons such as illness, pregnancy, vacation, or continuing medical education. When a substitute physician fills in, the regular physician submits the claim with modifier Q6 appended to the services