Chapter 5 Procedural Coding: CPT and HCPCS

A set of vocabulary flashcards covering key terms and definitions related to procedural coding, specifically focused on CPT and HCPCS.

CPT

Current Procedural Terminology, a standardized classification system for reporting medical procedures and services.

Category 1 codes

Five-digit procedure codes found in the main body of CPT.

Category II codes

Optional CPT codes that track performance measures.

Category III codes

Temporary codes for emerging technology, services, and procedures.

Modifiers

Two-digit numbers attached to CPT codes to indicate special circumstances.

E/M Codes

Evaluation and Management Codes, covering physicians' services performed to determine patient care.

Surgical package

Combination of services included in a single procedure code.

Bundling

Using a single payment for two or more related procedure codes.

Anesthesia Codes

Codes used to report anesthesia services performed or supervised by a physician.

Physical Status Modifiers

Codes indicating a patient's health status during anesthesia.

Office Visits

A type of consultation in which a patient is seen by a physician in an outpatient setting.

Established Patient

A patient who has received services from a provider within the last three years.

New Patient

A patient who has not received services from a provider within the past three years.

Consultation

A service where a physician advises another physician about a patient's care.

Referral

Transfer of total or partial care to another provider.

Radiology Codes

Codes reported for radiology procedures performed by a physician.

Pathology and Laboratory Codes

Cover services provided by physicians or technicians for lab procedures.

Medicine Codes

Codes used for evaluative, therapeutic, and diagnostic procedures.

Category II codes

Optional tracking codes for performance improvement.

Level II Codes

National codes that identify supplies, products, and services.

DME

Durable Medical Equipment, primarily used for medical purposes and can withstand repeated use.

Temporary Code

HCPCS codes that may become permanent but are not part of the standard code set.

CPT Index

An alphabetical arrangement of terms helping locate the main terms in CPT.

Unlisted Procedure

Service not listed in CPT which requires a special report.

Add-on Code

A code that describes secondary procedures carried out in addition to a primary procedure.

CPT Main Text

The main body of the CPT manual where codes are listed numerically.

CPT Appendices

Sections at the end of the CPT manual with additional information, modifiers, and clinical examples.

Telemedicine Codes

Codes used for remote medical services delivered via telecommunications.

Code Verification Process

Steps to confirm the correctness of a selected code in CPT.

Moderate (Conscious) Sedation

A type of sedation requiring specific CPT code reporting.

SARS-CoV-2 Vaccines

Specific codes for COVID-19 vaccine reporting.

Health Claim Form

A document required for the reimbursement process of healthcare services.

Coding Compliance

Conforming to coding standards and regulations for billing and reporting.