Chapter 29: Procedural Coding Basics

What is CPT used for?

Reporting medical procedures and services.

What does CPT stand for?

Current Procedural Terminology.

What is HCPCS Level II used for?

Supplies, equipment, drugs, and services not fully covered by CPT.

What is a modifier?

Two-character code that adds information about a service without changing the basic code meaning.

What is upcoding?

Reporting a higher-level service than documented/performed; fraudulent.

What is unbundling?

Billing separately for services that should be billed together; improper unless allowed.

What are Evaluation and Management codes generally used for?

Provider office visits and related evaluation services.

What does the CPT Surgery section include?

Procedural codes generally 10021-69990.

What is the correct order for selecting a CPT code?

Review documentation → identify service/procedure → locate code → verify code notes/guidelines → append modifiers if supported.

What documentation is needed for billing a procedure?

What was performed, reason, site, provider, date/time, and patient response as applicable.

What should the MA do if documentation does not support a code?

Query/clarify according to policy; do not guess.