Medical Ethics
Standards of conduct based on moral principals. Acting within ethical behavior boundries means carrying out one's responsibilities with
... [Show More] integrity, decency, respect, honesty, competence, fairness and trust.
Compliance Regulations
Most billing related cases are based on HIPAA and the False Claims Act.
HIPAA is an acronym for
Health Insurance Portability and Accountability Act of 1996.
Category 1 CPT codes
Medical Procedures.
Category 2 CPT codes
Supplemental Codes for Performance Measures.
Category 3 CPT codes
Emerging Technologies.
Add on Codes
Used for procedures that are always performed during the same operative session, as another surgery in addition to the primary service/procedure and is never performed separately.
Anesthesia is found
00100-01999, 99100-99140.
Evaluation and Management (E&M) codes
Are listed first in the CPT manual because they are used by all the different specialties.
Brackets
Used to enclose synonyms, alternative wording or and explanatory phrase.
Bullets
Represents a new procedure or service code added since the previous edition of the manual.
Chief Complaint (CC)
The reason the patient came to see the physician.
Circle with a line through it (🚫)
Exemption from modifier 51.
CPT
Used to report services and procedures by physicians.
E&M codes
99201-99499
Guidelines are found
At the beginning of each section and used to provide specific coding rules for that section.
History (HX)
The set of information the physician gathers from the patient concerning his/her past.
History of Present Illness (HPI)
A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present.
Indented Codes
Listed under associate and stand alone codes.
E Codes
For durable medical equipment for use in home.
Level 1 codes
Codes found in the CPT manual.
Level 2 codes
National codes for the physician and non-physician service not found in the CPT Level 1.
Level 3 codes
Used locally or regionally and have been eliminated by the CMS since the implementation of HIPAA.
The List of Modifiers is found where in the CPT
Appendix A and in the front of the book.
Modifier 50
Bilateral procedure.
Modifier 24
Attach to E/M service code when service is provided during postoperative period to indicate that the service is not part of postoperative care and not included in the Surgical Package.
Modifier 26
Provider only provided the professional component.
Modifier 51
Used more than one procedure during the same surgical episode.
Modifier 57
Modifier 57 is used on E/M services the day before or day of major surgery when the initial decision to perform the surgery is identified.
Modifier 78
Physician must return to Operating Room to address complication stemming from initial procedure.
Modifier 79
Procedure or service provided during postoperative period not associated with initial procedure.
Modifiers
Reporting indicators that indicate that the procedure or service has been altered by specific circumstance but has not changed in it's definition of code.
Parentheses
Used to enclose supplementary words, non-essential modifiers.
Past, Family and Social History (PFSH)
Consists of patients personal experiences with illnesses, surgeries, and injuries; Information of illnesses predominant in family' Patients educational background, occupation, marital status and other factors.
Pathology and Laboratory
80048-89356. [Show Less]