CPT and HCPCS Coding 2015

gena forshee
Flashcards by gena forshee, updated more than 1 year ago
gena forshee
Created by gena forshee over 4 years ago
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AMA American Medical Association
CMS Centers for Medicare and Medicaid Services
CPT Current Procedural Terminology Updated by AMA annually
HCPCS Healthcare Common Procedure Coding System Updated by CMS annually
HHS Health and Human Services
HIPPA Health Insurance Portability and Accountability Act
HIPPA Transaction and Code Set Standards Requires all electronic data interchange to be standardized. Code sets approved: ICD-9-CM, ICD-10-CM, ICD-10-PCS, CPT, HCPCS, CDT, and NDC.
ICD-9-CM International Classification of Diseases, Clinical Modification, 9th revision
ICD-10-CM/PCS International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Classification System
Physician Offices Diagnosis: ICD9/ICD10 Procedure: CPT and HCPCS
Hospital Outpatient Services Diagnosis: ICD9 / ICD10 Procedure: CPT and HCPCS
Hospital Inpatient Services Diagnosis: ICD9 / ICD10 Procedure: ICD-9-CM Procedure Codes and ICD-10-PCS
CPT Category 1 6 main sections: E&M Anesthesia Surgery Radiology Pathology/Laboratory Medicine
CPT Category II Supplementary tracking codes. Composed of 5 characters - 4 numbers followed by F. Codes are optional to use, but may be required for adjudication of claims.
CPT Category III Temporary codes for emerging technologies, services, and procedures. 5 characters - 4 numbers followed by T.
CPT Modifiers Supplementary codes that are 2 characters long and appended to CPT category 1 codes. Used to report additional info about unusual circumstances under which a procedure was performed.
HCPCS Level I Copywrited and published by AMA. Used by physicians to report services and hospital outpatient services. 80% of HCPCS reported yearly.
HCPCS Level II National Codes developed by CMS for reporting services not in CPT. Used for injectable drugs, ambulance, prosthetics, and selected provider services. 5 characters - first a capital letter followed by 4 numbers.
CMS-1500 Standard paper billing document for physician claims
NCD and LCD National Coverage Decisions and Local Coverage Determination Policies created by CMS contractors for making coverage decisions at their disgression. Includes decisions on items and services that are reasonable and necessary for the dx or tx of an illness or injury.
CMS-1450 (UB-04) Used primarily by hospitals for both outpatient and inpatient services. Used for Medicare Part A services and third-party payers to report outpt and inpt services by hospitals and ambulatory surgery centers (ASCs).
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