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CODE.MODE

CPT TERMS

Procedure

The term "procedure" refers to surgical and medical procedures. This also includes diagnostic tests.  

Physician 

A physician or other qualified healthcare professional is described as an individual who is deemed qualified either by education, training, licensure/ regulation, and facility privileging. 

NOTE: If advanced practice nurses or physicians assistants are working with physicians, then, for coding purposes, they are considered to be working in the exact same specialty / sub-specialty.  

Clinical Staff

A member of the clinical staff is allowed by law, regulation, and facility policy to perform or assist in the performance of a professional service, under the supervision of a physician or other qualified professional.  Members of clinical staff, however, can NOT individually report the professional service such a service.  

Facility​ 

The CPT uses the term "facility" to describe providers, such as hospitals and health care agencies.

 

Note: Services provided in the home by an agency are considered "facility" services, while services provided by a physician (or other healthcare professional) who is not a representative of the agency are considered "non-facility" services.   

Add-on Codes +

An add-on code is an additional or supplementary procedure in addition to the primary procedure being performed. These are designated with the + symbol and are listed in Appendix D. Tip: Look for "each additional" or "(List separately to primary procedure."

  • ALWAYS reported with primary 

  • NEVER a stand-alone Code

  • NEVER reported with Modifier -51

Time

Time is considered to be the "face-to-face" time with the patient.

 

A unit of time is

attained once a

mid-point has

passed. Thus, 31

minutes is reported

as 1 hour. 

NOTE: When a service is concurrent with a time-based service, DO NOT include the time associated with the concurrent service.

When codes are ranked in sequential "typical times," use the code closest to the actual time if the actual time is between the two "typical times."   

Continuous services that extend over calendar days DO NOT reset, but when there is a disruption in the service, this DOES create a new initial first hour.  

Report the total units of time provided continuously (for facility reporting on a single date or for continuous services after midnight). 

Modifier

Modifiers are two-characters (either numeric or alphanumeric) which are added to the end of a code to provide further information. They help to further report or indicate that a service or procedure has been altered or modified by a specific way, which does not change its definition nor the code. Other specialized modifiers can also provide physical status or location information. 

These are found within Appendix A of the CPT manual. 

Special Report

Some services that are new, rarely provided, variable, or unusual require a special report. These reports must include pertinent  information, including a description of the following:

  • nature, extent, & need for procedure

  • time, effort, & equipment necessary

Results

Results are considered the technical component of a service, such as data, slides, or images. Tests produce results, some of which require 

 interpretation.

Reports

Reports are considered to be the "work product" of the interpretation of test results. 

Interpretation 

Interpretation is processing the results into usable information for reports. s   

NOTE:

For more accurate, detailed descriptions, please refer to your current CPT manual.   

This has been created based upon AMA's CPT 2020 Professional Edition, ISBN#: 978-1-62202-898-6

References: 

CPT 2020 Professional Edition. (American Medical Association,   Chicao, IL, 2019).

Unlisted Procedure / Service

Unlisted codes are reported for services that are not included in the CPT book. The service or procedure should be described if an unlisted code is used. 

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