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Medical Ethics are
Standards of conduct based on moral principals. Acting within ethical behavior boundries means
carrying out one's responsibilities with 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 the 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 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 the the
service is not part of postoperative care and not included in the Surgical Package
Modifier 26
Provider only provided the professional component