CBCS Exam Study Guide
-24 Unrelated E/M Service by the same physician during a postoperative period - ANS-this is
attached to the code of the E/M service provided to a pt during the postop period to indicate
that the service is not part of the postoperative care which is usually part of the package of
services of the surgery performed. Major surgical procedures will usually have a postop
period of 90 days, minor, 10 days. Used only w/ E/M codes
\-26 Professional Component - ANS-Most procedures have both professional (physician)
and technical components. This modifier is attached to the procedure to indicate that the dr
provided only the professional component
\-32 Mandated Services - ANS-used to indicate that the service provided was required by
3rd party payer, gov, legislative or regulatory body. this does not include second opinion
requested by a pt, family member, or another physician
\-50 Bilateral Procedure - ANS-used when the same procedure is performed on a
mirror-image part of the body
\-51 Multiple Procedure - ANS-used when
-more than 1 procedure is performed in the same surgical episode
-one code does not describe all of the procedures performed
-the secondary procedure is not minor or incidental to the major procedure
Ex; *same operation, different site, *multiple operations, same operative session, *procedure
performed multiple times
\-58 Staged or Related Procedure or Service by the same Physician during the
Postoperative Period - ANS-used to explain that the procedure or service done during a
postop period was planned at the time of the original procedure. also used if a therapeutic
procedure is performed b/c of the findings from a diagnostic procedure
\-78 Return to Operating Room for a Related Procedure During the Postoperative Period -
ANS-to report a circumstance in which the dr returns to the operating room to address a
complication stemming from the initial procedure (third party payers usually pay the surgery
portion of the complications surgical package b/c the pt remains in the postop period of the
initial procedure. documentation must clearly indicate the reason for the return to the
operating room)
\-90 reference (outside) laboratory - ANS-used to indicate that the procedure was done by
outside lab and not by reporting facililty
\-99 Multiple Modifiers - ANS-used to report a procedure or service that has more than one
modifier but the payer does not allow the addition of multiple modifiers to the code. is
attached to the procedure code and the multiple modifier are listed in block 19 of claim form
\-algia - ANS-pain
\-centesis - ANS-surgical puncture
\-ectomy - ANS-removal, resection, excision
\-emia - ANS-blood condition
\-gram - ANS-record
\-graphy - ANS-process of recording
\-itis - ANS-inflammation
\-lysis - ANS-separation, breakdown, destruction
\-megaly - ANS-enlargement
,\-meter - ANS-measure
\-oma - ANS-tumor, mass
\-osis - ANS-abnormal condition
\-pathy - ANS-disease condition
\-pexy - ANS-surgical fixation
\-plasty - ANS-surgical repair
\-rrhagia - ANS-bursting forth of blood
\-rrhapy - ANS-suture
\-rrhea - ANS-discharge, flow
\-sclerosis - ANS-hardening
\-scopy - ANS-to view
\-scopy - ANS-visual examination
\-stomy - ANS-opening
\-therapy - ANS-treatment
\-tomy - ANS-incision, to cut into
\/When is the ICD manual updated - ANS-Annually, Usually in October
\2 types of CPT Codes - ANS-*Stand Alone Codes; contain the full description of the
procedure for the code
*Indented Codes- these are codes listed under associated stand-alone codes. To complete
the the description for indented codes, one must refer to the portion of the stand alone code
description before the semi-colon
\3 sections to Alphabetic Index - ANS-Section 1) Index to diseases
Section 2) Table of drugs and chemical
Section 3) Index to External Cause of Injury (E Codes)
\79 Unrelated Procedure or Service by the same physician during the postoperative period -
ANS-used to indicate that the procedure or service provided during the postop period was
not associated w/ the period. payment for the full fee of the subsequent procedure is
requested and a new global period starts
\A geographic practice cost index is applied to account for the economic variation across the
different area of the country - ANS-true
\a, an - ANS-without
\Abduction - ANS-movement away from the midline
\Abuse - ANS-incidences or practices, not usually considered fraudulent, that are
inconsistent w/ the accepted medical business or fiscal practices in the industry.
\Accept Assignment - ANS-mean the provider agrees to accept what the ins co approves as
payment in full for the claim
\Add-on codes - ANS-some procedures are carried out in addition to the primary procedure
performed. Designated as "add-on" codes w/ a "+" sign and they apply only to procedures
performed by same dr to describe additional intra-service work provided. Are never used
alone, rather they are always reported in addition to the primary procedure code. All add-on
codes are modifier -51 (multiple procedures) exempt
\Adduction - ANS-movement towards the midline
\Albino - ANS-deficient in pigment (melanin)
\Alopecia - ANS-absence of hair form areas where it normally grows
\Alphabetic Index (Volume 2) - ANS-Everything in the Index is listed by condition-that is,
diagnosis, signs, symptoms, and conditions such as pregnancy or admission
\Anatomy & Physiology - ANS-A professional medical coder must have knowledge of
anatomy & physiology so that coding assignment is quick & accurate.
, \Anesthesia - ANS-00100-01999, 99100-99140 (knocked out=0)
\ante - ANS-before
\Anterior, Ventral - ANS-front surface of the body
\anti - ANS-against
\Appendicular Skeleton - ANS-made up of the shoulder, collar, pelvic, arm & legs
\arth - ANS-cartilage
\Assignment of Benefits - ANS-reimbursement is sent directly from payer to provider
\Axial Skeleton - ANS-consist of the skull, rib cage & spine
\Basic Billing & Reimbursement Steps: - ANS--collect pt info
-verify insurances
-prepare encounter form (should reflect the diagnosis and services provided to pt, this is
used as the basis for billing)
-code diagnosis and procedures
-review linkage and compliance, review should include the following *appropriateness of the
codes *link between the diagnosis and the procedure *payers rules about the diag and proc
*documentation of the procedure *compliance w/ regulations
-calculate physician charges
-prepare claims
-transmit claims
-payer adjudication, claims received by the payers go through a series of steps to determine
whether it should be paid
-follow up reimbursement/record retention
\Basic Format of the levels of E&M services - ANS-1) a unique code # is listed
2) the place & type of service is specified
3) the content of the service is defined
4) the nature of the presenting problem(s) usually associated w/ a given level is (are)
described
5) time is typically specified in the descriptor of the code
\Benign - ANS-noninvasive, non-spreading, nonmalignant
\Birthday rule - ANS-the plan of the parent whose birthday falls earlier in the year (month and
date, not year) is primary to that whose b-day falls later in the calender year. If both parents
have same birthday, then the plan of the parent who has had the longest coverage is
primary. **In case of divorce, the plan of the parent w/ custody of the children is the primary
payer unless the divorce settlement states otherwise
\Blue Cross - ANS-covers hospital services, outpatient care, some institutional services and
home care
\Blue Cross/Blue Shield Plans - ANS-group of independently licensed local companies,
usually nonprofit that contracts w/ dr's and other health entities to provide services to their
insured companies and individuals. Most BC/BS plans offer HMO's, PPO's and POS plans
\Blue Shield - ANS-covers physician services, and in some cases, dental, outpatient services
and vision care
\Bones - ANS-complete organs made up of connective tissue called OSSEOUS. Inner core
of bones is comprised of HEMATOPOIETIC tissue. This is where the red bone marrow
manufactures blood cells. Other parts of the bones are storage areas for minerals necessary
for growth, ie; calcium and phosphorous
\brady - ANS-slow
\Capitated Rates - ANS-the dr provides a full range of contracted services to covered pt's for
a fixed amount on a periodic basis. While guaranteed a fixed amount the dr assumes the risk
-24 Unrelated E/M Service by the same physician during a postoperative period - ANS-this is
attached to the code of the E/M service provided to a pt during the postop period to indicate
that the service is not part of the postoperative care which is usually part of the package of
services of the surgery performed. Major surgical procedures will usually have a postop
period of 90 days, minor, 10 days. Used only w/ E/M codes
\-26 Professional Component - ANS-Most procedures have both professional (physician)
and technical components. This modifier is attached to the procedure to indicate that the dr
provided only the professional component
\-32 Mandated Services - ANS-used to indicate that the service provided was required by
3rd party payer, gov, legislative or regulatory body. this does not include second opinion
requested by a pt, family member, or another physician
\-50 Bilateral Procedure - ANS-used when the same procedure is performed on a
mirror-image part of the body
\-51 Multiple Procedure - ANS-used when
-more than 1 procedure is performed in the same surgical episode
-one code does not describe all of the procedures performed
-the secondary procedure is not minor or incidental to the major procedure
Ex; *same operation, different site, *multiple operations, same operative session, *procedure
performed multiple times
\-58 Staged or Related Procedure or Service by the same Physician during the
Postoperative Period - ANS-used to explain that the procedure or service done during a
postop period was planned at the time of the original procedure. also used if a therapeutic
procedure is performed b/c of the findings from a diagnostic procedure
\-78 Return to Operating Room for a Related Procedure During the Postoperative Period -
ANS-to report a circumstance in which the dr returns to the operating room to address a
complication stemming from the initial procedure (third party payers usually pay the surgery
portion of the complications surgical package b/c the pt remains in the postop period of the
initial procedure. documentation must clearly indicate the reason for the return to the
operating room)
\-90 reference (outside) laboratory - ANS-used to indicate that the procedure was done by
outside lab and not by reporting facililty
\-99 Multiple Modifiers - ANS-used to report a procedure or service that has more than one
modifier but the payer does not allow the addition of multiple modifiers to the code. is
attached to the procedure code and the multiple modifier are listed in block 19 of claim form
\-algia - ANS-pain
\-centesis - ANS-surgical puncture
\-ectomy - ANS-removal, resection, excision
\-emia - ANS-blood condition
\-gram - ANS-record
\-graphy - ANS-process of recording
\-itis - ANS-inflammation
\-lysis - ANS-separation, breakdown, destruction
\-megaly - ANS-enlargement
,\-meter - ANS-measure
\-oma - ANS-tumor, mass
\-osis - ANS-abnormal condition
\-pathy - ANS-disease condition
\-pexy - ANS-surgical fixation
\-plasty - ANS-surgical repair
\-rrhagia - ANS-bursting forth of blood
\-rrhapy - ANS-suture
\-rrhea - ANS-discharge, flow
\-sclerosis - ANS-hardening
\-scopy - ANS-to view
\-scopy - ANS-visual examination
\-stomy - ANS-opening
\-therapy - ANS-treatment
\-tomy - ANS-incision, to cut into
\/When is the ICD manual updated - ANS-Annually, Usually in October
\2 types of CPT Codes - ANS-*Stand Alone Codes; contain the full description of the
procedure for the code
*Indented Codes- these are codes listed under associated stand-alone codes. To complete
the the description for indented codes, one must refer to the portion of the stand alone code
description before the semi-colon
\3 sections to Alphabetic Index - ANS-Section 1) Index to diseases
Section 2) Table of drugs and chemical
Section 3) Index to External Cause of Injury (E Codes)
\79 Unrelated Procedure or Service by the same physician during the postoperative period -
ANS-used to indicate that the procedure or service provided during the postop period was
not associated w/ the period. payment for the full fee of the subsequent procedure is
requested and a new global period starts
\A geographic practice cost index is applied to account for the economic variation across the
different area of the country - ANS-true
\a, an - ANS-without
\Abduction - ANS-movement away from the midline
\Abuse - ANS-incidences or practices, not usually considered fraudulent, that are
inconsistent w/ the accepted medical business or fiscal practices in the industry.
\Accept Assignment - ANS-mean the provider agrees to accept what the ins co approves as
payment in full for the claim
\Add-on codes - ANS-some procedures are carried out in addition to the primary procedure
performed. Designated as "add-on" codes w/ a "+" sign and they apply only to procedures
performed by same dr to describe additional intra-service work provided. Are never used
alone, rather they are always reported in addition to the primary procedure code. All add-on
codes are modifier -51 (multiple procedures) exempt
\Adduction - ANS-movement towards the midline
\Albino - ANS-deficient in pigment (melanin)
\Alopecia - ANS-absence of hair form areas where it normally grows
\Alphabetic Index (Volume 2) - ANS-Everything in the Index is listed by condition-that is,
diagnosis, signs, symptoms, and conditions such as pregnancy or admission
\Anatomy & Physiology - ANS-A professional medical coder must have knowledge of
anatomy & physiology so that coding assignment is quick & accurate.
, \Anesthesia - ANS-00100-01999, 99100-99140 (knocked out=0)
\ante - ANS-before
\Anterior, Ventral - ANS-front surface of the body
\anti - ANS-against
\Appendicular Skeleton - ANS-made up of the shoulder, collar, pelvic, arm & legs
\arth - ANS-cartilage
\Assignment of Benefits - ANS-reimbursement is sent directly from payer to provider
\Axial Skeleton - ANS-consist of the skull, rib cage & spine
\Basic Billing & Reimbursement Steps: - ANS--collect pt info
-verify insurances
-prepare encounter form (should reflect the diagnosis and services provided to pt, this is
used as the basis for billing)
-code diagnosis and procedures
-review linkage and compliance, review should include the following *appropriateness of the
codes *link between the diagnosis and the procedure *payers rules about the diag and proc
*documentation of the procedure *compliance w/ regulations
-calculate physician charges
-prepare claims
-transmit claims
-payer adjudication, claims received by the payers go through a series of steps to determine
whether it should be paid
-follow up reimbursement/record retention
\Basic Format of the levels of E&M services - ANS-1) a unique code # is listed
2) the place & type of service is specified
3) the content of the service is defined
4) the nature of the presenting problem(s) usually associated w/ a given level is (are)
described
5) time is typically specified in the descriptor of the code
\Benign - ANS-noninvasive, non-spreading, nonmalignant
\Birthday rule - ANS-the plan of the parent whose birthday falls earlier in the year (month and
date, not year) is primary to that whose b-day falls later in the calender year. If both parents
have same birthday, then the plan of the parent who has had the longest coverage is
primary. **In case of divorce, the plan of the parent w/ custody of the children is the primary
payer unless the divorce settlement states otherwise
\Blue Cross - ANS-covers hospital services, outpatient care, some institutional services and
home care
\Blue Cross/Blue Shield Plans - ANS-group of independently licensed local companies,
usually nonprofit that contracts w/ dr's and other health entities to provide services to their
insured companies and individuals. Most BC/BS plans offer HMO's, PPO's and POS plans
\Blue Shield - ANS-covers physician services, and in some cases, dental, outpatient services
and vision care
\Bones - ANS-complete organs made up of connective tissue called OSSEOUS. Inner core
of bones is comprised of HEMATOPOIETIC tissue. This is where the red bone marrow
manufactures blood cells. Other parts of the bones are storage areas for minerals necessary
for growth, ie; calcium and phosphorous
\brady - ANS-slow
\Capitated Rates - ANS-the dr provides a full range of contracted services to covered pt's for
a fixed amount on a periodic basis. While guaranteed a fixed amount the dr assumes the risk
