Medical Ethics - 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 an...
Certification study guide for NHA CBCS
Exam with a complete solution 2022-
2023
Medical Ethics - 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
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.
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