CASCC key terms

A standardized system of five-digit codes maintained by the American Medical Association that describes medical, surgical, and diagnostic services for billing and reporting purposes.

A two-level coding system used for Medicare and other payers; Level I is CPT and Level II covers supplies, drugs, and services not represented in CPT.

The standardized diagnosis and procedure classification system used to report patient conditions and inpatient procedures, replacing earlier ICD versions.

An organized collection of alphanumeric codes with defined meanings, such as CPT, HCPCS, or ICD-10, used consistently across claims and clinical documentation.

The determination that a service is reasonable and required for the diagnosis or treatment of a patient's condition, consistent with accepted standards of care.

A nationwide policy issued by Medicare that specifies whether and under what conditions a particular service is covered for all beneficiaries.

A coverage policy issued by a Medicare Administrative Contractor that defines when a service is considered reasonable and necessary within its jurisdiction.

A private entity contracted by Medicare to process claims, issue coverage policies, and handle appeals within an assigned geographic region.

A written notice given to a Medicare beneficiary before a service that may not be covered, allowing the patient to accept financial responsibility if payment is denied.

A person enrolled in and entitled to benefits under a health insurance program such as Medicare or Medicaid.

The body system comprising the skin, subcutaneous tissue, nails, and related structures, which is the focus of many surgical excision and repair codes.

Surgical removal of a skin growth or mass; coding depends on whether the lesion is benign or malignant and on its size and location.

A cancerous skin growth, such as a carcinoma or melanoma, that requires different code selection than a benign lesion of similar size.

Closure of a wound using sutures, staples, or tissue adhesive; coding is based on wound length, complexity, and body site.

Removal of dead, damaged, or infected tissue from a wound or burn to promote healing; codes vary by depth and surface area.

The body system of bones, joints, muscles, tendons, and ligaments; surgical codes cover fracture care, joint procedures, and tendon repairs.

A minimally invasive procedure using a camera inserted into a joint to diagnose or treat conditions, coded by joint and specific surgical action performed.

Treatment of a broken bone through closed reduction, open reduction with fixation, or casting; code choice depends on the method and bone involved.

A relative value assigned to each anesthesia procedure that reflects the complexity of the service, separate from time-based units.

The minutes of anesthesia care measured from the start of the procedure to when the anesthesiologist is no longer in personal attendance, billed in time units.

A dollar amount multiplied by the total of base and time units to calculate payment for an anesthesia service.

A drug-induced state of depressed consciousness in which the patient responds purposefully to verbal commands, coded separately from general anesthesia.

An injection such as a nerve block or trigger point injection used to relieve pain, coded by the anatomical site and the medication delivered.

A CPT code describing a diagnostic imaging or radiation oncology service, organized by modality, body area, and whether contrast was used.

A substance administered to enhance the visibility of internal structures during imaging; its use changes the code selected for many radiology procedures.

A single code that includes the professional interpretation and the technical component of an imaging study, as opposed to split professional and technical billing.

The portion of a diagnostic service payment covering equipment, supplies, and technician work, billed separately with modifier TC when the professional component is billed elsewhere.

The portion of a diagnostic service payment covering the physician's interpretation and report, billed with modifier 26 when the technical portion is billed separately.

Federal regulations that set quality standards for laboratory testing and require certification of facilities performing certain tests.

A CPT code describing the examination of tissue, blood, or other specimens to diagnose disease, including surgical pathology and cytology services.

The process of obtaining a sample for laboratory analysis; collection may be coded separately from the test itself depending on the method and payer rules.

A laboratory test classified as simple and low-risk under CLIA that may be performed without the same regulatory oversight as moderate- or high-complexity testing.

A CPT category covering patient visits and consultations, coded by setting, patient type, and the level of medical decision making or time.

A two-digit code appended to an E/M service indicating that a significant, separately identifiable evaluation and management service was performed on the same day as a procedure.

A modifier used to indicate that a procedure or service was distinct and independent from other services performed on the same day, overriding standard bundling edits.

A Medicare program that publishes edits identifying code pairs that should not normally be billed together because one is considered part of the other.

The practice of combining multiple services into a single payment when they are considered integral to one another rather than separately billable.

A defined set of services included in a single payment for a surgical procedure, covering preoperative, intraoperative, and postoperative care during a specified period.

A facility where outpatient surgical procedures are performed and discharged the same day, reimbursed under a distinct payment system from hospital outpatient departments.

A classification that groups surgical procedures with similar resource costs to determine the facility payment rate under the ASC fee schedule.

A standardized document, such as the CMS-1500, used to submit coded services and charges to a payer for reimbursement.

A claim submitted with complete and accurate information that can be processed by the payer without additional documentation or correction.

A document from a payer explaining how a claim was adjudicated, including paid amounts, denials, and adjustment reason codes.