PCA CPP flashcards

31 cards. Read the term and the definition here. The deck at the top of this page is optional.

Excludes1 note

An ICD-10-CM note indicating that two conditions cannot be reported together because they are mutually exclusive, such as congenital versus acquired forms of the same condition.

Placeholder X

An ICD-10-CM character used only to fill empty positions so a required 7th character lands in the correct slot; it is never used as a trailing filler.

7th character A

The ICD-10-CM injury 7th character meaning initial encounter, used while the patient is receiving active treatment for the condition.

Z3A code

An ICD-10-CM code from category Z3A reporting weeks of gestation, reported as an additional code with obstetric codes when the pregnancy is documented.

Code first convention

An ICD-10-CM instruction that the underlying etiology or cause must be sequenced before the manifestation code, as directed in the Alphabetic Index.

MDM three elements

The three components of medical decision making: number and complexity of problems addressed, amount and complexity of data reviewed, and risk of complications or morbidity.

Total time definition

For office/outpatient E/M, all time personally spent by the reporting clinician on the date of the encounter, including pre-visit review and post-visit documentation.

Modifier 25

A CPT modifier appended to an E/M service indicating a significant, separately identifiable evaluation and management service was performed on the same day as another procedure.

Modifier 57

A CPT modifier appended to an E/M code when the decision for major surgery is made during that encounter, supporting separate payment for the decision.

Critical care time

Time spent by a physician providing critical care to a critically ill patient; 99291 covers the first 30–74 minutes and 99292 each additional 30 minutes.

Global surgical period

The number of days after surgery during which routine post-operative care is included in the surgical code; 90 days for major, 0 or 10 days for minor procedures.

Modifier 50

A CPT modifier indicating a bilateral procedure was performed on both sides of the body when the code descriptor permits bilateral reporting.

NCCI PTP edits

National Correct Coding Initiative Procedure-to-Procedure edits that prohibit reporting certain code pairs together unless a qualifying modifier and documentation support separate services.

Wound repair length

Wound repair codes are selected by summing wound lengths within the same anatomic group and complexity category before assigning the code.

Modifier 26

A CPT modifier identifying the professional component of a diagnostic service, such as the physician interpretation of a radiology study.

Modifier TC

A CPT modifier identifying the technical component of a diagnostic service, covering equipment, supplies, and non-physician personnel costs.

Surgical pathology range

CPT codes 88300–88309 report gross and microscopic examination of surgical specimens, with code selection based on specimen type and complexity.

Organ or disease panel

A group of laboratory tests ordered and reported together under a single panel code; individual components should not be unbundled from the panel.

J-code billing unit

The unit of measure stated in a HCPCS Level II J-code descriptor, such as per 1 mg or per vial, used to convert the administered dose into billable units.

ABN Form CMS-R-131

A notice given to a Medicare beneficiary before a service that may be denied as not medically necessary, allowing the patient to accept financial liability.

KX modifier

A HCPCS Level II modifier indicating that required documentation is on file to support the medical necessity of the item or service.

JW modifier

A HCPCS Level II modifier used to report drug or biological waste from a single-dose vial when the discarded amount is documented and the payer permits billing.

Sagittal plane

An anatomical plane that divides the body into left and right portions; the midsagittal plane divides the body into equal halves.

Appendicular skeleton

The portion of the skeleton comprising the limbs and their girdles, totaling 126 bones, as distinguished from the 80-bone axial skeleton.

Suffix -ostomy

A medical suffix meaning the surgical creation of an opening, such as a colostomy or tracheostomy, as distinguished from -otomy, which means incision.

Pulmonary circuit

The circulation path in which the right side of the heart pumps deoxygenated blood to the lungs and returns oxygenated blood to the left atrium.

Conversion factor

The dollar multiplier applied to the sum of geographically adjusted RVUs to calculate Medicare Physician Fee Schedule payment for a service.

CMS-1500 form

The standard paper claim form used to bill professional (non-institutional) services to Medicare and other payers.

Clean claim rate

The percentage of claims accepted and processed on first submission without rejection or denial, a key revenue cycle performance indicator.

Medicare Secondary Payer

Rules determining when Medicare pays after another payer, such as an employer group health plan or workers compensation, rather than as primary payer.

Excludes1 note

An ICD-10-CM note indicating that two conditions cannot be reported together because they are mutually exclusive, such as congenital versus acquired forms of a condition.