Glossary
Chapter 8
add–on code reported when another procedure is performed in addition to the primary procedure during the same operative session; modifier –51 (multiple procedures) is not used with add–on codes.
Advanced Beneficiary Notice (ABN) form completed and signed by a Medicare beneficiary each time a provider believes a normally covered service will not be covered and the provider wants to bill the beneficiary directly for the service.
Appendix A of CPT contains a list of CPT modifiers and detailed descriptions.
Appendix B of CPT contains annual CPT coding changes that include added, deleted, and revised CPT codes; it serves as the basis for updating interoffice documents and billing tools.
Appendix C of CPT contains clinical examples for codes found in the Evaluation and Management section.
Appendix D of CPT contains a list of add–on codes that are identified throughout CPT with a plus () symbol.
Appendix E of CPT contains a list of codes that are exempt from modifier –51 reporting rules and that are identified throughout CPT with a forbidden ( ) symbol.
Appendix F of CPT contains a list of codes that are exempt from modifier –63.
Appendix G of CPT contains a summary of CPT codes that include conscious sedation and that are identified throughout CPT with a bull’s–eye ( ) symbol.
Appendix H of CPT contains an alphabetic index of performance measures by clinical condition or topic.
Appendix I of CPT contains genetic testing modifiers.
Appendix J of CPT contains an electrodiagnostic medicine listing of sensory, motor, and mixed nerves that are reported for motor and nerve studies codes 95900, 95903, and 95904, respectively.
Appendix K of CPT contains a list of codes that are pending FDA approval but that have been assigned CPT codes; in the CPT manual, these codes are preceded by the flash () symbol.
Appendix L of CPT contains a list of vascular families that is intended to assist in the selection of first–, second–, third–, and beyond third–order branch arteries.
Appendix M of CPT contains a list of deleted CPT codes and descriptions with a crosswalk to new CPT codes.
bull’s–eye symbol symbol ( ) located to the left of CPT codes that identifies procedures that include conscious sedation.
bullet symbol symbol () located to the left of CPT codes that identifies new procedures and services added to CPT.
Category I code procedures/services identified by a fivedigit CPT code and descriptor nomenclature; this type of code is traditionally associated with CPT and organized within six sections.
Category II code optional CPT “performance measurements” tracking code that is assigned an alphanumeric identifier with a letter in the last field; this type of code is located after the CPT Medicine section.
Category III code “emerging technology” temporary CTP code assigned for data collection purposes that are assigned an alphanumeric identifier with a letter in the last field; this type of code is located after the Medicine section, and it will be archived after five years if it is not accepted for placement within Category I sections of CPT.
column 1/column 2 edits code pairs that should not be billed together because one service inherently includes the other; previously called comprehensive/component edits.
comprehensive/component edits code pairs that should not be billed together because one service inherently includes the other.
descriptive qualifiers clarify assignment of a CPT code; occur in the middle of a main clause or after the semicolon; may or may not be enclosed in parentheses.
flash symbol symbol () located to the left of CPT codes that identifies products pending FDA approval but that have been assigned a CPT code.
forbidden symbol symbol () located to the left of CPT codes that identifies codes exempt from modifier –51.
functional modifier pricing modifier that a third–party payer considers when determining reimbursement.
green reference symbol symbol () located below a code description to indicate that the coder should refer to the CPT Assistant monthly newsletter and/or the CPT Changes: An Insider’s View annual publication that contains all coding changes for the current year.
guidelines define terms and explain the assignment of codes for procedures and services located in a particular section of CPT.
hollow circle symbol symbol (Ο) located to the left of a Category III code to indicate a reinstated or recycled code.
horizontal triangle symbols symbols () that surround revised guidelines and notes; these symbols are not used for revised code descriptions.
inferred words used to save space in the CPT index when referencing subterms.
informational modifiers clarify aspects of the procedure or service provided for the payer.
mutually exclusive edits code pairs that, for clinical reasons, are unlikely to be performed on the same patient on the same day.
National Correct Coding Initiative (NCCI) implemented by the Centers for Medicare & Medicaid Services (CMS) to promote national correct coding methodologies and to control the improper assignment of codes that results in inappropriate reimbursement of Medicare Part B claims.
notes appear throughout CPT sections to clarify the assignment of codes.
Notice of Exclusions from Medicare Benefits (NEMB) form completed and signed by a Medicare beneficiary before items, procedures, and services excluded from Medicare benefits are provided.
number symbol symbol (#) located to the left of CPT codes to indicate out–of–numerical sequence codes.
plus symbol symbol () located to the left of CPT codes that identifies add–on codes (also located in Appendix D of CPT) for procedures that are commonly, but not always, performed at the same time and by the same surgeon as the primary procedure.
prohibitory symbol see forbidden symbol.
range of codes code numbers separated by a dash or a series of codes separated by commas in the CPT index.
red reference symbol symbol () located below a code description to indicate that the coder should refer to the Clinical Examples in Radiology quarterly newsletter.
semicolon symbol (;) used to save space in CPT code descriptions.
single code single code number listed in the CPT index.
special report document that must accompany the claim to describe the nature, extent, and need for the procedure or service when an unlisted procedure or service code is reported.
triangle symbol symbol () located to the left of CPT codes that identifies revised code descriptions.
unlisted procedure code assigned when the provider performs a procedure or service for which there is no CPT code.
unlisted service see unlisted procedure.