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 - New, Revised, & Deleted Codes & Advice 2021
Appendix B - Crosswalks for Deleted Codes
Appendix C - -Inpatient Only Procedue Codes
Appendix D - CPT Modifiers, Definitions, & Tips
Appendix E- CPT Category ll Modifiers
Appendix F - HCPCS Level ll Modifiers, Definitions, & Tips
Appendix G - Resequenced CPT Codes
Appendix H -Vascular Families Interventional Radiology
Appendix I - Modifier 51 Exempt, & Add on Codes
Appendix J - Brand Name & Generic Vaccinations
Appendix K - Place of Service/Type of Service
Appendix L - Drug Class List
Appendix M - APC Status Indicator
Appendix N - ASC Payment Indicators
Appendix O - 2021 E/M Office or Other Outpatient (99202-99215 Audit Worksheet
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 five digit 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.
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