Your FREE CPC Flashcards 2026 – 200+ Cards

The AMA's Current Procedural Terminology — codes that report physician and outpatient procedures and services; the core code set for the CPC exam.

10000 Integumentary, 20000 Musculoskeletal, 30000 Respiratory/Cardiovascular/Hemic-Lymphatic, 40000 Digestive, 50000 Urinary/Genital/Maternity, 60000 Endocrine/Nervous/Eye/Auditory.

The Integumentary System — skin, subcutaneous tissue, and accessory structures (lesion excision, repairs, skin grafts, breast procedures).

By the EXCISED DIAMETER = greatest clinical diameter of the lesion + the narrowest margins required, then by anatomic site and benign vs malignant.

Excised diameter = lesion diameter plus two times the narrowest margin. Code each lesion separately; choose benign (11400–11471) or malignant (11600–11646) by anatomic site.

Simple (superficial, one-layer), Intermediate (layered closure), Complex (more than layered — debridement, extensive undermining). Coded by site and total length.

Add together the lengths of repairs in the same classification and anatomic group and report a single code for that combined length.

The Musculoskeletal System — fractures, dislocations, casting/strapping, arthroscopy, spine, joints, and grafts.

Refers to the TREATMENT method, not the fracture type. Closed = no surgical opening; open = surgical exposure of the fracture; percutaneous = fixation through the skin.

Respiratory, Cardiovascular, Hemic & Lymphatic, and Mediastinum & Diaphragm systems.

Combination codes bundle the catheter placement, imaging supervision, and injection; selective vs non-selective catheter placement determines the code.

The Digestive System — mouth to anus plus the liver, biliary tract, and pancreas (endoscopy, hernia repair, cholecystectomy).

Code the endoscopy to the FURTHEST extent reached. If a surgical endoscopy is performed, it includes the diagnostic endoscopy of the same procedure.

Code by hernia type (inguinal, ventral, umbilical), whether it is initial vs recurrent, reducible vs incarcerated/strangulated, and patient age (for inguinal).

Urinary, Genital (male and female), and Maternity Care & Delivery systems.

Antepartum care + delivery + postpartum care reported with one global code (e.g., 59400 vaginal). Report components separately only when the same provider doesn't furnish all care.

Endocrine, Nervous, Eye & Ocular Adnexa, and Auditory systems.

A surgical CPT code includes the operation plus related pre-op evaluation, local anesthesia, and routine post-op care during the global period — not billed separately.

A code designated '(separate procedure)' is bundled when done with a more comprehensive related procedure; report it alone only when it is the only/independent service.

Append modifier 50 to the CPT code for a procedure performed on both sides of the body in the same session (one line, increased payment), unless the code is inherently bilateral.

Coded by graft type (autograft, allograft, xenograft, skin substitute), recipient site, and size in square centimeters (sq cm).

Reported by depth (skin, subcutaneous, muscle/fascia, bone) and total surface area; deeper level codes are chosen when deeper tissue is removed.

Arthroscopy = joint surgery through a scope; arthrotomy = open surgical incision into a joint. A surgical arthroscopy includes the diagnostic arthroscopy.

59025 = fetal non-stress test, reported separately from the global OB package.

A single physician acts as both surgeon and pathologist, removing skin cancer in stages; coded by stage and number of tissue blocks (17311–17315).

Codes 17000–17286 report destruction (e.g., laser, cryosurgery, electrosurgery) of benign, premalignant, or malignant lesions, often by lesion count.

Biopsy removes a sample for diagnosis; mastectomy (partial, simple, modified radical, radical) removes breast tissue therapeutically — coded by extent.

Reported separately only when the cast/strap is NOT part of the global fracture-care code (e.g., a replacement cast or when no restorative treatment is done).

Vertebral approach, arthrodesis (fusion), instrumentation, and bone graft may each be reported; many graft/instrumentation codes are add-on (+) codes.

Reported by approach and the most extensive procedure performed (diagnostic vs with biopsy, brushing, or therapeutic intervention); the surgical bronchoscopy includes the diagnostic.

Coded by the NUMBER and TYPE of grafts: venous (33510–33516), arterial (33533–33536), and combined arterial-venous (add-on 33517–33523 with arterial codes).

Coded by single vs dual vs biventricular lead system and whether it is an initial insertion, replacement, or revision of the generator and/or leads.

CPT distinguishes laparoscopic from open procedures; if a laparoscopy converts to an open procedure, report only the open code.

Laparoscopic cholecystectomy 47562–47564 (with or without cholangiography/exploration); open 47600–47620. Code the approach actually completed.

Endoscopic exam of the bladder and urethra (52000 series); the code reflects the most extensive procedure performed (biopsy, stone removal, fulguration).

Used when one provider does the delivery but not all global care (e.g., 59409 vaginal delivery only); separate antepartum/postpartum codes apply for split care.

59510 = routine global C-section (antepartum + cesarean delivery + postpartum); 59514 = cesarean delivery only.

Craniotomy = bone flap removed and replaced; craniectomy = bone removed and not replaced. Coded in the 61000–62258 nervous-system range.

Coded by technique — extracapsular, phacoemulsification, or with intraocular lens (IOL) insertion (66982–66984); complex cataract codes require documentation.

Insertion of ventilating tubes (69433/69436) in the auditory section; general anesthesia vs local affects code selection.

Thyroidectomy coded by extent — partial/total lobectomy, total/subtotal, with or without limited neck dissection (60210–60271).

Header (patient, date, surgeon), preoperative and postoperative diagnoses, procedure(s) performed, and the body describing what was done — the coder's source for CPT selection.

For lesion excision, measured BEFORE removal (the lesion plus margins), not the pathology specimen size after fixation/shrinkage.

When a lesion is treated during a scope, report the surgical endoscopy code; it includes the diagnostic endoscopy of the same site.

CPT codes (99202–99499) reporting non-procedural physician visits — office, hospital, ED, consults, critical care — the signature CPC topic.

Codes 99202–99215 are leveled by Medical Decision Making (MDM) OR total time on the date of the encounter. History and exam no longer determine the level.

(1) Number and complexity of problems addressed, (2) amount/complexity of data reviewed, (3) risk of complications/morbidity. The level needs 2 of the 3 met or exceeded.

New = not seen by the provider (or same-specialty group) in the prior 3 years; established = seen within 3 years. New-patient visits require/allow higher work.

Straightforward, Low, Moderate, High — these map to the office/outpatient E/M levels (e.g., 99213 = low, 99214 = moderate, 99215 = high).

Total time = all time the physician/QHP personally spends on the date of the encounter (face-to-face AND non-face-to-face), not just counseling time.

99291 = first 30–74 minutes of critical care; +99292 = each additional 30 minutes. Time-based and includes bundled services (e.g., interpretation of certain data).

History, Examination, and Medical Decision Making — still used to level E/M categories other than 2021+ office/outpatient (e.g., some hospital/consult rules vary by year).

A request from another provider for opinion/advice, the rendering of that opinion, and a written report back to the requesting provider (the classic 'three R's').

'Decision for surgery' — appended to the E/M visit at which the decision to perform a MAJOR (90-day global) surgery was made.

+99417 reports each additional 15 minutes beyond the highest-level office E/M (99205/99215), used when leveling by total time.

99281–99285 report emergency department visits; ED codes have no new vs established distinction (all ED patients are treated the same way).

Preventive (99381–99397) is age-based wellness; if a significant problem is also addressed, report a problem E/M with modifier 25 in addition.

99231–99233 report follow-up inpatient visits; leveled (low/moderate/high) by MDM or time per the current E/M rules.

99221–99223 report the first encounter of the admitting provider; observation and inpatient initial-care codes were merged in the CPT update.

99241–99245 (office consults) and inpatient consults 99251–99255 exist in CPT, but Medicare does not pay consultation codes — report the appropriate E/M visit instead.

99238 (30 minutes or less) and 99239 (more than 30 minutes) report hospital discharge services; time-based on the total discharge-day work.

99304–99318 report nursing-facility initial and subsequent care visits.

99341–99350 report E/M services in a patient's home or residence (new and established).

99490 and related codes report non-face-to-face care coordination for patients with multiple chronic conditions, by clinical staff time per month.

99495/99496 report care after discharge to a community setting, including a timely interactive contact and a face-to-face visit within a set window.

99460–99463 report initial and subsequent normal newborn care; separate codes apply to attendance at delivery and resuscitation.

When counseling/coordination dominates a non-2021-office visit (>50% of time), total time may drive the E/M level — document the time and content.

The risk element considers diagnostic/treatment options, including prescription drug management, decisions about surgery, and social determinants affecting management.

Counts the number and complexity of problems managed at the encounter — self-limited, stable chronic, undiagnosed new problem, acute with systemic symptoms, etc.

Similar services provided to the same patient by more than one provider on the same day; each reports their own E/M, with documentation distinguishing the work.

Office/outpatient (2021+) use MDM or total time; other categories may still use the three key components or counseling-dominated time rules.

Begins when the anesthesiologist prepares the patient and ends when the patient is safely placed under post-anesthesia care; reported in time units plus base units.

Payment = (base units + time units + modifying units) times a conversion factor. Each CPT anesthesia code carries assigned base units for the procedure's complexity.

P1 (normal healthy) through P6 (brain-dead organ donor) — describe the patient's condition; P3–P5 may add complexity units.

Add-on codes 99100–99140 for situations that complicate anesthesia (extreme age, hypothermia, emergency); reported in addition to the anesthesia code.

Professional component (modifier 26) = the physician's interpretation; technical component (modifier TC) = the equipment/technician; global = both together.

26 = professional component (interpretation and report only); TC = technical component (equipment, supplies, technician). No modifier = global (both).

'With contrast' in radiology means contrast administered intravascularly, intra-articularly, or intrathecally — oral/rectal contrast alone is coded 'without contrast.'

Codes that report the imaging guidance and interpretation portion of a procedure, often paired with the surgical/injection CPT code.

Organ/disease panels (e.g., 80053 comprehensive metabolic) bundle specific tests; all listed tests must be performed to report the panel code.

Repeat clinical diagnostic laboratory test — appended when the same test is repeated on the same day to obtain subsequent results (not for confirming an initial result).

88300–88309 are leveled (I–VI) by the specimen's complexity and the work of examination; each specimen is reported separately.

Reports non-surgical services: immunizations, injections, dialysis, cardiovascular (ECG, stress test), pulmonary, ophthalmology, psychiatry, and physical medicine.

Report the vaccine/toxoid product code AND the administration code (e.g., 90471 first immunization administration) — both are required.

96372 = therapeutic/prophylactic/diagnostic subcutaneous or intramuscular injection; report the drug supplied separately with a HCPCS J code.

Anesthesia modifiers QS (MAC service), G8, and G9 describe MAC; the same base/time-unit methodology applies.

AA (anesthesiologist personally), QK (medical direction of 2–4 concurrent), QX (CRNA with direction), QZ (CRNA without medical direction).

Reported with 99151–99157 by patient age and time; some procedures include sedation inherently and it is not separately reported.

Diagnostic radiology, diagnostic ultrasound, radiologic guidance, mammography, bone/joint studies, radiation oncology, and nuclear medicine.

A treatment course is coded across phases: consultation, clinical treatment planning, simulation, dosimetry, treatment delivery, and management.

Includes the imaging study; the radiopharmaceutical (diagnostic or therapeutic) is reported separately, often with a HCPCS code.

Presumptive (80305–80307) screens for a drug class; definitive (80320 series) identifies specific drugs/metabolites — code per the methodology and number of analytes.

Tier 1 codes report specific gene analyses; Tier 2 codes group analyses by level of complexity when no Tier 1 code exists.

Clinical lab = chemistry, hematology, microbiology on specimens; anatomic pathology = surgical pathology and cytopathology of tissue/cells.

ECG (93000 components), echocardiography, cardiac stress testing, and catheter-based diagnostics live in the Medicine section (93000 series).

End-stage renal disease (ESRD) services are reported per month by patient age and number of visits (90951–90970).

97000-series codes report PT/OT modalities and therapeutic procedures; many are timed (per 15 minutes) under the 8-minute rule.

92002–92014 (eye exam codes) may be reported instead of E/M for eye visits, by new/established and intermediate/comprehensive.

Psychotherapy 90832–90838 are time-based; add-on codes report psychotherapy provided with an E/M service.

Allergy testing (95004 series, by number of tests) is separate from allergen immunotherapy (95115–95170).

hyper- = excessive/above normal; hypo- = deficient/below normal (e.g., hyperglycemia vs hypoglycemia).

Surgical removal/excision (e.g., appendectomy = removal of the appendix).

-otomy = a surgical incision into; -ostomy = creation of an artificial opening (stoma). Colotomy = incision; colostomy = opening.

Surgical repair or reconstruction (e.g., rhinoplasty = repair of the nose).

Inflammation (e.g., appendicitis, gastritis).

Without or absence of (e.g., apnea = without breathing).

Heart (e.g., cardiomyopathy = disease of the heart muscle).

Both mean kidney; nephr/o is Greek-derived (nephrectomy) and ren/o is Latin-derived (renal).

Sagittal (left/right), coronal/frontal (front/back), transverse/axial (upper/lower). Used to describe imaging and surgical orientation.

Proximal (nearer the trunk) vs distal (farther); anterior/ventral (front) vs posterior/dorsal (back); medial (toward midline) vs lateral (away).

Dorsal (cranial + spinal) and ventral (thoracic + abdominopelvic). The diaphragm divides the thoracic and abdominopelvic cavities.

RUQ, LUQ, RLQ, LLQ — used to localize symptoms and surgical sites (e.g., appendicitis pain classically in the RLQ).

Epidermis (outer), dermis (middle, with vessels/nerves), subcutaneous/hypodermis (fat). Lesion-excision depth affects CPT selection.

Integumentary, musculoskeletal, respiratory, cardiovascular, digestive, urinary, reproductive, endocrine, nervous, and special senses — mirror the CPT surgery sections.

Surgical fixation or suspension (e.g., nephropexy = fixation of the kidney).

Surgical suturing/repair (e.g., herniorrhaphy = suture repair of a hernia).

-scopy = visual examination with a scope; -graphy = the process of recording an image (e.g., angiography).

Surgical puncture to remove fluid (e.g., thoracentesis, amniocentesis).

Breakdown, destruction, or freeing from adhesions (e.g., adhesiolysis).

brady- = slow (bradycardia); tachy- = fast (tachycardia).

Painful, difficult, or abnormal (e.g., dysphagia = difficulty swallowing).

Liver (e.g., hepatomegaly = enlargement of the liver).

Bone (e.g., osteoarthritis, osteotomy).

cyt/o = cell; hist/o = tissue (cytology vs histology).

enter/o = small intestine; gastr/o = stomach (gastroenteritis = inflammation of stomach and intestine).

Both relate to lung/air; pneum/o (pneumonia, pneumothorax) and pulmon/o (pulmonary).

Two atria (upper, receiving) and two ventricles (lower, pumping); the right side handles deoxygenated blood, the left side oxygenated.

Nose/pharynx → larynx → trachea → bronchi → bronchioles → alveoli (site of gas exchange).

Mouth → esophagus → stomach → small intestine (duodenum, jejunum, ileum) → large intestine (colon) → rectum → anus.

Kidneys → ureters → bladder → urethra; the nephron is the functional filtering unit of the kidney.

Axial skeleton (skull, vertebral column, rib cage) and appendicular skeleton (limbs and girdles).

Skeletal (voluntary, striated), cardiac (involuntary, striated, in the heart), and smooth (involuntary, in organs/vessels).

The U.S. diagnosis code set used in all settings to report the reason for the encounter; 3–7 alphanumeric characters with a required decimal after the third character.

A = initial encounter (active treatment), D = subsequent encounter (healing/recovery), S = sequela (late effect). Placeholder X fills empty positions before the 7th.

A dummy 'X' that fills an empty character position so a required 7th character lands in the correct slot (e.g., T36.0X1A).

Excludes1 = NOT coded here — the two conditions cannot occur together. Excludes2 = 'not included here' — both conditions MAY be coded together if documented.

Instructs the coder to sequence the underlying/etiology condition before the manifestation code (e.g., code the underlying disease first, then the manifestation).

Tells the coder to add a secondary code to fully describe the condition (e.g., add a code for the infectious organism or causal agent).

Do NOT code signs/symptoms that are integral to a confirmed definitive diagnosis; code them when no definitive diagnosis is established or when they are not routinely associated.

In the OUTPATIENT setting, never code 'probable,' 'suspected,' 'rule out,' or 'questionable' diagnoses — code to the highest degree of certainty (the signs/symptoms).

A single code that classifies two diagnoses, or a diagnosis with an associated manifestation or complication (e.g., type 2 diabetes with diabetic neuropathy).

ICD-10-CM codes for factors influencing health status and encounters for reasons other than disease (screenings, aftercare, exposure, status).

Many codes specify right, left, or bilateral. If the side isn't documented and laterality is required, an unspecified-side code may be needed or the provider queried.

ICD-10-CM coding for taking LESS of a medication than prescribed; coded with a T36–T50 code with the 5th/6th character '6' for underdosing — never with a poisoning code.

NOS = Not Otherwise Specified (= unspecified; lacking detail). NEC = Not Elsewhere Classifiable (the detail exists but no specific code is available).

When 'code first' and 'use additional code' appear together, the etiology is sequenced first and the manifestation second; manifestation codes are never first-listed.

An alphanumeric code set (A–V) for products, supplies, and services not in CPT — drugs, DME, ambulance, prosthetics, orthotics, and supplies.

Report injectable/infusion drugs and their dosage amounts (e.g., a J code for a specific drug per unit) — pair with the CPT administration code.

CPT (HCPCS Level I) reports physician/outpatient procedures; HCPCS Level II reports supplies, drugs, and equipment not described by CPT.

Level II modifiers are alphanumeric (e.g., LT/RT for left/right, GA for ABN on file, the X{EPSU} subset of modifier 59) and refine the service.

A residual condition produced after the acute phase of an injury/illness has ended; coded with the condition first, then the cause with 7th character S.

The code listed next to the main term in the Alphabetic Index — used when the documentation doesn't specify a more detailed condition.

When both acute and chronic forms are documented and separately indexed at the same indentation, code BOTH, sequencing the ACUTE/subacute first.

If it occurred, code as a confirmed diagnosis; if it did not, reference the Index for 'impending' or 'threatened' and code the underlying signs/symptoms.

Use the combination codes in E08–E13 by type and the manifestation/complication; 'with' presumes a causal link unless documentation states otherwise.

Malignant primary, malignant secondary, Ca in situ, benign, uncertain behavior, and unspecified — select the column matching the documented behavior.

List first the diagnosis/condition chiefly responsible for the services provided (first-listed diagnosis in the outpatient setting).

Chronic conditions treated on an ongoing basis may be coded as many times as the patient receives treatment for them.

Optional ICD-10-CM codes describing how an injury happened, the place, activity, and status; never sequenced first.

3 to 7 characters; the first character is a letter, the second is a number, and a decimal follows the third character when more characters are present.

A manifestation-code title that means the code is never first-listed; it must follow the underlying etiology code.

Transportation/ambulance, medical/surgical supplies, and administrative/miscellaneous services.

Durable medical equipment (DME) — wheelchairs, hospital beds, walkers, and similar reusable equipment.

Temporary procedure/professional service codes established by CMS, often for Medicare-specific services not yet in CPT.

Temporary codes for drugs, biologicals, and certain services/supplies assigned by CMS.

GA (waiver of liability/ABN on file), GX (voluntary ABN), GY (statutorily excluded), GZ (expected denial, no ABN).

First-listed = the main reason for the encounter; secondary diagnoses are coexisting conditions that affect treatment at this visit.

Used for routine, planned care during the healing/recovery phase (e.g., attention to an artificial opening); not for active injury treatment, which uses 7th character A.

Z11–Z13 screening codes are first-listed when the visit is solely for screening; any finding may be added as a secondary code.

HCPCS Level II modifiers indicating the left (LT) or right (RT) side; used to identify which side a one-sided procedure was performed on.

A significant, separately identifiable E/M service by the same provider on the same day as a procedure — billed in addition to the procedure.

Distinct procedural service — flags a procedure not normally reported together that is appropriate here (separate session, site, or lesion).

Multiple procedures performed at the same session by the same provider — appended to the secondary/lesser procedures (the primary is reported without it).

More specific subsets of modifier 59: XE (separate encounter), XS (separate structure), XP (separate practitioner), XU (unusual non-overlapping service).

Bilateral procedure — one procedure performed on both sides of the body in the same operative session.

Increased procedural services — work substantially greater than typically required; requires supporting documentation.

52 = reduced services (procedure partially reduced/eliminated at provider discretion); 53 = discontinued procedure (stopped due to patient risk after anesthesia/start).

58 = staged/related procedure in the global period; 78 = unplanned return to the OR for a related problem; 79 = unrelated procedure during the global period.

Reported in addition to a primary procedure code, never alone, and are modifier-51 exempt. The '+' symbol designates them in CPT.

Marked with the ⊘ symbol; add-on codes and certain others are exempt from multiple-procedure reduction — do not append modifier 51.

Indicates a NEW code added to CPT for the current edition.

Indicates a code whose DESCRIPTOR was REVISED in the current edition.

The text before the semicolon is the common (parent) description shared by the indented child codes that follow; read the parent + indented portion together.

Enclose NEW or REVISED text within the guidelines or a code descriptor in the current edition.

Marks a RESEQUENCED code — placed out of numeric order to keep it with related codes.

Used when no specific CPT code describes the service; require a special report (operative note) and are governed by the section guidelines for that CPT range.

Category I = standard 5-digit procedure codes; Category II = optional performance-measurement tracking codes (4 digits + F); Category III = temporary emerging-technology codes (4 digits + T).

National Correct Coding Initiative procedure-to-procedure edits prevent improper code pairs (unbundling); a modifier indicator shows whether a modifier (e.g., 59) may override.

NCCI limits on the maximum units of a code reportable for one patient on one day — flag claims exceeding the expected unit count.

Reporting components of a service separately to gain higher payment when a single comprehensive code applies — a compliance/fraud risk that NCCI edits target.

Assigning a higher-level or more expensive code than the documentation supports — fraud; never code beyond what the record shows.

A service must be reasonable and necessary for the diagnosis or treatment; the ICD-10-CM diagnosis must support the CPT/HCPCS procedure billed.

A notice given to a Medicare patient before a service likely to be denied as not medically necessary, transferring financial responsibility; signaled by modifier GA.

NCD = national coverage determination (CMS, nationwide); LCD = local coverage determination (set by a Medicare Administrative Contractor for its region).

Fraud = knowing/intentional deception for unauthorized benefit; abuse = practices inconsistent with sound fiscal/medical practice causing unnecessary cost (intent is the key difference).

Federal law imposing liability for knowingly submitting false or fraudulent claims to the government (e.g., Medicare); a core CPC compliance topic.

The Office of Inspector General — investigates health-care fraud/abuse and publishes compliance program guidance and the annual Work Plan.

OIG's voluntary program elements: written policies, a compliance officer, training, communication, auditing/monitoring, enforcement/discipline, and corrective action.

The exam allows the CPT, ICD-10-CM, and HCPCS Level II code books only — tab and index them in advance; 100 questions in 4 hours is ~2.4 minutes each.

70% — at least 70 of the 100 multiple-choice questions correct.

Designation for a coder who passes the CPC without the required experience; the '-A' is removed once 2 years of experience (or the alternate path) is documented.

Professional component — the physician's interpretation and report portion of a service that has both a professional and technical component.

76 = repeat procedure by the SAME physician; 77 = repeat procedure by a DIFFERENT physician.

Unrelated E/M service by the same physician during a postoperative (global) period.

Synchronous telemedicine service rendered via real-time interactive audio and video; the ★ symbol flags CPT codes eligible for synchronous telemedicine.

Anesthesia by the surgeon — appended to the surgical code when the operating surgeon also provides regional/general anesthesia (not the anesthesia codes).

Mandated services — a service required by a third party (e.g., payer, governmental, or regulatory mandate).

Two surgeons — each acting as a primary (co-)surgeon for distinct parts of the same procedure; each appends modifier 62.

80 = assistant surgeon; 81 = minimum assistant surgeon; 82 = assistant surgeon when a qualified resident is unavailable.

Surgical team — a highly complex procedure requiring several physicians of different specialties working together.

90 = reference (outside) laboratory; 99 = multiple modifiers (when more modifiers apply than the claim line allows).

Pricing/payment modifiers (e.g., 26, 50, 51, 80) are generally listed before informational/statistical modifiers on the claim.

Documentation accompanying an unlisted, new, or rarely used service that describes the nature, extent, need, time, and effort of the procedure.

Look up the procedure/service, anatomic site, condition, synonym, or eponym in the alphabetic Index, then VERIFY the code in the main (tabular) text — never code from the Index alone.

Services integral to a procedure (prepping, closing, routine post-op) are bundled into the surgical code and not reported separately.

Copying forward documentation that doesn't reflect the current encounter can support an inaccurate code and is a compliance/audit risk.

Prohibits a physician from referring designated health services payable by Medicare to an entity with which they have a financial relationship, absent an exception.

Criminal law prohibiting knowingly offering/paying/soliciting/receiving remuneration to induce referrals for items/services payable by a federal health-care program.

Protects patient health information; coders access only the minimum necessary PHI to assign and report codes.

Two-digit codes identifying where a service was furnished (e.g., 11 office, 21 inpatient hospital, 22 outpatient hospital, 23 ED); affects payment.

A claim with no defects or missing information that can be processed without additional documentation; reduces denials and delays.

73 = discontinued outpatient procedure BEFORE anesthesia; 74 = discontinued AFTER anesthesia administration (facility reporting).

On an NCCI PTP edit, an indicator of 0 = no modifier allowed (always bundled); 1 = a modifier may bypass the edit when clinically appropriate; 9 = edit not applicable.

AAPC — the credentialing organization for the Certified Professional Coder; CPC is the standard for physician/outpatient (professional-fee) coding.

CPC (AAPC) = physician/outpatient, CPT+HCPCS heavy. CCS (AHIMA) = hospital facility/inpatient, ICD-10-PCS and MS-DRG heavy. Different bodies, different settings.

100 multiple-choice questions in 4 hours, open-book with the CPT, ICD-10-CM, and HCPCS Level II code books.

The Resource-Based Relative Value Scale underlying the Medicare Physician Fee Schedule; payment is based on work, practice-expense, and malpractice RVUs, adjusted geographically and multiplied by a conversion factor.

The unit measuring the resources for a service under RBRVS: physician work, practice expense, and malpractice components.

Multiple outpatient hospital E/M encounters on the same date (facility reporting).

Preventive services — identifies a service furnished as a recommended preventive benefit (often waiving cost-sharing).

Some CPT/ICD codes are inherently bilateral (don't add modifier 50); read the descriptor before appending laterality.

Always reported with its designated primary procedure on the same claim; never reported as a standalone service.