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These digits are not intended to reflect the placement of the code in the regular (Category I) part of the CPT codebook. Appendix H in CPT section contains information about performance measurement exclusion of modifiers, measures, and the measures' source(s). Currently there are 11 Category II codes. They are: (0001F–0015F) Composite measures
HCPCS includes three levels of codes: Level I consists of the American Medical Association's Current Procedural Terminology (CPT) and is numeric.; Level II codes are alphanumeric and primarily include non-physician services such as ambulance services and prosthetic devices, and represent items and supplies and non-physician services, not covered by CPT-4 codes (Level I).
The original mammogram codes (film based mammograms) are CPT codes (77055, 77056, and 77057), so it would be easy to overlook the increasingly used digital mammogram codes that remain as HCPCS Level 2 codes if one did not know they existed (and possibly under-report mammogram statistics).
These code pairs are further categorized into two sets: Modifier: the appropriate use of a modifier allows these code pair to be reported together. In most cases, the -59 modifier is used, although there are other acceptable modifiers. These modifiers must be supported by documentation in the medical record.
A clinical coder—also known as clinical coding officer, diagnostic coder, medical coder, or nosologist—is a health information professional whose main duties are to analyse clinical statements and assign standardized codes using a classification system.
The same code billed on different lines for the same date of service are subject to duplicate adjudication edits where CPT Modifiers like 59, 76 and 77 may impact the payment. [4] [5] The edits were not publicly released until 2009, with some of them remaining confidential out of concern for abuse [6]. [7]
Some acts may receive more than their one or more main code details called Modifiers. A modifier is information associated with a label that identifies a particular criterion for the performance of an act or his recovery. It applies to a specific list of acts. Modifiers are explicitly allowed in respect of each of the acts concerned.
A numeric character reference refers to a character by its Universal Character Set/Unicode code point, and a character entity reference refers to a character by a predefined name. A numeric character reference uses the format &#nnnn; or &#xhhhh; where nnnn is the code point in decimal form, and hhhh is the code point in hexadecimal form.