Welcome to Medical Coding Knowledge-Base

In this section you can access to basics of Medical Coding , Abbreviations and terminologies used in Medical Coding, Policies, Procedures, rules & regulation and Guidlines from the key regulatory organizations of Medical Coding .

What is Medical Coding ?

Medical coding is the process of transformation of healthcare diagnosis, procedures, medical services, and equipment into universal medical codes. The diagnoses and procedure codes are taken from medical record documentation. Medical coding professionals help ensure the codes are applied correctly during the medical billing process, which includes abstracting the information from documentation, assigning the appropriate codes, and creating a claim to be paid by insurance carriers.Some important Codes are mentioned below.

Modifiers
CPT codes (Procedure Codes)
DX codes (ICD-Codes)
Modifiers CPT codes DX codes NCCI EDITS

Modifiers

Modifiers can be two digit numbers, two character modifiers, or alpha-numeric indicators. Modifiers provide additional information to payers for the services rendered.There are two main categories of modifiers

(i) Level I Modifiers-These CPT modifiers are maintained by AMA and comprised two digits only.

(i) Level II Modifiers-Level II (HCPCS ) modifiers are maintained by the CMS. HCPCS Level II modifiers are alphanumeric or have two letters.

Further these modifiers are classified into mentioned groups

1-General

2-Advance Beneficiary Notice of Noncoverage (ABN)

3-Anatomic

4-Anesthesia

5-Assist at Surgery

6-Chiropractic

7-Physician Quality Reporting System (PQRS)

8-Telehealth

9-Therapy

Below is the category wise list for the modifiers and thier description.

1-General Modifiers

Modifier Description
22 Increased Procedural Services (surgical/procedures codes only)
24 Unrelated evaluation and management service by the same physician during a postoperative period
25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service
26 Professional Component Only (separate from technical component)
50 Bilateral Procedure
51 Multiple procedures
52 Partially Reduced/Eliminated Services
53 Discontinued Procedure (professional services only)
54 Surgical Care Only
55 Postoperative Management Only
57 An evaluation and management (E/M) service that resulted in the initial decision to perform the surgery may be identified by adding modifier 57 to the appropriate level of E/M service.
58 Staged or Related Procedure or Service During Postoperative Period by Same Physician
59 Distinct Procedural Service
62 Co-Surgeons
66 Team Surgeons – Surgical Team
73 Prior Discontinued Ambulatory Surgical Center (ASC) or Outpatient Hospital
74 After Anesthesia Administration - Discontinued Ambulatory Surgical Center (ASC) or Outpatient Hospital
76 Repeat procedure by same physician
77 Repeat procedure by another physician
78 Return to Operating Room for related surgery during post op period
79 Unrelated procedure or service by same physician during postoperative period
90 Reference (Outside) Laboratory
91 Repeat Clinical Diagnostic Lab Test
99 Multiple Modifiers (same line, same code)
AI Principal Physician of Record
AY Item or service furnished to ESRD patient - not for ESRD treatment
CR Catastrophe/Disaster
CT Computed tomography services furnished using equipment that does not meet each of the attributes of the National Electrical Manufacturers Association (NEMA) XR-29-2013 standard
FS Split (or shared) evaluation and management visit
FT Unrelated evaluation and management during post-op global period
FX X-ray taken using film
FY X-ray taken using computed radiography
GC Service has been performed in part by a resident under the direction of a teaching physician
GJ Opt-out physicians billing on an emergency basis for non-contracted patients.
G0 Used to identify telehealth services furnished for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke.
GV Attending physician is not employed or paid under agreement by the patient's Hospice provider
GW Condition not related to the patient's terminal condition
JW Drug amount discarded/not administered to any patient
PD Diagnostic or related non diagnostic service within three-day inpatient admit
PT Colorectal cancer screening test; converted to diagnostic test or other procedure./td>
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
Q0 Investigational clinical service provided in a clinical research study that is in an approved clinical research study
UN Two patients served (portable x-ray)
UP Three patients served (portable x-ray)
UQ Four patients served (portable x-ray)
UR Five patients served (portable x-ray)
US Six or more patients served (portable x-ray)
XE Separate encounter, A service that is distinct because it occurred during a separate encounter
XP Separate Practitioner, A service that is distinct because it was performed by a different practitioner
XS Separate Structure, A service that is distinct because it was performed on a separate organ/structure
XU Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service