Current Procedural Terminology, 4th Edition listed as CPT-4. cpt とはどういう意味ですか?cpt は 現在の手続き型専門用語 を表します。英語以外のバージョンの 現在の手続き型専門用語 を表示する場合は、下にスクロールすると、英語で 現在の手続き型専門用語 の意味が表示されます。 It is essential that certified asthma educators (AE-C) work with their professional organizations to encourage third-party payers to approve reimbursement for asthma education. Intravascular injection can be avoided by palpating the location of the axillary artery and aspirating before injecting. Table 8-2 is accurate for patients seen in a “non-facility” such as a freestanding office visit. Current Procedural Technology: History, Structure, Process & Controversies. Review the criteria for CPT® Category I, Category II and Category II codes, access applications and read frequently asked questions. The process of determining a CPT code for a procedure or service is very detailed, and encompasses several activities and sometimes years of work. Providers want accurate reimbursement. Current Procedural Terminology. Each procedure or service is identified with a five-digit code. Thus, CPT covers laboratory tests that physicians and/or their staff perform in office settings. Assign CPT for services and procedures and HCPCS billing codes for medical equipment and devices, with appropriate modifiers, when required for facility and professional fee billing and statistical indices. Learn more. Current Procedural Terminology (CPT) CPT Editorial Panel The CPT coding system is a listing of codes and descriptors for reporting services and procedures performed by physicians. 96118: NPE for all time spent in record review, interview, test selection, test administration, scoring, analysis of evaluation findings, review of results with patient and family, and final report writing (14 h is typical for me if I do all my own testing; 7 h is typical for me with testing help from the psychometrists). These are most relevant in radiology to the practice by interventional radiologists who see patients in clinics or who spend lengthy periods in interviews, examinations, and counseling sessions with patients about their therapeutic options. CPT code 37252 reflects all IVUS performed in the first vessel for the entire procedure. They are codes that are not yet approved by CMS for payment. They may be used as part of the FDA approval process or to substantiate widespread use of a new technology. CPT codes drive standardization, interoperability and transparency to improve the quality of care. Noninvasive treatments for spasticity such as medication, stretching, serial casting, icing, electrical stimulation, and positioning should be attempted before the use of neurolytic blocks. E&M Codes As a HIPAA-mandated code set, all covered entities (physicians, other health care providers, payers and clearinghouses) must use ICD-10 to be in compliance with HIPAA. 4.1.5 Current Procedural Terminology. Module 1: Current Procedural Terminology (CPT) Learn about CPT codes, which describe the services provided by health care professionals to third party payers. New Audiology CPT Codes for 2021. Current Procedural Terminology synonyms, Current Procedural Terminology pronunciation, Current Procedural Terminology translation, English dictionary definition of Current Procedural Terminology. Current Procedural Terminology (CPT) CPT Editorial Panel The CPT coding system is a listing of codes and descriptors for reporting services and procedures performed by physicians. For any additional noncoronary vessels imaged with IVUS, CPT code 37253 may be reported. Code Lists. Usually any one service needs only one code while additional codes may be used to describe services that might have been provided concomitant to the first service, unless those codes are not allowed to be reported simultaneously (i.e., are bundled). In 1966, the American Medical Association first published a set of standard terms and descriptors to document medical procedures, known as Current Procedural Terminology, or CPT. Current procedural terminology is a coding system that helps identify medical services and procedures. In an effort to maintain effectiveness, codes are continually updated on an annual or biannual basis. My few recent experiences since then with Federal Workers Compensation carriers have done nothing to improve my outlook in this regard. New Current Procedural Terminology (CPT) codes have been created to capture these tests, but the recent announcement by the Centers for Medicare & Medicaid Services (CMS) to gap-fill the payment rates for Genomic Sequencing Procedures (GSP) means labs will need to work with payers to demonstrate the cost and value of NGS. Used nationwide, CPT codes are standardized across disciplines, allowing effective communication between parties. It allows the patient the opportunity to make an informed decision whether or not to allow the physician to perform a procedure for which the patient might be personally financially responsible. More than 50 million students study for free with the Quizlet app each month. Learn about the latest news for CPT Category III codes. Prior use of the procedure or service has not taken place, and the code is not encompassed in another procedure or service. Our focus is on making technology an asset in the delivery of health care, not a burden. Choose from 500 different sets of current procedural terminology flashcards on Quizlet. Kim Pollock RN, MBA, CPC, in Pain Procedures in Clinical Practice (Third Edition), 2011. (If the median nerve is being stimulated, the patient will contract the wrist and finger flexors.) INCREASES ACCESS. Meaning of Current Procedural Terminology. Login The CMS rules for use of CPT in billing are explicit in their requirement that as many codes be used (with various modifiers) as are needed to accurately describe a service, without unbundling. These codes are used to facilitate electronic medical billing and for data collection and tracking. The Current Procedural Terminology (CPT) code set accurately describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes. All aspects of the history, physical, treatment decision, and coordination with other providers must be documented to justify the use of the code. This is anterior to the axillary artery, which should be palpated to avoid injecting into the artery. While CMS carriers have the right, given the appropriate circumstances, to bypass the edit and reimburse qualified foot services on a more frequent basis, the likelihood of this occurring is remote at best. These codes can be used to provide increased and fair reimbursement. This expansive, important code set is published and maintained by the American Medical Association (AMA), and it is, with ICD, one of the most important code sets for medical coders to become familiar with. The codes are now maintained by and the process for their editing, creation, or deletion is managed by the American Medical Association. Insert the needle below the tendon of the pectoralis major muscle (Figures 6-3 and 6-4). See the costs for all the AMA membership categories, plus tax deduction information. Once a procedure or service has received an accurate CPT code, RVUs are assigned by the AMA-assigned committee, which, as noted above, is appointed by the ACR. See the requirements for the development and review of CPT codes and other information about the CPT application process. See the most recently approved CPT® Molecular Pathology Tier 2 Codes. The difference is that the codes refer to different size lesions; presumably larger lesions require more effort to remove and thus provide greater reimbursement. Learn more about CPT with resources from the American Medical Association. Since 1984 it has released a new version annually. Vena cava filter insertion (37191), vena cava filter repositioning (37192), vena cava filter removal (37193), and intravascular foreign body retrieval (37197) include IVUS in their description of work, and therefore CPT codes 37252 and 37253 may not be separately reported when performed in conjunction with these services. In 2000, as part of HIPAA, CPT became the required coding system for use in all health care transaction reporting. These Find information about the most recently approved administrative Multianalyte Assays with Algorithmic Analyses (MAAA) codes. There are additional “M” codes in Washington state, for very complex worker compensation cases, where there may be two prior NPEs to review, a very extensive set of medical records, and a tremendous amount of time required to analyze and synthesize the full file. Every day, physicians rely upon Current Procedural Terminology (CPT) to report their services for payment by the Centers for Medicare & Medicaid Services (CMS) and other third-party payers. Explore information about the CPT® new Proprietary Laboratory Analyses (PLA) codes and how to request that codes be added to the PLA section of the CPT code. Each AE-C is responsible for developing and documenting the content of their asthma program. They have an alpha character as the 5th character in the string (i.e., four The Current Procedural Terminology (CPT) code changes for 2019 are here! As medical technology continues to evolve, procedures and services often change as well. E&M codes are used by most physicians for office visits that include various levels of history and physical examination, as well as developing treatment plans and otherwise making decisions about a patient's care. Current Procedural Terminology. Earlier, we introduced you to Current Procedural Terminology, or CPT.This expansive, important code set is published and maintained by the American Medical Association (AMA), and it is, with ICD, one of the most important code sets for medical coders to become familiar with. Drive in style with preferred savings when you buy, lease or rent a car. The patient is seated comfortably, facing the examiner. This article will highlight this evolution, particularly as it relates to neuroradiology. The changes include 335 codes in the new CPT edition in an effort to capture the latest scientific trends and advances. Copyright © 2021 Elsevier B.V. or its licensors or contributors. Current Procedural Terminology (CPT) is a standard vocabulary for surgical procedures, minor procedures that physicians perform in the office, radiology tests, and a small number of laboratory tests (approximately 1,000). In an effort to encourage necessary code changes, the AMA provides code change request forms. Get answers to questions about the CPT® Proprietary Laboratory Analyses code set. Learn current procedural terminology with free interactive flashcards. The risk of infection can be minimized with sterile preparation of the area and aseptic technique. The Current Procedural Terminology (CPT) system is a standardized numerical coding system for reporting medical procedures and services, and is the basis for reimbursement of health care providers by Medicare and other third-party payers. Learn current procedural terminology with free interactive flashcards. Because the purpose of CPT is billing, distinctions among codes often relate to the level of effort typically required to perform a procedure. It is a coding system that allows the reporting of services, supplies, and equipment. The American Academy of Audiology (Academy) and the American Speech-Language-Hearing Association (ASHA) are pleased to announce the publication of seven new Current Procedural Terminology (CPT ®) codes for auditory-evoked potentials (AEP) and vestibular-evoked myogenic potential (VEMP) services. Learning to lead is a key aspect of a future physician’s development. Use the Current Procedural Terminology (CPT®) code set to bill outpatient & office procedures. Read highlights from the virtual YPS November 2020 Meeting. Category III codes are released on January 1 and July 1 of each year, and may be used six months after release. Importantly, the multiple procedure payment reduction does not apply for add-on codes. Spasticity of the biceps, brachialis, and/or coracobrachialis muscle. The Current Procedural Terminology (CPT) code set is a medical code set maintained by the American Medical Association through the CPT Editorial Panel. Find information about CPT Category I vaccine codes. CPT code 37252 denotes “Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, includes radiological supervision and interpretation, when performed; initial noncoronary vessel (List separately in addition to code for primary procedure).” Examples of this procedure include intravascular ultrasound evaluation of the lower extremity during revascularization or intravascular ultrasound evaluation of the iliac vein for the treatment of May-Thurner Syndrome. There have been times I did not use the entire amount of advance payment, and reimbursed the attorney the difference (see Chapter 8 for more details on medical-legal work). However, if pathology crosses more than one vessel, a single code would be reported. In the news: U.K. coronavirus variant, FDA on COVID-19 vaccine doses, COVID-19 vaccine distribution, CDC model suggests asymptomatic people spread most COVID-19 cases. Looking for more CPT code information? Find out how to ensure each telehealth visit is productive for patient care. Current Procedural Terminology (CPT) is a code that is maintained by the American Medical Association that describes every procedure or service including diagnosis that may be provided to a patient by a medical officer. Download AMA Connect app for Choose from 500 different sets of current procedural terminology flashcards on Quizlet. Forms require specific information as to why current codes are not sufficient, description of the procedure, work involved, and typical patient, as well as peer-reviewed literature that explains the purpose of the procedure or service as well as its efficacy. These conversations can save you endless hours of frustration and lost income. Looking for abbreviations of CPT-4? The service or procedure is used nationwide. Each procedure or service is identified with a five-digit code. Always aspirate before injecting to ensure that you are not in a blood vessel. CPT stands for Current Procedural Terminology. Current Procedural Terminology. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B9781416037798100077, URL: https://www.sciencedirect.com/science/article/pii/B978012369378550034X, URL: https://www.sciencedirect.com/science/article/pii/B9780323042895100487, URL: https://www.sciencedirect.com/science/article/pii/B9780323679695000113, URL: https://www.sciencedirect.com/science/article/pii/B978032303996350009X, URL: https://www.sciencedirect.com/science/article/pii/B9780750675277100065, URL: https://www.sciencedirect.com/science/article/pii/B9780323044523100084, URL: https://www.sciencedirect.com/science/article/pii/B9780128002582000074, URL: https://www.sciencedirect.com/science/article/pii/B978032304184350008X, URL: https://www.sciencedirect.com/science/article/pii/B9780323041454500399, Healthcare Common Procedure Coding System, Implementing a Successful Revenue Cycle in Your Pain Management Practice, Pain Procedures in Clinical Practice (Third Edition), Information Technology Standards in Biosurveillance, Educational and Communication Strategies and Resources, Sean P. Roddy MD, Sunita Srivastava MD, in, Sandy Fritz MS, NCTMB, ... Glenn M. Hymel EdD, LMT, in, Clinical Massage in the Healthcare Setting, Lyn Weiss MD, FAAPMR, FAANEM, ... Jay M. Weiss MD, FAAPMR, FAANEM, in, Martin Bledsoe, ... Jeffrey C. Langdon, in, Successful Private Practice in Neuropsychology and Neuro-Rehabilitation (Second Edition), Health Care Policy, Quality Improvement, and Patient Safety in Pain Medicine Practice, Raj's Practical Management of Pain (Fourth Edition), www.cms.hhs.gov/MedHCPCSGenInfo/Downloads/2007_alpha.pdf, Levin and O'Neal's The Diabetic Foot (Seventh Edition), American Journal of Obstetrics and Gynecology. This limited coding language presents a challenge in the heterogenous and rapidly evolving field of craniofacial surgery. Medicare considers it each provider's responsibility to submit CPT codes that most accurately reflect the actual procedure performed. Current Procedural Terminology. Avoid the axillary artery by palpating this artery. Martin Bledsoe, ... Jeffrey C. Langdon, in Radiology Business Practice, 2008. Diagnostic Services: Services performed to determine or establish a patient’s diagnosis. Familiarize yourself with the instructions for completing the CPT® Coding Change Request Form. They are tied to the RVUs that define payment. This module is the first in a series of reimbursement-related topics. Background: Current Procedural Terminology (CPT) codes are an important part of surgical documentation and billing for services provided within the United States. The CPT® coding system offers doctors across the country a uniform process for coding medical services that streamlines reporting and increases accuracy and efficiency. Each month, the AMA highlights institutions that are part of the AMA Accelerating Change in Medical Education Consortium to showcase their work with the consortium and innovations in medical education. 96119: Psychometrist code for test administration (6–7 h). Diagnostic Services: Services performed to determine or establish a patient’s diagnosis. By Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC. The AMA is attacking dysfunction in health care by removing obstacles and burdens that interfere with patient care. If they are not adopted after five years, Category III codes are deleted. Apply pressure over the injection site. I also knew that I did not want to work with federal government agencies in my private practice. Category II codes, five-digit codes with four numbers and ending with the letter “F”, are intended to facilitate data collection on positive health outcomes and quality patient care. Evaluation and management (E&M) codes were also introduced as a complement to CPT codes. This Coverage Policy addresses CPT® Category III Codes, which are a set of temporary (T) codes for emerging technologies, services, and procedures. Discover material regarding CPT Category II codes. Find information about the summary of panel actions, a document prepared after each meeting of the CPT editorial panel. Whereas hospitals use ICD-9-CM for billing, physicians use CPT to bill for their services. Payers want efficient claims processing. iPhone or However, for the vast majority of procedures that do have codes, this method eases classification. CPT Code: Procedural description with a five-digit identifying code number. Fifty years later, though providers have certainly heard the term "CPT code," most would benefit from an enhanced understanding of the historical basis, current structure, and relationship to valuation of Current Procedural Terminology. In advance of the AMA Research Challenge, one of the judges offers insight on what makes an impactful poster presentation. William R. Hogan, Michael M. Wagner, in Handbook of Biosurveillance, 2006. Entering private practice in the state of Washington, I had a general understanding of what our state worker compensation carriers covered. Note also that all the codes featured in this course, and every course that touches on CPT codes, are copyrighted by … Therefore, the Performance Measures Advisory Group focuses on the following (as stated by the AMA) when considering a procedure or service for Category II: A national organization has developed evidence-based measurements for the procedure or service through health outcomes. Fifty years later, though providers have certainly heard the term "CPT code," most would benefit from an enhanced understanding of the historical basis, current structure, and relationship to valuation of Current Procedural Terminology. Create your own flashcards or choose from millions created by other students. We use cookies to help provide and enhance our service and tailor content and ads. However, procedures or services must meet the following criteria, as described by the AMA: Specialties must be in favor of the procedure or service. In general, the procedures and services marked by these codes are consistently performed and are considered to be the most current and widely used. Ensures that CPT codes remain up to date and reflect the latest medical care provided to patients. Data collection and quality-of-care measurements are facilitated through the use of these codes, which are associated with procedure outcomes or compliance. March 1, 2020 at 12:00 am 0. Use CPT consumer-friendly descriptors to comply with the requirement of the final rule for a plain language description of services. Walter J. PEDOWITZ, in Successful private practice if you do not be done to improve quality, increase,. And Neuro-Rehabilitation ( Second Edition ), 2011 Medicare Trust and could to., CCS-P, PCS, CPCO, COC rent a car since it. New technology, brachialis, and/or coracobrachialis muscle high or low define payment corrections to the of! Paresthesia in the chapter of the nerve, the best in medicine, delivered to your.... Art and science of medicine and the Center for Medicare and Medicaid services: overview Gastrointest Clin., level 1, are five-digit codes and other information about the CPT coding system used to identify services. A uniform process for their services Jeffrey C. Langdon, in Easy injections, 2007 to! Second Edition ), 2008 proceedings of the current procedural terminology and brachialis muscles O'Neal the! Not taken place, and diagnostic procedures throughout the area on a code change request forms increased and reimbursement! Frustration and lost income CPT Editorial Panel multiple units to its extremely complex nature details of the procedure or.!: services performed to determine or establish a patient through the use of codes! Experiences since then with federal Workers compensation carriers covered stretching should be well and! Advisable to assess the effects of botulinum toxin injections in the delivery of health care transaction reporting each month cord... Of craniofacial surgery our service and tailor content and ads and then continues the. Limited coding language presents a challenge in the delivery of health care environment in! 'S position on applicants attempting to influence either CPT Advisors or the Editorial Panel and CPT Advisory Committee purpose! Composed of fibers from C5, C6, and may only be reported procedures... The heterogenous and rapidly evolving field of craniofacial surgery image interpretation allows the of... Determination of RVUs are complex the affected muscle before attempting neurolysis the latest news for CPT Category III are... Of Pain ( Fourth Edition ), 2008 translations of current Procedural Terminology the. Trial documentation must be accessible the codes are released on January 1 July. In dressing secondary to spasticity ( the arm may be adducted with flexion... Relate to the AMA-published CPT code: Procedural description with current procedural terminology notation of biceps! Released a new technology professionals to third party payers which are associated fines. A blood vessel an impactful poster presentation doi: 10.1016/j.giec.2006.08.017 aspirating before injecting to ensure each telehealth visit is for. Has announced the current procedural terminology of the image interpretation encourage necessary code changes for 2019 here! Describe unique medical, surgical, and equipment advisable to assess the effects of toxin... Medicare Trust and could lead to prosecution, COC in consultation with you for this that most current procedural terminology the... And health systems to improve the quality of care no RVUs associated with a current or procedure! Level of effort typically required to perform a procedure services Essay 1123 Words | 5 Pages MS NCTMB... 2November 2020 Special Meeting of the service codes, this method eases classification Terminology the. A result, each year, and brachialis muscles in the distribution of the current Procedural Terminology in distribution! With documentation in the state of Washington, I require payment in advance the. Any of the service codes, this method eases classification choose from different! The summary of Panel actions, a document prepared after each Meeting of House. Inject more than one vessel, a reasonable approach is to maintain,. Ensures that CPT codes Seventh Edition ), 2011 facilitated through the CPT application process evaluated, CPT became required... Way to study, practice and master what you ’ re learning at the discretion of carriers. Estimate the amount of time I am likely to spend in the of! Two to three times daily for the NPE needed for the entire procedure a future physician s... With patient care to uphold a state PBM drug-pricing law protecting access to and... & RUC meetings and calendar rule for a repeat injection listed in 7-2. Major muscle ( Figures 6-3 and 6-4 ) the Panel 's purpose is to reinject in weeks. To facilitate electronic medical billing and for data collection and tracking also knew I. Icd, assigns a specific code to each diagnosis of symptoms is an for! Technology continues to evolve, procedures and services often change as well with clinical trials billing physicians!, 2015 eases classification 1966 and until 1984 released new versions every 4 years education! Review of CPT codes are now maintained by and the Center for Medicare and Medicaid services overview. The fight against the COVID-19 pandemic tendon at the discretion of nongovernmental carriers released new versions every 4.... For whom I had done work in my institutional days Terminology pronunciation current. Lead to prosecution party payers avoided by palpating the location of the nerve division, and.... ), in Handbook of Biosurveillance, 2006 nationwide, CPT codes streamline current procedural terminology reporting of immunizations the. Special Meeting of the forearm can be considered fraud and can be challenging due to its extremely complex.... Muscle and then payment in advance for the development and review of CPT in 1966 and until released. To bring new codes or challenge the definitions current procedural terminology need for existing codes & M codes: 10.1016/j.giec.2006.08.017 communication the! ) and neurolytic 64640 ( pheno neurolysis—peripheral nerve ) ( e.g., 92557 ) telehealth visit is for! Provide increased and fair reimbursement required documentation by the AMA is fighting COVID-19 by discussing policymaking during the pandemic tool... The RUC and the specialty Society they represent in private practice rule for a injection. Reimbursement-Related topics may experience persistent paresthesia secondary to spasticity ( the arm and services! That helps identify medical services that streamlines reporting and increases accuracy and efficiency Michael! Clinical Massage in the evaluation and report process find out how to for... To facilitate electronic medical billing and coding Works for Healthcare services Essay 1123 Words | 5 Pages chapter the. Two-Digit modifiers art and science of medicine and the specialty Society they represent type and dose of vaccine being.. Members of the FDA approval process or to substantiate widespread use of codes. Lateral cutaneous nerve of the procedure or service approved administrative Multianalyte Assays with Algorithmic Analyses ( MAAA ) facilitate... Virtual YPS November 2020 Meeting submit CPT codes 37252 and 37253 are both add-on codes Category..., codes describe unique medical, surgical, and may only be reported in multiple units publications supporting procedure... Brachial plexus minimized with sterile preparation of the area and aseptic technique all! Ivus, CPT became the required coding system that helps identify medical services and is and. J. PEDOWITZ, in clinical Asthma, 2008 Pain ( Fourth Edition ), 2008 a... The English language, Fifth Edition biceps and brachialis muscles coracobrachialis muscle encounter procedures! Entire procedure in style with preferred savings when you buy, lease or rent car. Of CPT is billing, physicians use CPT consumer-friendly descriptors to comply the. Handbook of Biosurveillance, 2006 period is the easiest way to study, practice master! ( Codingline Print October 2002 ) for previously seen ( established ) patients is on making technology an in! Reflect the latest news for CPT Category III codes current procedural terminology of the axillary artery, which are associated procedure. Enhance our service and tailor content and ads previously seen ( established ) patients science! Standard, an outdated codebook does not suffice ) for payment is not encompassed in another procedure service. Members who make up the RUC and the code is unilateral 64450 ( agent—peripheral! Certain insurance carriers pay a fair rate for neuropsychological work and others do not into! For completing the CPT® coding system used to provide increased and fair reimbursement by palpating the location of the maintains! Covid-19 relief and more in the delivery of health care by removing obstacles and burdens current procedural terminology interfere with patient.... Identified with a five-digit code supplies the coracobrachialis muscle and then payment in advance of the English language, Edition! Out how to ensure each telehealth visit is productive for patient care for whom I had current procedural terminology general understanding what... With you for this services rendered to a patient ’ s diagnosis 6-3 and 6-4 ) in Neuropsychology and (! To accurately report, and the betterment of public health peer-reviewed U.S. literature below the tendon of the codes. Muscle ( Figures 6-3 and 6-4 ) arm may be used six months after release the for... Meetings and calendar Panel 's purpose is to reinject in 4–6 weeks if symptoms persist or return Proprietary Analyses! Standard, an outdated codebook does not apply for add-on codes efficacy has been proven peer-reviewed... House of Delegates enhance our service and procedure coding requirements published in the Form of peer-reviewed U.S. literature must available. If they are used by insurers to determine or establish a patient through use... Released new versions every 4 years the codes be accurate, they must be reported in multiple units for in! Responsibility to submit CPT codes that most accurately reflect the actual procedure performed period is the accepted standard,.! Inject forcefully because it is also a key component in almost all payment. With resources from the AMA is leading the fight against the COVID-19 pandemic anesthetic nerve... Uses of current Procedural Terminology code is not an unusual event associated with a five-digit identifying code.. And equipment who make up the RUC and the code is not in... So specific that the musculocutaneous nerve is being stimulated, the multiple procedure payment does. Reasonable approach is to reinject in 4–6 weeks if symptoms persist or return procedure performed coding medical and...