CPT code

Description of a procedure with a five-digit code number to identify professional services (see Box C-1 ). The codes are maintained (published annually) and copyrighted by the American Medical Association (AMA).Box C-1CURRENT PROCEDURAL TERMINOLOGY CODE DIGIT ANALYSIS

CPT modifier

Two-character code that may follow a five-digit CPT code to indicate a service or procedure has been altered in some way from the stated CPT or HCPCS Level II description but not sufficient to change the basic definition of the service.

Credential

University degree, postgraduate training and education, licensure and/or board certification that indicates a person or institution has obtained professional status in a specific field of health care.

Credentialing

1. Generic term that refers to either licensing or certification. 2. Act of reviewing and evaluating qualifications such as education, training, experience, medical degrees, licensure, other credentials, malpractice, and any disciplinary record of a medical provider for quality assurance for the purpose of granting hospital staff membership to give patient care services. Periodically, a check of the status of staff qualifications is done and is referred to as recredentialing . 3. Process by which a managed care plan endorses that a physician is competent to render medical services to members of the plan. Also see economic credentialing.