Procedure or service that is unique or an atypical finding that affects the patient’s treatment. When billing for an unusual procedural service, a -22 modifier is appended to the usual five-digit CPT procedure code when the service provided is greater than that usually required for the listed procedure.

Deliberate manipulation of Current Procedural Terminology (CPT) codes for increased payment by using a code for a higher payment than the code for the service performed (e.g., a podiatrist who performs a simple nail clip service but bills for foot surgery). Under the False Claims Act, providers who are caught upcoding face a civil monetary penalty of $5,000 to $10,000 per service. In addition, the federal government can make an assessment against a provider of up to three times the service claim amount as repayment for a Medicare case. Also called code creep or overcoding .

Annual adjustment of the Medicare fee schedule to raise or lower base payment amounts to allow for changes in cost of living by determining the relative values of new and revised procedure codes. See Medicare economic index (MEI) and Medicare Volume Performance Standard (MVPS) .

Inpatient hospital admission category. Patients in this category need to be admitted as soon as a bed is available, within 24 to 48 hours. See urgent admission .

Inpatient hospital or facility acceptance of a patient who requires immediate medical or psychiatric care because of life-threatening, serious, and possible disabling conditions.

Medically necessary treatment required for illness or injury that is not a serious threat and would not result in further disability or death if not treated immediately (e.g., ear infection, ear wax removal, small laceration).