HIT 182 Final

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In which CPT appendix would additions, deletions and revisions be found?

appendix B

Where is specific coding information about each section located?

guidelines

according to the E/M guidelines, time is not a descriptive component for the ??? department levels of E/M service.

emergency

How may sections are there in the CPT manual?

6

The words that follow a code in the CPT manual are called?

procedure/service descriptor

what is the function of an add-on code?

identifies a code that is never used alone.

T or F? If a coder is unable to locate a code that describes the exact service provided, it is acceptable to use a code that approximates the service provided.

false

The ? section guidelines contain the definition of a separate procedure.

surgery

procedures that are experimental, newly approved or seldom used are reported with what type of code?

unlisted/category III

The universal health insurance form for submission of outpatient services is the ?

CMS 1500

Which of the following represent the three of the six elements that a special report must contain?

nature, need and extent

which punctuation mark between codes in the index of the CPT manual indicates two codes are available?

comma

A ?? must accompany claims when using an unlisted procedure code.

special report

What year was CPT first developed?

1966

Health care providers are ? based on the codes submitted on a claim form for procedures and services rendered.

reimbursed

Level II codes are not used in what setting?

inpatient

according to the notes preceding the category III codes in the CPT manual, the digits of the category III codes are not intended to reflect the placement of the code in the category I section of the CPT.

nomenclature.

What modifier would you use if you were coding only the technical component of a diagnostic procedure?

-TC

the modifier that indicates multiple procedures is?

-51

Modifier -52 reduced services is used to indicate?

a service was reduced without changing the definition of the code

Modifiers may affect ?

the way payment is made by a third party payer

Modifier -59, distinct procedure service is used to indicate that?

services are usually bundled into one payment were provided as separate services.

Mr. Coslett has multiple surgeries performed during the same operative session. Which modifier would you use?

-51

Multiple modifiers are indicated with which modifier?

-99

Modifier 51, multiple procedures, is used on what type of services?

surgery

modifier -57 decision for surgery, is used on what type of service?

E/M

Mrs. smith presented to her physician's office for an office visit for a URI. The physician examines the patient and describes and prescribes antibiotics. the physician notices the patient has a suspicious looking mole. they physician examined the mole and determined that it should be removed. the mole was removed during the same office visit. the physician bills both an E/M code and a procedure code. Which modifier would you use on the E/M code?

-59

where are some HCPCS modifiers located in the CPT book?

appendix A

Modifier -32 is used to indicate a service is mandated. Which of the following is an example of when a service is mandated?

an insurance company requires a second opinion prior to surgery.

t or f? the pre-release draft of the ICD 10 was released in june of 2003 and replaced with a revision in july of 2007.

true

this crosswalks icd 9 codes to icd 10 codes

GEMS

maximum number of characters in an I10 code?

7

name three reasons for implementing physician payment reform?

decrease medicare expenditures, redistribute physicians' payment more equitably and to ensure quality health care at a reasonable rate.

MACS or fiscal intermediaries do what for CMS?

they're usually and insurance company and they handle the daily operations for medicare, including paperwork claims payments.

name and briefly describe the 4 parts of medicare.

Part A: hospital insurance
Part B: outpatient coverage
Part C: additional insurance for gap
Part D: prescription drug coverage

which of the following is an example of a discount that should be permitted as a safe harbor from fraud abuse regulations?

An HMO contracts with a lab for all lab services and received a discounted price.

which type of organization reviews hospital and care, as well as whether the hospital adheres to the drg system?

quality improvement organization

name three of the most common forms of medicare fraud:

submitting forms for services not rendered
misrepresenting kickbacks
kickbacks
unbundling

t or f- ICD 9 codes are required on the claim by payers in order to pay the claims

true

t or f? the words "and" and "with" have similar meanings.

false

t or f? when a code is listed inside slanted brackets, you must sequence that code after the underlying condition code.

true

t or f? the symbol that instructs you to use an additional ICD10 code in all manuals is a plus symbol?

false

What is the UHDDS definition for a principal diagnosis?

"that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care"

medicare was established when?

1965

inpatient hospital procedures are coded with what code sets?

I-10, I-9 volume 3

diagnosis codes come from what code sets?

ICD 9 and 10, volume 1 & 2

physician services/other health services use what code sets?

HCPCS and CPT

RVUs are based on three components...

work, overhead and malpractice

procedures that are experimental, newly approved or seldom used are reported with what type of code?

unlisted- category III

t or f? italicized type codes cannot be assigned as a first listed diagnosis because they're always listed after another code

true

t or f? when using the neoplasm table, it is not necessary to refer to volume 1?

false

t or f? the hypertension table is found in volume one?

false

e codes are used to report?

external causes of injury and poisoning

v codes are located where?

volume 1

section four of the official guidelines for coding and reporting applies to what settings?

outpatient

t or f? z codes cannot be used in the outpatient setting?

false

t or f? z codes can be assigned as first listed or secondary diagnosis?

true

t or f? A patient is admitted to an observation unit for medical condition that has worsened and is then admitted as an inpatient to the same hospital for the same medical condition. The primary diagnosis would be the medical condition that led to the admission.

true

t or f? for an outpatient service, a history code (z80-z87) may be assigned as a secondary code if the historical condition or family history has an impact on the current care or has an influence on the treatment.

true

t or f? assign z01.89, encounter for other specified special exam for encounters for routine lab/radiology testing in the absence of any signs, symptoms or associated diagnoses.

true

t or f? the same coding guidelines apply to botht he inpatient and outpatient settings?

false

t or f? the first listed diagnosis is the diagnosis that the physician lists first?

false

t or f? v codes can be assigned as first listed or secondary diagnoses?

true

t or f? if a patient is admitted for observation for a medical condition, a code is assigned for the medical condition as the first listed diagnosis.

true

to code long term use of high risk meds?

go to long term-

to code preop exam for elective cholecyctectomy due to gallstones...patient is seen by pulmonologist because of COPD..3 codes.

1. exam-preop-respiratory
2. calculus- gallbladder- see also cholithiasis..cholelithiasis= 574.2- go to tabular
3. disease- pulmonary- diffuse obstructive

patient admitted for observation following accident at work....

observation- accident- at work

the official guidelines for coding and reporting are updated every year?

true

t or f? the routinely associated signs and symptoms should not be coded in addition to a code for the particular disease or condition?

true

t or f? it is unacceptable to code an impending condition as if it exists?

true

t or f? when sequencing codes for residuals, the residual is coded first?

true

t or f? multiple codes should not be used when there is a combo code that identifies all the elements documented in the diagnosis?

true

code threatened spontaneous abortion

go to threatened...abortion

acute and chronic diastolic heart failure

failure- heart-diastolic- acute on chronic

acute cystitis due to shiga toxin producing ecoli?

cystitis- acute= 595.0
infection- e coli= 041.4

acute and chronic laryngitis

LIST ACUTE FIRST: 464.00 and 476.0

calculus of the bile duct with acute and chronic cholecystitis

choledocholithiasis- acute: 574.3 add 0 without obstruction and chronic, 574.4, add 0 without obstruction

t or f? icd 9 presumes a cause and effect relationship between hypertension and chronic kidney disease

true

cochlear otosclerosis

otosclerosis- cochlear

t or f? hiv infection can be reported if documented as "suspected" or "possible"

false

primary malignancy of the roof of the mouth-

neoplasm table- mouth- roof

chronic lymphangitis

lymphangitis- chronic

pancytopenia due to myelodysplastic syndrome

code myelodysplastic syndrome first= 238.75
pancytopenia= 284.1

staphylococcus aureus septicemia

septicemia- staph aureus= 038.11

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