5 Written Questions
5 Matching Questions
- CPT, Category I
- ICD-9 CM codes
- Colon :
- Stark Law
- "V" Codes
- a are placed after an incomplete term which requires one or more of the modifying terms that follow it in order to make the code assignable to a given category.
- b a physician is prohibited from making any referral to a provider of designated health services if the physician has a "financial relationship" with the provider. a healthcare provider is prohibited from submitting for services rendered to patients referred in violation of the statute
- c most commonly used for reporting diagnostic services. Often times additional diagnoses will be reported secondary to the "v" code.
Radiology and pathology/lab services are usually listed with a "V" code as the primary diagnosis and the pt complaints, symptoms and signs or other diagnoses secondarily.
- d Evaluation and Management (E/M) Services
Describe services provided to evaluate patients and manage their care
These codes are widely used and cover a large portion of the medical care provided to patients
Codes are specific to setting (office, hospital, ER, home) and whether it is a new or established pt.
Codes are based on what was done (and documented) in three areas:
Medical decision making
- e International Classification Of Disease, 9th Revision, Clinical Modifications
Initially developed by the World Health Organization as a way to report morbidity and mortality statistics worldwide
Not initially meant to be used for billing purposes
Maintained and updated yearly by the National Center for Health Statistics
5 Multiple Choice Questions
- An E/M service that resulted in the initial decision to perform surgery
A practitioner is consulted to determine whether surgery is necessary for a pt with abd pain. The services meet the criteria to report consultation*. The requesting MD agrees w/ consult and surgeon takes over case. Later that day surgery to repair perf ulcer is done.
99244-57 office consultation for a new or established pt
44602 suture of small intestine for perf ulcer...
- Used to enclose supplementary words which may or may not be present in the disease statement and which do not affect code selection per se.
- Billing for tests not performed
- Pronounced "hick picks"
Health Care Financing Administration's Common Procedural Coding System
HCFA (Health Care Financing Administration) Now CMS (Centers for Medicare and Medicaid Services) was/is the governing agency of Medicare and Medicaid
CPT (Common Procedural Terminology)
National Codes or alpha-numeric codes
Local codes (phased out in 2003)
- length of wound is always documented and measured in (cm). When there's more than one wound in the same classification add teh length of the wounds and code it as one repair. repairs involving nerves/tendons/vessels are coded differently (see NS/muscsktl/cv-surgury)
*Code Length and severity
5 True/False Questions
Coding of underlying diseases → *Code to the highest level of certainty at that visit.
*Only code the reason for the encounter, and those conditions that affect the care delivered
*Use the most specific code available (4th=complications of the disease; 5th=clarifies condition)
*Do not use "rule out" or "suspected" diagnosis (codes as a pre-existing condition to insurance co)
Instead use a code from the "symptoms, signs, and ill-defined conditions" chapter.
*Make sure the ICD-9 code supports the CPT code.
Modifier 25 → Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service.
Pt is seen for fever, h/a, vomiting, and stiff neck. A spinal tap is performed as well as the E&M services consistent with 99214.
62270 Spinal puncture, lumbar, diagnostic
Indicates that same provider did both procedures at the same visit.
HEAT → Medicare/medicaid program that aims at catching fraud
CPT → Medicare/medicaid program that aims at catching fraud
When can you bill "Incident to"? → • When a physician has previously diagnosed and has established care and a management plan for the Medicare patient, and the NPP is providing the follow up care.
• When any physician is on the premises and available if the NPP needs assistance.
• In any clinic not associated with hospitals.