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5 Written Questions

5 Matching Questions

  1. Preventive Medical Services
  2. When can you bill "Incident to"?
  3. Modifier 51
  4. Stark Law
  5. Billing based on time
  1. a Codes 99381-99397
    The "Comprehensive" nature of the Preventive Medicine Services reflects an age and gender appropriate history/exam.
    (anticipitory guidence, risk factor reduction, etc)
  2. 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
  3. c Time is only a factor in determining the level of service if > 50% of the time spent is spent in counseling/coordination of care.
    You must document the total amount of time spent and indicate that >50% of that time was spent in counseling/coordination of care
  4. d • 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.
  5. e "MULTIPLE PROCEDURES"
    List the major procedure first, with the additional lesser procedure(s) secondary with mod 51
    For example, if a 100 sq. cm. knee wound is debrided, then reconstructed with a medial gastrocnemius muscle flap and split thickness skin graft, the procedure is reported:
    15738 Muscle flap
    15100-51 STSG
    15000-51 Wound preparation
    The major procedure is the muscle flap and the "-51" modifier is not appended to its CPT code. The secondary procedure CPT codes take the "-51" modifier.

5 Multiple Choice Questions

  1. Problem focused= 1-5 elements

    Expanded problem focused= >6

    Detailed= >12

    Comprehensive= 18+ or 2 bullets in 9 systems
  2. repairs requiring more than layered closure (ie: scar revision, debridement, etc.)
  3. It's how we get paid.

    Optimal Reimbursement
    Avoid denials/delay in payment

    Avoid audit by coding properly
    Documentation must support code
    "If it isn't documented, you didn't do it"
  4. 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.
  5. Billing for tests not performed

5 True/False Questions

  1. What is coding?The application of a number of systems used to uniformly document and track health care services delivered.

    Used for:
    Billing & reimbursement
    practice profiling
    Quality measurement

          

  2. Modifier 22, Unusual procedural servicesCodes 99381-99397
    The "Comprehensive" nature of the Preventive Medicine Services reflects an age and gender appropriate history/exam.
    (anticipitory guidence, risk factor reduction, etc)

          

  3. NPI (National Provider Identifier)Means Unspecified (don't know yet)
    Used when the coder does not have enough information to select a more definitive diagnosis (ie. Cultures are pending)

          

  4. Simple repairsrepairs requiring more than layered closure (ie: scar revision, debridement, etc.)

          

  5. Intermediate repairswhen repair involves layer closure of 1 or more of the subcutaneous tissues and superficial facia

          

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