5 Written questions
5 Matching questions
- CPT, Category I
- Modifier 22, Unusual procedural services
- Modifyer -59
- When can you bill "Incident to"?
- a When the service provided is > that usually required for the listed procedure (E/M - 21)
A provider excises a lesion from the crease of the neck of a very obese person. The obesity makes the excision more difficult. The provider indicates the complexity of the removal by adding 22 modifier to code. It may be helpful to include copy of operative report.
- b "DISTINCT PROCEDURE"
Indicates that codes that usually are bundled together as a part of a global code are in this particular circumstance describing DISTINCT or SEPARATE precedures
- c • 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.
- d 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)
- e 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
5 Multiple choice questions
- when repair involves layer closure of 1 or more of the subcutaneous tissues and superficial facia
- a bribe or financial incentive
- Left to the anesthesiologists
Moderate (conscious) sedation (actually a medicine code-not part of the anesthesia codes) 99143-99145
Codes of interest to emergency medicine bundling:
- Problem focused= 1-5 elements
Expanded problem focused= >6
Comprehensive= 18+ or 2 bullets in 9 systems
- "A consultation is a type of service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source."
5 True/False questions
What is coding? → Inflating the seriousness of the patient's condition or the level of E/M needed to help the patient to obtain a higher reimbursement the one is entitled
HEAT → PROCEDURAL CODE
CPT codes account for the majority of the HCPCS coding system
Maintained/Updated by the AMA
Codes for >7,000 procedures and services
5-digit code 00100-99199
Followed by a verbal description
I= Evaluation & Management
II= Performance Measurement
III= New/emerging technology
Up Coding → Inflating the seriousness of the patient's condition or the level of E/M needed to help the patient to obtain a higher reimbursement the one is entitled
Suturing coding tips → The application of a number of systems used to uniformly document and track health care services delivered.
Billing & reimbursement
Coding Rules → *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.