5 Written questions
5 Matching questions
- Phantom Employees
- Reflex Testing
- Suturing coding tips
- Code Jamming
- a 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
- b Inserting or "jamming" incorrect ICD-9 code to get coverage for a lab or test
- c A superbill is a form used by medical practitioners that can be quickly completed and submitted to an insurance company or employer for reimbursement.
It generally has both CPT codes and ICD-9 codes that are frequently used in your practice in a check-box format.
- d Expensing employees or hours worked that do not exist
- e Automatically running a test based on a previous test result w/o the MD/PA requesting the second test
5 Multiple choice questions
- 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
- Codes are a series of 3-5 numbers, the last two numbers separated by a decimal (111.11)
3 digits before decimal = general category
2 digits post decimal = specific description
(4th Digit = Subcategory)
(5th Digit = Subclassification)
Codes are divided into 17 primary chapters
Separated out by body systems etc.
- Billing for tests not performed
- Used to enclose a series of terms, each of which is modified by the statement appearing to the right of the brace.
- used to enclose synonyms, alternative wordings or explanatory phrases
5 True/False questions
Radiology → 2-digit numeric code
Used to indicate that a procedure has been altered by some specific circumstance, but not changed in its definition
Medical Necessity → *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 22, Unusual procedural services → 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.
History component levels → Problem Focused= HPI: Brief (1-3); ROS & PFSF N/A
Expanded Problem Focused= HPI: Brief (1-3); ROS:Problem pert (1); PFSH: N/A
Detailed= HPI: Extended (4-3 chronic); ROS Extended (2-9); PFSH: Pertinent (at least 1)
Comprehensive= HPI: Extended (4 or 3 chronic); ROS: Complete (10+); PFSH: Complete (2 established) (3 new/consult)
False information → Billing for services not provided or not at the level billed for
False Claims Act- allows individuals to file claims against companies that they think have defrauded the government. More than $17 billion dollars have been recovered by the government since 1987