5 Written questions
5 Matching questions
- NEC - Not Elsewhere Classifiable
- Pathology and Lab
- Phantom Billing
- Physical Exam Levels
- a Billing for tests not performed
- b Problem focused= 1-5 elements
Expanded problem focused= >6
Comprehensive= 18+ or 2 bullets in 9 systems
- c can be used in two instances:
1) not enough info available to determine which specific diagnosis code should be used in situations where ICD-9 provides very specific diagnoses.
2) The coder has specific information about the diagnosis that is not an option in the choice of ICD-9 codes
- d Pretty straightforward
Certain "panels" have one code for related blood tests (liver function, lipids, thyroid functions)
Everything in the panel will be listed with the code
- e using tow codes when a combined code exists
5 Multiple choice questions
- • 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.
- repairs requiring more than layered closure (ie: scar revision, debridement, etc.)
- 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
- Many procedure codes also include procedures and supplies that are routinely necessary to perform the procedure
Only services not typically performed, or materials not typically used, should be billed separately
Charging for these items separately, known as "unbundling" or "fragmenting," is against the law.
- 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)
5 True/False questions
Modifiers → "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
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.
Preventive Medical Services → 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)
Starred procedures → Procedures in which the follow-up is generally non-existent or varies with the patient's underlying condition
When billing for a starred procedure, the charge does not include any pre or post-operative care
ICD-9 CM codes → Example:
Q0113 Pinworm examinations (kit given= supply billed)
A0100 Non-emergency transportation; taxi
D0270 Bitewing-single film
H0030 Behavioral health hotline service
J0120 Injection, tetracycline, up to 250 mg
P9019 Platelets, each unit
K0005 Ultralightweight wheelchair
CPT, Category I → 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