5 Written Questions
5 Matching Questions
- Starred procedures
- Up Coding
- Brackets [ ]
- "V" Codes
- a 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
- b 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
- 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 used to enclose synonyms, alternative wordings or explanatory phrases
- e using tow codes when a combined code exists
5 Multiple Choice Questions
- Expensing employees or hours worked that do not exist
- Medicare/medicaid program that aims at catching fraud
- 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
- Billing for tests not performed
- Automatically running a test based on a previous test result w/o the MD/PA requesting the second test
5 True/False Questions
Modifyer -59 → "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
Modifier 51 → 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.
Kickbacks → a bribe or financial incentive
Coding of underlying diseases → both the manifestation of the condition and its underlying cause need to be listed. ITALICIZED codes are never to be reported w/o an additional code and they are never to be reported as the patients primary diagnosis.
HCPCS → 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)