5 Written Questions
5 Matching Questions
- Suturing coding tips
- When can you NOT bill "incident to"?
- ICD-9 volumes
- HCPCS Level II - National Codes
- a Vol 1= "Diseases- Tabular List"
Vol 2= "Diseases- Alphabetical Index"
Vol 3= Listing of procedure codes and an index to the procedures.
- b • If a physician is not on the premises at the time the NPP sees the patient.
• If the patient is new to the clinic and has not been previously seen by the physician.
• If the NPP makes a new diagnosis.
• In a hospital.
- c 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.
- d Created by CMS
Services and supplies not found in the CPT code set
Ambulance services and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)
Alpha-numeric (one letter plus 4 numbers)
- e 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
5 Multiple Choice Questions
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
- Automatically running a test based on a previous test result w/o the MD/PA requesting the second test
- This is a unique identification number for covered health care providers which they use to bill Medicare for their services
- 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
- 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)
5 True/False Questions
Anesthesia → Medicare/medicaid program that aims at catching fraud
Services not Rendered → 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
Incident To → • A Medicare billing provision that enables services provided by NNPs (non-physician providers) in an office or clinic setting to be reimbursed at 100% of the physician fee schedule by billing using the physician's NPI (otherwise reimbursed 85%)
Modifier 25 → "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.
Phantom Employees → Expensing employees or hours worked that do not exist