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5 Written Questions

5 Matching Questions

  1. HCPCS Level II - National Codes
  2. Billing based on time
  3. Modifier 25
  4. "V" Codes
  5. Reflex Testing
  1. a 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)
  2. b Automatically running a test based on a previous test result w/o the MD/PA requesting the second test
  3. c 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
  4. d 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
    99214-25
    Indicates that same provider did both procedures at the same visit.
  5. e 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.

5 Multiple Choice Questions

  1. 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
  2. • 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%)
  3. 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.
  4. Suturing of superficial tissues where wound requires simple one layer closure
    Local anesthetic included in charge
    If wound is closed with adhesive strips, use E/M code instead (regular office visit)
    However use of dermabond or staples would be procedural codes
    Heavily contaminated wounds requiring extensive cleaning and simple closure may be coded as Intermediate repair
    3types of repairs: Simple, Intermediate, Complex
  5. 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:

5 True/False Questions

  1. History component levelsProblem focused= 1-5 elements

    Expanded problem focused= >6

    Detailed= >12

    Comprehensive= 18+ or 2 bullets in 9 systems

          

  2. CPTPROCEDURAL 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
    Three Categories:
    I= Evaluation & Management
    II= Performance Measurement
    III= New/emerging technology

          

  3. Parentheses ( )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:

          

  4. SuperbillMany 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.

          

  5. Intermediate repairsSuturing of superficial tissues where wound requires simple one layer closure
    Local anesthetic included in charge
    If wound is closed with adhesive strips, use E/M code instead (regular office visit)
    However use of dermabond or staples would be procedural codes
    Heavily contaminated wounds requiring extensive cleaning and simple closure may be coded as Intermediate repair
    3types of repairs: Simple, Intermediate, Complex

          

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