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5 Written questions

5 Matching questions

  1. Code Jamming
  2. HCPCS
  3. Modifier 22, Unusual procedural services
  4. Preventive Medical Services
  5. HEAT
  1. a 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)
  2. b 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

    Three levels:
    CPT (Common Procedural Terminology)
    National Codes or alpha-numeric codes
    Local codes (phased out in 2003)
  3. c 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.
  4. d Inserting or "jamming" incorrect ICD-9 code to get coverage for a lab or test
  5. e Medicare/medicaid program that aims at catching fraud

5 Multiple choice questions

  1. Evaluation and Management (E/M) Services
    Describe services provided to evaluate patients and manage their care
    These codes are widely used and cover a large portion of the medical care provided to patients

    Codes are specific to setting (office, hospital, ER, home) and whether it is a new or established pt.
    Codes are based on what was done (and documented) in three areas:
    Physical examination
    Medical decision making
  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. It's how we get paid.

    Optimal Reimbursement
    Avoid denials/delay in payment

    Avoid audit by coding properly
    Documentation must support code
    "If it isn't documented, you didn't do it"
  4. An x-ray code for a film assumes that both the technical and professional components are included (the fee for the machine and film, the technician, and the reading of the film.)
    71010, single frontal view chest x-ray
    If a film is taken elsewhere, but interpreted by a provider, use same code + professional component modifier-26
    Ex) 71010-26
    (This indicates you are only billing for interpretation of film)
  5. 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

5 True/False questions

  1. AnesthesiaMedicare/medicaid program that aims at catching fraud


  2. Braces { }are placed after an incomplete term which requires one or more of the modifying terms that follow it in order to make the code assignable to a given category.


  3. importance of documentationrequired for payment. It provides the justification & support for the procedures and services you render by making the medical necessity of your service clear to the 3rd party


  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. What is coding?The application of a number of systems used to uniformly document and track health care services delivered.

    Used for:
    Billing & reimbursement
    practice profiling
    Quality measurement


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