5 Written questions
5 Matching questions
- NOS - Not Otherwise Specified
- Complex repairs
- Stark Law
- a using tow codes when a combined code exists
- b repairs requiring more than layered closure (ie: scar revision, debridement, etc.)
- c a physician is prohibited from making any referral to a provider of designated health services if the physician has a "financial relationship" with the provider. a healthcare provider is prohibited from submitting for services rendered to patients referred in violation of the statute
- d 2-digit numeric code
Used to indicate that a procedure has been altered by some specific circumstance, but not changed in its definition
- e 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 Multiple choice questions
- 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
- EXTERNAL causes of injuries and poisonings. Shouldn't be listed as a primary diagnosis; they are considered supplementary codes.
- • 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.
- "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.
- 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.
5 True/False questions
Billing based on time → 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
Radiology → 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
(This indicates you are only billing for interpretation of film)
ICD-9 CM codes → Vol 1= "Diseases- Tabular List"
Vol 2= "Diseases- Alphabetical Index"
Vol 3= Listing of procedure codes and an index to the procedures.
NEC - Not Elsewhere Classifiable → 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
Reflex Testing → Inserting or "jamming" incorrect ICD-9 code to get coverage for a lab or test