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42 terms

Medical Coding Guideline Review

Medical Billing and Coding
According to the Medicine Guidelines, some of the listed procedures are commonly carried out in addition to the:
Primary procedure performed
Some of the procedures or services listed in CPT that are commonly carried out as an integral component of a total service or procedure have been identified by:
Separate procedure
99070 is used to identify:
Supplies and materials
The subsction information paragraph in the Medicine Guidelines contains a listing of those special subsections within the medicine section that have:
Special instructions
This modifier may be used to indicate a procedure that is not considered to be a component of another procedure but is a distinct, independent procedure:
Modifier -59
This type of immunization does not cause an immune response:
Passive immunizations
When coding a routine vaccination, what are the two types of codes that will always have to be reported?
Administration and the substance given
A 65-year-old Medicare patient presents for an influenza vaccination, split virus, intramuscular injection
90658 - vaccine
G0008 - administration
Outpatient Clinic: Therapeutic infusion of saline solution with 5% dextrose IV, 500 ml for dehydration, lasting 148 minutes.
96360 - infusion
J7042 - saline solution with 5% detrose, IV 500 ml
This part of Medicare covers the hospital portion:
Part A
This entity is assigned the daily operation of the Medicare program by CMS:
This is the money that supports the Medicare program:
Social Security Taxes
Under which part of Medicare would home health visits be covered?
Part A
Which of the following is the "PRO", not responsible for reviewing: Admission, discharge, diagnoses, coverage.
A service that is supportive of care of the patient, such as laboratory services:
Ancillary services
The numeric designation for a group of providers that is used instead of the Individual Provider Number:
GPN (Group Provider Number)
This 10-digit number is assigned to providers to be used for identification purposes when submitting services to payers:
NPI (National Provider Identification)
According to the E/M, there are five elements to the basic format of the services found in the E/M section. The first is the unique code number, the second is the place/type of service, the third is the content of the service, and the fourth is the nature of presenting problem. What is the fifth element?
History, Examination, and medical decision making are:
Key components
The E/M Guidelines list clinical examples.
The E/M Guidelines contain a listing of categories and subcategories of service located in the E/M section.
According to the E/M Guidelines, when counseling and/or coordination of care dominates more than ____% of the physiciabn/patient and /or family encounter, time is considered to be the key or controlling factor to qualify for a particular level of service.
Within the Pathology and Laboratory Guidelines, there are codes that can be assigned without further reference to the code within the section.
This type of service may require a special report in determining the medical appropriateness of the service.
Rarely provided, variable, or new
According to the Pathology and Laboratory Guidelines, it is not appropriate to designate multiple procedures that are rendered on the same date by separate entries.
Which of the following would NOT usually be included in a special report for pathology or laboratory services: Time it takes to complete the assessment, Final diagnosis of the patient, Complexity of the symptoms of the patient, Concurrent problems related to the assessment,
Time it takes to complete the assessment
This type of code groups several laboratory services into one code and can be reported only if all the tests in the grouped code have been provided.
Panel/organ panel
According to the Radiology Guidelines, when a procedure or servie that is designated as a "separate procedure" is carried out independently or considered to be unrelated or distinct fromn other procedures/services provided at that time, the procedure or service should be reported with modifier:
Modifier -59
A written report, signed by this individual, should be considered an integral part of a radiologic procedure or interpretation:
Interpreting physician
The phrase "with contrast", used in the codes for procedures performed using contrast for imaging enhancement, represents contrast material admiinistered:
Intravascularly, intra-articularly, or intrathecally
When a procedure is performed by ___________, the radiologic portion of the procedure is designated as _________.
two physicians, radiological supervision and interpretation.
Injection of this type of contrast material is part of the "with contrast", CT, CTA, MRI, MRA procedure
According to the Surgery Guidelines, this type of anesthesia service is NOT included in the surgical package:
General anesthesia
Follow-up care for this type of procedure includes only that care related to the recovery from the procedure itself:
Diagnostic procedure
Which supply code is referenced in the Materials Supplied by Physician in the Surgery Guidelines?
The Surgery Guidelines contain a list of all unlisted service and procedure codes in the Surgery section.
The Surgery Guidelines specify that this part of a surgical procedure, even though different methods are not ordinarily listed separately, unless the technique substantially alters the standard management of the problem or condition.
According to the CPT manual, skin tag codes include ________ anesthesia.
According to the Anesthesia Guidelines, time for anesthesia procedures may be reported as is customary in this area:
Local anesthesia
The CPT Anesthesia Guidelines indicate that the six levels of Physical Status Modifiers are consistent with this organization's ranking of patient's physical status:
ASA (American Society of Anesthesiology)
This Physical Status modifier refers to patients of extreme age:
Consider this modifier when reporting regional or general anesthesia provided by a physician who is also performing the service for which the anesthesia is being provided:
Modifier -47