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95 terms

Mod 6 Final

STUDY
PLAY
RVUs represent
the total RVS for components of the schedule
Unit Value
a numerical value assigned by a relative value study to a procedure code. The unit value is multiplied by the conversion factor to determine the UCR allowance or a basic allowance
Microtia
This surgery is considered reconstructive
Surgical pathology
report tests done in preparation for or during surgery
Moderate (conscious) sedation
used to bill for conscious sedation (with or without analgesia) when the actual procedure is provided by the same physician
Panel tests are composed of
Multiple tests that are combined and run from one specimen
consultation physician
cannot be responsible for the regular management of the patient
Special Services
these codes are used to bill for special circumstances regarding services performed, such as the handling of a laboratory specimen
The structure of nose
is responsible for airway obstruction are the septum and the nasal turbinates
Automated Laboratory charge
offer their services primarily to dr's offices
The basic benefit
usually has a dollar conversion factor specified in the plan document
Unbundling
when a surgeon bills separately for procedures that are a part of the major procedure
Amount in excess of UCR
are not considered allowed amount
Incidental procedure
is one that does not add significant time or complexity to the operative session
Modifier -57
was necessary to determine the need of subsequent surgery
Actual Time
Some carriers allow one time unit for each fifteen minutes, regardless of the amount of time a patient is under anesthesia
A procedure listed in the surgery section of the CPT
does not mean that the procedure is allowable under a benefit plan
In vitro fertilization
fertilization of the ovum within a test tube
In Utero fetal surgery
surgery performed on a fetus while it is in the mother's womb, also to remove the fetus from the womb, perform surgery, and return it back to the womb
Surgery
is defined as the branch of medicine that treats diseases, injuries, and deformities through operative or invasive methods.
Therapeutic procedure
performed to remove or correct the functioning of a body part that is diseased or injured
Allowed amount
UCR - Usual, Customary and reasonable
fee schedule
Fees are assigned according to the particular CPT code, and this is considered the allowable amount for that particular procedure
Modifier code
numbers that are added on to a code to report particular fact
Procedure Code
codes that identify medical treatment or diagnostic services
Endocrine System
bill for procedures on the thymus, adrenal glands, thyroid and parathyroid
Hemic and Lymphatic system
used to bill for procedures of the spleen and lymph nods, as well as bone marrow transplants
Nervous system
bill for procedures on the organs of the nervous system, including the nerves, brain and spinal cord
Mediastinum and Diaphragm
bill for procedures of the mediastinum and diaphragm
Urinary system
bill for kidneys, ureter, bladder, urethra and includes prostate resections
Diagnostic x-ray
flat or two dimensional pictures of a particular body part or organ
Diagnostic Ultrasound
Ultrasoundgraphy provides a more definitive type of picture than x-rays
Radiation oncology
is used in conjunction with chemotherapy to treat malignant cancers
Nuclear Medicine
combines the use of radioactive elements and x-rays to image an organ or body part
prolonged service
used to bill for prolonged or standby service that is beyond the usual service for inpatient or outpatient services
Preventive medicine service
do not have an illness or injury
Therapeutic or diagnostic infusions
billed for infusion services provided by a physician who was in constant attendance during the infusion
Special E/M Services
bill for basic life or disability evaluations
Care plan oversight services
the reviewing of a patient's medical care and record usually for a patient under the care of a home health agency, hospice, or nursing home
Regional Anesthesia
the loss of sensation of a part of the body due to the interruption of nerve conduction
Topical Anesthesia
applied directly to the surface of the area to be anesthetized
local Anesthesia
affects only a localized area
Spinal Anesthesia
nerves blocked in the subarachnoid space
General Anesthesia
produces a sate of unconsciousness
endoscopies
determined by the organs the endoscope is passed through
Leision
coded according to the overall size of the lesion removed
repair
coded according to the length of the wound being repaired
skin grafts
coded according to the size of the recipient area
microscopies
.
Consultations
provided by a specialist who has been requested to provide an opinion only
Custodial Care Services
primarily for the purpose of meeting the personal daily needs of the patient, can be provided with personnel without medical care skills or training
professional services
performed by a licensed individual
stat fee
charge for DXL services performed on an expedited priority basis
physical medicine
manipulation and physical therapy associated with the nonsurgical care and treatment of the patient
relative value study
...
relative value unit
represents the total RVS for components of the schedule
UCR calculation
the process of determining the fee usually charged by similar providers for the same procedure in the same geographic area during a specified period of time
Unit value
a numerical value assigned by a relative value study to a procedure code
UCR
Usual, customary and reasonable, define covered expenses as charges for the services and supplies
confirmatory consultations
surgeries that have a reputation for being done needlessly
Critical care services
involves the care of critically ill patients during a medical emergency that requires the constant attention of the provider
skilled nursing facility
skilled nursing care or rehabilitation services and other related health services
rest home service
primarily for the purpose of meeting the personal daily needs of the patient, can be provided with personnel without medical care skills or training
home service
in lieu of hospitalization
chromosomal analysis
amniocentesis is the transabdominal perforation of the uterus for the purpose of withdrawing amniotic fluid
Exogenous obesity
is obesity caused by overeating
Endogenous obesity
is obesity caused by an internal malfunction usually hormonal
global approach
the total billed amount should be compared with the total UCR amount
block procedures
multiple surgical procedures performed during the same operative session, in the same operative area
gastroenterology
esophagus, stomach and intestines
Ophthalmology
eye care provided either by an optometrist or an ophthalmologist
Orthoptics
the retaining of the muscles that control vision
otorinoaryngologics services
services associated with the head
pulmonary services
used for billing procedures of the lungs and airways
Medical direction of anesthesiology
the monitoring of the patient will be performed by an anesthesia assistant or a certified registered nurse anesthetist (DRNA) under the direction of a physician
endocrinology
glucose monitoring
integumentary system
lesions, repair, and skin grafts
Repairs to the outer ear
are in the surgery section for the integumentary system
2 ways to calculate anesthesia time
actual time and block time
photodynamic therapy
treatment method for some type of cancer
-QS
denote that claim is for MAC services
UCR for assistant surgeon
would be calculated as RVS
surgical repair of the eye lids is called
blepharoplasty
Sterilization is
a surgical method to achieve permanent infertility
Basic allowance is paid at
100% under basic benefits
special services
lab specimen handling
Medical services categories
professional services, facility services, misc services
charges made by a staff anesthesiologist
are usually covered as a hospital ancillary expense
multiple procedure
more than one surgical procedure performed during the same operative session
Medical section in the CPT
listed towards the back of the book
modifier denoted to the left of the CPT code
by Astrix
rhinomanometry
test used to document airway obstruction
Modifier is required for
of an operative report
Modifier for 3rd party consultation
-32
laboratory examination
consist of the analyzing of body substances to determine their chemical or tissue make-up