5 Written questions
5 Matching questions
- Phantom Employees
- NOS - Not Otherwise Specified
- HCPCS Level II - National Codes
- History component levels
- a Expensing employees or hours worked that do not exist
- b Medicare/medicaid program that aims at catching fraud
- c 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)
- d Problem Focused= HPI: Brief (1-3); ROS & PFSF N/A
Expanded Problem Focused= HPI: Brief (1-3); ROS:Problem pert (1); PFSH: N/A
Detailed= HPI: Extended (4-3 chronic); ROS Extended (2-9); PFSH: Pertinent (at least 1)
Comprehensive= HPI: Extended (4 or 3 chronic); ROS: Complete (10+); PFSH: Complete (2 established) (3 new/consult)
- e 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)
5 Multiple choice questions
- It's how we get paid.
Avoid denials/delay in payment
Avoid audit by coding properly
Documentation must support code
"If it isn't documented, you didn't do it"
- "DISTINCT PROCEDURE"
Indicates that codes that usually are bundled together as a part of a global code are in this particular circumstance describing DISTINCT or SEPARATE precedures
- • 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%)
- 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)
- A superbill is a form used by medical practitioners that can be quickly completed and submitted to an insurance company or employer for reimbursement.
It generally has both CPT codes and ICD-9 codes that are frequently used in your practice in a check-box format.
5 True/False questions
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
Medical Necessity → it is improper to bill medicare for services or treatment that is not medically necessary. To knowingly do so is a violation of the false claims act.
CPT, Category I → Inflating the seriousness of the patient's condition or the level of E/M needed to help the patient to obtain a higher reimbursement the one is entitled
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.
Coding of underlying diseases → *Code to the highest level of certainty at that visit.
*Only code the reason for the encounter, and those conditions that affect the care delivered
*Use the most specific code available (4th=complications of the disease; 5th=clarifies condition)
*Do not use "rule out" or "suspected" diagnosis (codes as a pre-existing condition to insurance co)
Instead use a code from the "symptoms, signs, and ill-defined conditions" chapter.
*Make sure the ICD-9 code supports the CPT code.