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5 Written questions

5 Matching questions

  1. Phantom Employees
  2. NOS - Not Otherwise Specified
  3. HCPCS Level II - National Codes
  4. History component levels
  5. HEAT
  1. a Expensing employees or hours worked that do not exist
  2. b Medicare/medicaid program that aims at catching fraud
  3. 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)
  4. 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)
  5. 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

  1. 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"
    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
  3. • 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%)
  4. 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)
  5. 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

  1. NEC - Not Elsewhere Classifiablecan 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


  2. Medical Necessityit 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.


  3. CPT, Category IInflating 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


  4. ICD-9 CM codesVol 1= "Diseases- Tabular List"
    Vol 2= "Diseases- Alphabetical Index"
    Vol 3= Listing of procedure codes and an index to the procedures.


  5. 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.