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5 Written questions

5 Matching questions

  1. "V" Codes
  2. Modifier 51
  3. When can you bill "Incident to"?
  4. CPT
  5. Modifier 25
  1. a PROCEDURAL CODE
    CPT codes account for the majority of the HCPCS coding system
    Maintained/Updated by the AMA
    Codes for >7,000 procedures and services
    5-digit code 00100-99199
    Followed by a verbal description
    Three Categories:
    I= Evaluation & Management
    II= Performance Measurement
    III= New/emerging technology
  2. b 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
    99214-25
    Indicates that same provider did both procedures at the same visit.
  3. c • 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.
  4. d most commonly used for reporting diagnostic services. Often times additional diagnoses will be reported secondary to the "v" code.

    Radiology and pathology/lab services are usually listed with a "V" code as the primary diagnosis and the pt complaints, symptoms and signs or other diagnoses secondarily.
  5. e "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
    15100-51 STSG
    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.

5 Multiple choice questions

  1. Example:
    Q0113 Pinworm examinations (kit given= supply billed)
    A0100 Non-emergency transportation; taxi
    D0270 Bitewing-single film
    H0030 Behavioral health hotline service
    J0120 Injection, tetracycline, up to 250 mg
    P9019 Platelets, each unit
    K0005 Ultralightweight wheelchair
  2. Billing for tests not performed
  3. repairs requiring more than layered closure (ie: scar revision, debridement, etc.)
  4. The application of a number of systems used to uniformly document and track health care services delivered.

    Used for:
    Billing & reimbursement
    practice profiling
    Quality measurement
  5. Evaluation and Management (E/M) Services
    Describe services provided to evaluate patients and manage their care
    These codes are widely used and cover a large portion of the medical care provided to patients

    Codes are specific to setting (office, hospital, ER, home) and whether it is a new or established pt.
    Codes are based on what was done (and documented) in three areas:
    History
    Physical examination
    Medical decision making

5 True/False questions

  1. When can you NOT bill "incident to"?• If a physician is not on the premises at the time the NPP sees the patient.

    • If the patient is new to the clinic and has not been previously seen by the physician.

    • If the NPP makes a new diagnosis.

    • In a hospital.

          

  2. False informationMedicare/medicaid program that aims at catching fraud

          

  3. Braces { }used to enclose synonyms, alternative wordings or explanatory phrases

          

  4. Services not RenderedThe simplest scheme of HC fraud is the billing for services that were never rendered to patients

          

  5. Starred proceduresSuturing of superficial tissues where wound requires simple one layer closure
    Local anesthetic included in charge
    If wound is closed with adhesive strips, use E/M code instead (regular office visit)
    However use of dermabond or staples would be procedural codes
    Heavily contaminated wounds requiring extensive cleaning and simple closure may be coded as Intermediate repair
    3types of repairs: Simple, Intermediate, Complex