5 Written questions
5 Matching questions
- Incident To
- Pathology and Lab
- Preventive Medical Services
- Starred procedures
- "E" Codes
- a 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)
- b • 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%)
- c Procedures in which the follow-up is generally non-existent or varies with the patient's underlying condition
When billing for a starred procedure, the charge does not include any pre or post-operative care
- d EXTERNAL causes of injuries and poisonings. Shouldn't be listed as a primary diagnosis; they are considered supplementary codes.
- e Pretty straightforward
Certain "panels" have one code for related blood tests (liver function, lipids, thyroid functions)
Everything in the panel will be listed with the code
5 Multiple choice questions
- Problem focused= 1-5 elements
Expanded problem focused= >6
Comprehensive= 18+ or 2 bullets in 9 systems
- both the manifestation of the condition and its underlying cause need to be listed. ITALICIZED codes are never to be reported w/o an additional code and they are never to be reported as the patients primary diagnosis.
- When the service provided is > that usually required for the listed procedure (E/M - 21)
A provider excises a lesion from the crease of the neck of a very obese person. The obesity makes the excision more difficult. The provider indicates the complexity of the removal by adding 22 modifier to code. It may be helpful to include copy of operative report.
- Suturing 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
- 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
I= Evaluation & Management
II= Performance Measurement
III= New/emerging technology
5 True/False questions
bundling → Many procedure codes also include procedures and supplies that are routinely necessary to perform the procedure
Only services not typically performed, or materials not typically used, should be billed separately
Charging for these items separately, known as "unbundling" or "fragmenting," is against the law.
False information → using tow codes when a combined code exists
Modifier 25 → 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
Indicates that same provider did both procedures at the same visit.
Modifiers → 2-digit numeric code
Used to indicate that a procedure has been altered by some specific circumstance, but not changed in its definition
ICD-9 characteristics → Codes are a series of 3-5 numbers, the last two numbers separated by a decimal (111.11)
3 digits before decimal = general category
2 digits post decimal = specific description
(4th Digit = Subcategory)
(5th Digit = Subclassification)
Codes are divided into 17 primary chapters
Separated out by body systems etc.