5 Written questions
5 Matching questions
- Mod 57, Decision for surgery
- Suturing coding tips
- History component levels
- National Codes
- a 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
- b An E/M service that resulted in the initial decision to perform surgery
A practitioner is consulted to determine whether surgery is necessary for a pt with abd pain. The services meet the criteria to report consultation*. The requesting MD agrees w/ consult and surgeon takes over case. Later that day surgery to repair perf ulcer is done.
99244-57 office consultation for a new or established pt
44602 suture of small intestine for perf ulcer...
- c "A consultation is a type of service provided by a physician whose opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source."
- 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 length of wound is always documented and measured in (cm). When there's more than one wound in the same classification add teh length of the wounds and code it as one repair. repairs involving nerves/tendons/vessels are coded differently (see NS/muscsktl/cv-surgury)
*Code Length and severity
5 Multiple choice questions
- required for payment. It provides the justification & support for the procedures and services you render by making the medical necessity of your service clear to the 3rd party
- 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.
- a bribe or financial incentive
- 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.
- This is a unique identification number for covered health care providers which they use to bill Medicare for their services
5 True/False questions
ICD-9 characteristics → Vol 1= "Diseases- Tabular List"
Vol 2= "Diseases- Alphabetical Index"
Vol 3= Listing of procedure codes and an index to the procedures.
HCPCS → 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
Pathology and Lab → 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
Incident To → • 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%)
Colon : → are placed after an incomplete term which requires one or more of the modifying terms that follow it in order to make the code assignable to a given category.