5 Written questions
5 Matching questions
- Physical Exam Levels
- What is coding?
- Simple repairs
- Mod 57, Decision for surgery
- Brackets [ ]
- a Problem focused= 1-5 elements
Expanded problem focused= >6
Comprehensive= 18+ or 2 bullets in 9 systems
- b 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
- c 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...
- d The application of a number of systems used to uniformly document and track health care services delivered.
Billing & reimbursement
- e used to enclose synonyms, alternative wordings or explanatory phrases
5 Multiple choice questions
- 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.
- Left to the anesthesiologists
Moderate (conscious) sedation (actually a medicine code-not part of the anesthesia codes) 99143-99145
Codes of interest to emergency medicine bundling:
- • 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%)
- "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
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.
- 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"
5 True/False questions
When can you bill "Incident to"? → Billing for tests not performed
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.
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.
"E" Codes → 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.
Kickbacks → Pronounced "hick picks"
Health Care Financing Administration's Common Procedural Coding System
HCFA (Health Care Financing Administration) Now CMS (Centers for Medicare and Medicaid Services) was/is the governing agency of Medicare and Medicaid
CPT (Common Procedural Terminology)
National Codes or alpha-numeric codes
Local codes (phased out in 2003)