5 Written questions
5 Matching questions
- ICD-9 volumes
- Modifier 22, Unusual procedural services
- NOS - Not Otherwise Specified
- Incident To
- Coding Rules
- a 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)
- 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 Vol 1= "Diseases- Tabular List"
Vol 2= "Diseases- Alphabetical Index"
Vol 3= Listing of procedure codes and an index to the procedures.
- d 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.
- e *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.
5 Multiple choice questions
- Billing for tests not performed
- 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
- when repair involves layer closure of 1 or more of the subcutaneous tissues and superficial facia
- Automatically running a test based on a previous test result w/o the MD/PA requesting the second test
- 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
Starred procedures → 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
Complex repairs → repairs requiring more than layered closure (ie: scar revision, debridement, etc.)
Mod 57, Decision for surgery → 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...
When can you NOT bill "incident to"? → EXTERNAL causes of injuries and poisonings. Shouldn't be listed as a primary diagnosis; they are considered supplementary codes.
NEC - Not Elsewhere Classifiable → can 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