5 Written questions
5 Matching questions
- National Codes
- ICD-9 characteristics
- Services not Rendered
- Colon :
- a The simplest scheme of HC fraud is the billing for services that were never rendered to patients
- b 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.
- c 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
- d 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.
- e using tow codes when a combined code exists
5 Multiple choice questions
- Medicare/medicaid program that aims at catching fraud
- "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."
- "DISTINCT PROCEDURE"
Indicates that codes that usually are bundled together as a part of a global code are in this particular circumstance describing DISTINCT or SEPARATE precedures
- International Classification Of Disease, 9th Revision, Clinical Modifications
Initially developed by the World Health Organization as a way to report morbidity and mortality statistics worldwide
Not initially meant to be used for billing purposes
Maintained and updated yearly by the National Center for Health Statistics
- Billing for tests not performed
5 True/False questions
bundling → using tow codes when a combined code exists
Phantom Employees → Expensing employees or hours worked that do not exist
Coding of underlying diseases → 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.
Brackets [ ] → Used to enclose a series of terms, each of which is modified by the statement appearing to the right of the brace.
Physical Exam Levels → Problem focused= 1-5 elements
Expanded problem focused= >6
Comprehensive= 18+ or 2 bullets in 9 systems