5 Written questions
5 Matching questions
- ICD-9 volumes
- Colon :
- When can you NOT bill "incident to"?
- importance of documentation
- a 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.
- b • 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.
- 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 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
- e Vol 1= "Diseases- Tabular List"
Vol 2= "Diseases- Alphabetical Index"
Vol 3= Listing of procedure codes and an index to the procedures.
5 Multiple choice questions
- repairs requiring more than layered closure (ie: scar revision, debridement, etc.)
- 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
- "Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary to bill a higher level of evaluation and management service when a lower level of service is warranted. The volume of documentation should not be the primary influence upon which a specific level of service is billed."
- 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)
- 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
5 True/False questions
CPT, Category I → Inflating the seriousness of the patient's condition or the level of E/M needed to help the patient to obtain a higher reimbursement the one is entitled
Kickbacks → a bribe or financial incentive
Stark Law → 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.
Up Coding → using tow codes when a combined code exists
CPT → 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