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Medical |! Coding |! exam |! 1 |! with |!
precise |! solutions
What |! is |! coding? |! - |! Correct |! answer |! ✔The |! application |! of |! a |! number |! of |! systems |! used |! to |! uniformly |! document |! and |! track |! health |! care |! services |! delivered. Used |! for: Billing |! & |! reimbursement practice |! profiling Quality |! measurement importance |! of |! documentation |! - |! Correct |! answer |! ✔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 Why |! Code? |! - |! Correct |! answer |! ✔It's |! how |! we |! get |! paid. Optimal |! Reimbursement Avoid |! denials/delay |! in |! payment Avoid |! audit |! by |! coding |! properly
Documentation |! must |! support |! code "If |! it |! isn't |! documented, |! you |! didn't |! do |! it" ICD-9 |! CM |! codes |! - |! Correct |! answer |! ✔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 ICD-9 |! characteristics |! - |! Correct |! answer |! ✔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. NEC |! - |! Not |! Elsewhere |! Classifiable |! - |! Correct |! answer |! ✔can |! be |! used |! in |! two |! instances: |!
"V" |! Codes |! - |! Correct |! answer |! ✔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. Superbill |! - |! Correct |! answer |! ✔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. HCPCS |! - |! Correct |! answer |! ✔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 Three |! levels: CPT |! (Common |! Procedural |! Terminology) National |! Codes |! or |! alpha-numeric |! codes Local |! codes |! (phased |! out |! in |! 2003)
CPT |! - |! Correct |! answer |! ✔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- Followed |! by |! a |! verbal |! description Three |! Categories: I= |! Evaluation |! & |! Management II= |! Performance |! Measurement |! III= |! New/emerging |! technology CPT, |! Category |! I |! - |! Correct |! answer |! ✔Evaluation |! and |! Management |! (E/M) |! Services Describe |! services |! provided |! to |! evaluate |! patients |! and |! manage |! their |! care These |! codes |! are |! widely |! used |! and |! cover |! a |! large |! portion |! of |! the |! medical |! care |! provided |! to |! patients Codes |! are |! specific |! to |! setting |! (office, |! hospital, |! ER, |! home) |! and |! whether |! it |! is |! a |! new |! or |! established |! pt. Codes |! are |! based |! on |! what |! was |! done |! (and |! documented) |! in |! three |! areas: History Physical |! examination Medical |! decision |! making
Complex |! repairs |! - |! Correct |! answer |! ✔repairs |! requiring |! more |! than |! layered |! closure |! (ie: |! scar |! revision, |! debridement, |! etc.) Suturing |! coding |! tips |! - |! Correct |! answer |! ✔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 Anesthesia |! - |! Correct |! answer |! ✔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: Radiology |! - |! Correct |! answer |! ✔An |! x-ray |! code |! for |! a |! film |! assumes |! that |! both |! the |! technical |! and |! professional |! components |! are |! included |! (the |! fee |! for |! the |! machine |! and |! film, |! the |! technician, |! and |! the |! reading |! of |! the |! film.) 71010, |! single |! frontal |! view |! chest |! x-ray If |! a |! film |! is |! taken |! elsewhere, |! but |! interpreted |! by |! a |! provider, |! use |! same |! code |! + |! professional |! component |! modifier- Ex) |! 71010- (This |! indicates |! you |! are |! only |! billing |! for |! interpretation |! of |! film) Pathology |! and |! Lab |! - |! Correct |! answer |! ✔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 Modifiers |! - |! Correct |! answer |! ✔2-digit |! numeric |! code Used |! to |! indicate |! that |! a |! procedure |! has |! been |! altered |! by |! some |! specific |! circumstance, |! but |! not |! changed |! in |! its |! definition Modifier |! 22, |! Unusual |! procedural |! services |! - |! Correct |! answer |! ✔When |! the |! service |! provided |! is |! > |! that |! usually |! required |! for |! the |! listed |! procedure |! (E/M |! - |!
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. Modifier |! 25 |! - |! Correct |! answer |! ✔Significant, |! separately |! identifiable |! E/M |! service |! by |! the |! same |! physician |! on |! the |! same |! day |! of |! the |! procedure |! or |! other |! service. Pt |! is |! seen |! for |! fever, |! h/a, |! vomiting, |! and |! stiff |! neck. |! A |! spinal |! tap |! is |! performed |! as |! well |! as |! the |! E&M |! services |! consistent |! with |! 99214. 62270 |! Spinal |! puncture, |! lumbar, |! diagnostic |! 99214- Indicates |! that |! same |! provider |! did |! both |! procedures |! at |! the |! same |! visit.
Alpha-numeric |! (one |! letter |! plus |! 4 |! numbers) National |! Codes |! - |! Correct |! answer |! ✔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 Coding |! of |! underlying |! diseases |! - |! Correct |! answer |! ✔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 |! [ |! ] |! - |! Correct |! answer |! ✔used |! to |! enclose |! synonyms, |! alternative |! wordings |! or |! explanatory |! phrases Parentheses |! ( |! ) |! - |! Correct |! answer |! ✔Used |! to |! enclose |! supplementary |! words |! which |! may |! or |! may |! not |! be |! present |! in |! the |! disease |! statement |! and |! which |! do |! not |! affect |! code |! selection |! per |! se. Colon |! : |! - |! Correct |! answer |! ✔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.
Braces |! { |! } |! - |! Correct |! answer |! ✔Used |! to |! enclose |! a |! series |! of |! terms, |! each |! of |! which |! is |! modified |! by |! the |! statement |! appearing |! to |! the |! right |! of |! the |! brace. ICD-9 |! volumes |! - |! Correct |! answer |! ✔Vol |! 1= |! "Diseases- |! Tabular |! List" Vol |! 2= |! "Diseases- |! Alphabetical |! Index" Vol |! 3= |! Listing |! of |! procedure |! codes |! and |! an |! index |! to |! the |! procedures. "E" |! Codes |! - |! Correct |! answer |! ✔EXTERNAL |! causes |! of |! injuries |! and |! poisonings. |! Shouldn't |! be |! listed |! as |! a |! primary |! diagnosis; |! they |! are |! considered |! supplementary |! codes. Modifyer |! -59 |! - |! Correct |! answer |! ✔"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 Phantom |! Employees |! - |! Correct |! answer |! ✔Expensing |! employees |! or |! hours |! worked |! that |! do |! not |! exist Phantom |! Billing |! - |! Correct |! answer |! ✔Billing |! for |! tests |! not |! performed Code |! Jamming |! - |! Correct |! answer |! ✔Inserting |! or |! "jamming" |! incorrect |! ICD-9 |! code |! to |! get |! coverage |! for |! a |! lab |! or |! test
Lack |! of |! medical |! Neccessity |! - |! Correct |! answer |! ✔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. HEAT |! - |! Correct |! answer |! ✔Medicare/medicaid |! program |! that |! aims |! at |! catching |! fraud Incident |! To |! - |! Correct |! answer |! ✔• |! 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%) NPI |! (National |! Provider |! Identifier) |! - |! Correct |! answer |! ✔This |! is |! a |! unique |! identification |! number |! for |! covered |! health |! care |! providers |! which |! they |! use |! to |! bill |! Medicare |! for |! their |! services When |! can |! you |! bill |! "Incident |! to"? |! - |! Correct |! answer |! ✔• |! When |! a |! physician |! has |! previously |! diagnosed |! and |! has |! established |! care |! and |! a |! management |! plan |! for |! the |! Medicare |! patient, |! and |! the |! NPP |! is |! providing |! the |! follow |! up |! care.
- |! When |! any |! physician |! is |! on |! the |! premises |! and |! available |! if |! the |! NPP |! needs |! assistance.
- |! In |! any |! clinic |! not |! associated |! with |! hospitals.
When |! can |! you |! NOT |! bill |! "incident |! to"? |! - |! Correct |! answer |! ✔• |! 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. Preventive |! Medical |! Services |! - |! Correct |! answer |! ✔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) Consultation |! - |! Correct |! answer |! ✔"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." Billing |! based |! on |! time |! - |! Correct |! answer |! ✔Time |! is |! only |! a |! factor |! in |! determining |! the |! level |! of |! service |! if |! > |! 50% |! of |! the |! time |! spent |! is |! spent |! in |! counseling/coordination |! of |! care. |! You |! must |! document |! the |! total |! amount |! of |! time |! spent |! and |! indicate |! that |!
50% |! of |! that |! time |! was |! spent |! in |! counseling/coordination |! of |! care
