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Procedural

Chapter Review

QuestionAnswer
To insure highest reimbursement make sure services are accurately reflected in the codes and modifiers
A patient is considered new if they have not been to the practice for 3 years
What are most commonly used codes Evaluation and Management
Intentional unbundling is fraud
HCPCS Level II was first created for Medicare patients
Ins co. analysis of connection between diagnostic and procedural information for medical necessity is called code linkage
Fraud is defined as an act of deception used to take advantage of another person or entity
_________ will help minimize the risk of fraudulent coding and shows effort to follow coding regulations compliance plan
Choosing the correct coding resource for codes is done by using date of service
plus sign add-on code
___________ are used to show special circumstances for the service being billed modifiers
National codes issued by CMS HCPCS Level II
CPT is updated January 1 every year
six main sections of CPT are E/M, Anesthesia, Surgery, Radiology, Path and Lab, Medicine
In the introduction to the CPT manual you will find information about prefixes and suffixes and word roots
CPT codes are described as 5 digit numeric codes
HCPCS II codes are describes as 5 characters letters or numbers or both
blue triangle means code description has changed
add-on code other procedures done with main procedure
# code is out of numerical sequence
Appendix A modifiers
Appendix D add-on codes
when a procedure begins but is stopped or shortened this modifier is used 52
when a procedure takes much longer 22
Category II codes may include tobacco cessation or weight reduction counseling
3 R's of consultation request, record (document), report
problem-focused, expanded problem-focus, detailed and comprehensive levels of patient history
straightforward, low-complexity, moderate-complexity, high-complexity medical decision making
self-limited complaint common cold
subheadings in this begin with head and work down to foot musculoskeletal
spleen and bone are found in hemic/lymphatic
billing injections 2 codes
where to start when coding surgical procedures alphabetic index
code ranges in alphabetic index should be checked individually
when there are two E/M codes in same visit 25
how many modifiers can be used up to 4
reimbursement is lower than the code the provider billed for downcoding
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