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Insur. bill. & Code
Chapter 6
| Question | Answer |
|---|---|
| Who developed HCPCS codes? | CMS(centers for medicare services) |
| How often are CPT codes revised? | annually(October) |
| What does CPT stand for? | Current Procedural Terminology |
| How many levels of HCPC's are there? | 3 |
| How many digits are there in the CPT code? | 5 |
| What is inpatient status? | FORMALLY admitted to Hospital or Healthcare facility for over night stay. |
| What is outpatient status? | services received in an office, clinic,urgent care center,ER,or surgery center. |
| What is observation status? | NOT FORMALLY admitted,on hold while a decision is made to discharge the patient based on conditions observed. |
| What is preventative medicine? | services provided to prevent occurrence of illness, injury and disease. |
| How is preventative medicine categorized? | by the patients AGE. |
| What are bundled services? | services grouped together that are related to a procedure. |
| What criteria need to be met in order to bill 99211? | Face to Face,Physician must be in office,separate service must be provided,proper documentation |
| What is a referral? | transfer of total or specific care of patient from one physician to another. NOT A CONSULT. |
| What ways are referral's used/AKA? | Can also be an authorization for a patient to receive services, typically with HMO members. |
| What is an Initial new patient consult? | first visit by consulting doctor. |
| What is a Follow-up in patient consult? | when doctor is asked to follow-up after patient is admitted but DOES NOT assume management of patient's condition. |
| What is a Confirmatory consult? | Consulting Doctor offers an opinion about the treatment plan after a diagnosis ha been made. |
| What is an office/outpatient consult? | When the patient is seen in the office by a specialist. |
| What is E/M(Evaluation&management)? | services that the physician provides to evaluate patients that were previously referred to as office,hospital,or home visits. |
| What is a consult? | when an opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness. |
| What is a Follow-up? | when a patient comes back for a return visit after the initial visit. |
| How is a consult Vs. a Follow-up coded? | Code Initial 1st, Code Established second.DO NOT USE FOLLOW UP CONSULT CODES,b/c patient is established. After the consultation is complete & the physician assumes management of the patient's condition. |
| What is a New Patient? | has not been seen by group or provider within the past 3 years. |
| What is an Established patient? | Has been seen by group or provider with the past 3 years |
| What is an Inpatient? | someone who has been FORMALLY admitted to the hospital. |
| What are the contributory factors to level of service? | Counseling;Coordination of Care;Time;Nature of presenting problem. |
| What are the key components used to ID the correct level of Service? | History;Exam;Medical decision making. |
| How many key components need to be present to assign a code? | New patient- 3of3 Established/Subsequent patient- 2of3 |
Created by:
First Institute
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