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AR Chapter 6

Procedural Coding

evaluation & management (E/M services) services physician provides to evaluate patients
key components need to be present to assign a code ~ 3 of 3 for a new patient ~ 2 of 3 for an established patient (subsequent means the same as established)
key components used to ID the correct level of service ~history ~examination ~MDM (medical decision making)
what are the contributory factors ~counseling ~coordination of care ~time ~nature of presenting problem
new patient have not received any professional services w/ in 3 years
established patient have received professional services in the last 3 years
inpatient formally admitted into the hospital
consult when services are rendered by a doctor whose opinion is requested by another doctor to evaluate or treat a patients illness
follow-up when the patient comes back after the consult
how to code consult & follow-up under consultation section in CPT book
initial hospital new patient consult 1st visit by consulting doctor
follow-up inpatient consult when doctor is asked to follow up while the patient is admitted
confirmatory consult consulting doctor offers an opinion about the treatment plan after dx has been made
office/outpatient consult patient seen in office by a specialist
referral total transfer of care of a patient from physician to another & when requesting an authorization for the patient to receive services
relative value unit doctors are paid based on these
criteria needed to bill 99211 ~face to face time, ~a physician must be in the office, ~seperate service must be provided, ~proper documentation
what is bundled services? services grouped together related to a procedure (ex. panels)
preventative medicine services provided to prevent, occurance of illness, injury, and disease
preventative medicine is catergorized by the patients age
inpatient status formally admitted into hospial or other health care facility for an overnight stay
outpatient status service received in an office, clinic, urgent care center, ER, or surgery center
observation status not formally admitted (on hold) while a decision is made to admit or discharge based on patients condition observed, Not considered INPATIENT at this point
how many digits are there in the CPT code? 5
what does CPT stand for? current procedural terminology
how many levels of the HCPCS are there? 3
how often are CPT codes revised? annually
who developed HCPCS codes? CMS (Centers for Medicare and Medicaid Services)
emergency care care for an unexpected medical condition or worsening of a condition that poses a threat to life, limb, or sight
critical care intensive care provided in a variety of acute life threatening conditions requiring constant bed side attention by the physician
relative value unit formula RVU x GAF x CF = medicare $ per service
counseling discussion between physician and patient, family or both, regarding health concerns
modifier gives a more accurate description of services rendered (2 digit code)
inpatient consultation 4 R's ~request, ~render, ~report, and ~reason
observation status time length 24 hours
T/F ~ could take up to 8 months for insurance companies to reimburse new codes? T
Created by: maxphia32