Help

Options

focusNode

Didn't know it?
click below

Knew it?
click below

Don't Know

Remaining cards (0)

Know

retry

shuffle

restart

0:00

Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

Normal Size Small Size show me how

Workbook Chap 6

CPT Coding

Question	Answer
The coding system used for billing professional medical services and procedures is found in a book titled	Current Procedural Terminology
The Medicare program uses a system of coding composed of two levels, and this is called	Healtcare Common Procedure Coding System (HCPCS)
A medical service or procedure performed that differs in some way from the code description may be shown by using a CPT code with a	Modifier
A relative value scale or schedule is a listing of procedure codes indicating the relative value of services performed, which is shown by	unit values
Name three methods for basing payments adopted by insurance companies and by state and federal programs	1. Fee schedules 2. UCR - usual, customary and reasonable 3. Relative value scale
Name 4 situations that can occur in a practice when referring to charges and payments from a fee schedule	1. Medicare Par physician paid from Medicare fee schedule 2. Non-par physician paid based on limiting fee schedule 3. Managed care paid on basis of the fee schedule written into negotiated contract 4. Work related injuries paid using a WC fee schedule
Name the six sections of Category I in the CPT book	1. E/M 2. Anesthesiology 3. Surgery 4. Radiology, Nuc. Medicine, Ultrasound 5. Pathology and Lab 6. Medicine
Name five hospital departments where critical care of a patient takes place	1. Coronary care unit 2. Intensive care unit 3. Pediatric ICU 4. Respiratory care unit 5. Emergency care facility
A surgical package includes what?	The operation Anesthesia (local infiltration, topical, metacarpal, metatarsal or digital block) E/M encounter day before or same day as surgery Immediate post-op care writing orders evaluating patient post-anesthesia recovery Post-op follow-up care
Medicare global surgery policy includes: Pre-operative visit (day before or of surgery) Intraoperative services that are usual and necessary part of the procedure and also includes:	Complications of surgery that don't require added trips Post-op visits - variable post-op periods range from 0, 10, 30 or 90 day. Writing orders; evaluating patient in recovery & normal post-op pain mgmnt
A function of computer software that performs online checking of codes on an insurance claim to detect improper code submission is called	code edits; code editing
A single code that describes two or more component codes bundled together as one unit is known as a	comprehensive code
To group related codes together is commonly referred to as	bundling
Use of many procedural codes to identify procedures that may be described by one code is termed	unbundling
A code used on a claim that does not match the code system used by the third-party payer and is converted to the closest code rendering less payment is termed	downcoding
Intentional manipulation of procedural codes to generate increased reimbursement is called	upcoding
Some reasons for using modifiers on insurance claims include: To report either a professional or technical component of a service/procedure To report a service/procedure performed > one doc or in > one location	To report a service has been increased or reduced Service provided >once Only part of service was performed Adjunctive service was performed Bilateral procedure was performed Unusual events occurred
What modifier is usually used when billing for an assistant surgeon who is not in a teaching hospital?	-80
When is modifier -99 used?	If a procedure requires more than one modifier code; -99 goes after the CPT code and added modifiers on separate lines
Unusual anesthesia	modifier -23
Increased service	modifier -22
Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service	modifier -25
Professional component	modifier -26
multiple procedures	modifier -51
Reduced service	modifier -52
Decision for surgery	modifier -57
Staged or related procedure	modifier - 58
Bilateral procedures	modifier -50
Assistant surgeon	modifier -80
Outside Lab	modifier -90
Multiple modifiers	modifier -99
The codes used to bill ambulance services, surgical supplies and durable medical equipment are	Level II HCPCS national codes
A complex reimbursement system in which three fees are considered in calculating payment is known as	Usual, customary and reasonable (UCR)
Medicare defines the postoperative global periods as	0, 10, 30 or 90 days
To code a bilateral procedure as two separate codes that include the same surgical approach may be referred to as	unbundling
When two surgeons work together as primary surgeons performing distinct parts of a procedure and each doctor bills for performing their distince part of the procedure, the CPT surgical code is listed with modifier	-62
True or False: Procedure coding is the transformation of written descriptions of procedures and professional services into numeric designations (code numbers)	True
True or False: Category II codes describe clinical components that may be typically included in E/M services or clinical services	True
True or False: When multiple lacerations have been repaired using the same technique and are in the same anatomic category, each repair should be assigned a code when billing an insurance claim	False
True or False: When listing a steril tray for an in-office surgical procedure, the tray is bundled with the procedure unless additional supplies are needed in addition to those usually used.	True
True or False: HCPCS Level II modifiers consist of only two alphanumeric characters	False
I & D	incision and drainage
IM	intramuscular
Pap	papanicolau smear
ER	emergency
EEG	electroencephalogram
DPT	diphtheria, pertussis, tetanus
ECG	electrocardiogram
IUD	intrauterine device
OB	obstetrics
D & C	dilation and curettage
OV	office visit
KUP	kidney, ureter, bladder
GI	gastrointestinal
Hgb	hemoglobin
new pt	new patient
rt	right
UA	urinalysis
est pt	established patient
ASHD	arteriosclerotic heart disease
tet.tox.	tetanus toxoid
CBC	complete blood count
E/M	evaluation and management
CPT	Current Procedural Terminology
Ob-Gyn	Obstetrics Gynecology
TURP	Transurethral resection of the prostate
cm	centimeter
T & A	tonsillectomy and adnoidectomy
mL	milliliter
inj	injection
hx	history
NC	no charge

Created by: mpeoples

"Know" box contains:
Time elapsed:
Retries: