Question | Answer |
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 |