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