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coding w/modifiers
chp1
| Question | Answer |
|---|---|
| HIPPA | health insurance portability and accountability act |
| the administrative simplification section of the health insurance portability and accountability act of 1996 mandated the department of health and human services (HHS) adopt national standards for electronic transmission of | health care information |
| the final rule for transmissions and codes sets was issued | august 17, 2000 |
| physical status modifiers | they distinguish at various levels of complexity the anesthesia service provided |
| a 72 yr old woman with hypertension, type 1 diabetes mellitus, uncontrolled chronic obstructive pulmonary disease, and a hx of sever claudication in both lower extremities was scheduled for diagnostic femoral arteriography and venography und gen anesthia | P3 (level 1 hcpcs modifier) |
| The ama's cpt editorial panel is responsible for | maintaining cpt code sets, authorized to revise/update/modify cpt codes |
| the panel members are appointed by the | ama's board of trustees |
| 45 yr old patient in good physical condition underwent a lumbar and ventral hernia repair under general anesthesia in the outpatient surgery department of a local hospital. Modifier? | P1 (level 1 hcpcs modifier) |
| what is "interested party" | an individual or entity that may potentially be impacted by the panel's decision, regardless of whether they participated in the panel's original consideration of the matter |
| category 1 cpt codes describe | a procedure or service indentified with a 5 digit numeric cope and descriptor nomenclature |
| TC | technical component (modifier) |
| category 2 cpt codes (performance measurement) are intended to | facilitate data collection by coding certain services and/or test results that are agreed on as contributing to positive health outcomes and quality patient care |
| category 2 codes are set of | tracking codes for performance measurement, may be services typically included in an evaluation and management (e/m) services |
| category 2 codes are reviewed by | the performance measures advisory group (PMAG) |
| performance measures advisory group (PMAG) | advisory body to the cpt editorial panel and the cpt/hcpac advisory committee |
| the cpt performance measurement codes are assigned an | alphanumeric identifier with the letter f in the last field, which are located in a separate section of the cpt codebook, following the medicine section. These codes are optional and not required for correct coding. |
| category 3 cpt codes (emerging technology) are | temporary set of tracking codes for new and emerging technologies. Intended to facilitate data collection on and assessment of new services and procedures. Codes will be assigned a numeric-alpha identifier. |
| the assignment of a cpt category 3 code to a service does not indicate what? | that it is experimental or of limited utility, but only that the service for technology is new and is being tracked for data collection |
| what was developed in 1983 to standardize the coding systems used to process medicare claims on a national basis? | hcpcs coding system |
| the hcps coding system is structured in how many levels? | two |
| the two levels of the hcps coding system are | cpt nomenclature and national codes |
| which level of the hcps coding system makes up the majority of the hcpcs? | level one: nomenclaute |
| level two: national codes of the hcps coding system are assigned, updated, and maintained by who? | cms |
| level 2: national codes of the hcps coding system identify | services and supplies not found in the cpt code set (durable medical equipment, ambulance services, medical and surgical supplies, drugs, orthotics, prosthetics, dental procedures, vision services) |
| level 2 national codes are made up of the following | 1) five character alphanumeric codes, first character is a letter A through V followed by 4 numeric digits 2) alphabetic and alphanumeric midifiers |
| what is a modifier? | a modifier provides a means by which a physician or other qualified health care professional can indicate a service or procedure was altered by specific circumstances but not changed in its definition or code, they are essential tool in the coding process |
| who developed the hcpcs level one modifiers? | AMA |
| modifiers are used to | enhance a code narrative to describe the circumstances of each procedure or service and how it individually applies to the patient |
| a chest x ray with 2 views was performed on a patient with suspected pneumonia. The service was performed in teh outpatient radiology department of the hospital. The radiologist is not employed by the hospital. What is the cpt code and modifier? | 71020 - 26 (radiological examination, chest, 2 views, frontal and lateral) |
| when 2 surgeons work together as primary surgeons and perform distinct part(s) of a procedure, each surgeon should report his/her surgical work by adding what modifier? | -62 |
| two general surgeons were performing a complete cystectomy with intestinal anastomosis with a bilateral lymphadenectomy. One physician performed the radical cystoprostatectomy, and the second surgeon performed the bowel loop. Codes/modifiers? | surgeon one: 51595 - 62 surgeon two: 51595 - 62 |
| a neurosurgeon and an otolaryngologist work together to perform a transsphenoidal excision of the pituitary neoplasm. Each physician performs a distinct part of the procedure. What are the codes and modifiers? | 61548 - 62 |
| what are the two levels of modifiers within the hcpcs coding system? | hcpcs level 1 (cpt modifiers) and hcpcs level 2 (hcpcs modifiers) |
| cpt modifiers are | 2 digit numeric and/or alphanumeric |
| unrelated evaluation and management services by the same physician or other qualified health care professional during a postoperative period. what is the modifier? | 24 (level 1 hcpcs modifier) |
| office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of 3 key components: | expanded problem focused hx; expanded problem focused exam; medical decision making of low complexity code 99213 |
| staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period. what is the modifier? | 58 (level 1 hcpcs modifier) |
| hcpcs level 2 (hcpcs modifier) | used for the medicare program |
| level 3 modifiers: local codes | developed by medicare contractors for use by physicians, practitioners, providers, and suppliers. Eliminated october 16, 2003 |
| when surgical procedures are billed, every procedure is connected to a | global period is 0-90 days and defined by each carrier individually |
| global period includes | preoperative management, the surgical procedure, certain types of anesthesia, and all typical follow-up care up to and including the global period (sometimes called global days) |
| modifier 25 is appended only to the | E/M service when the physician or other qualified health care professional needs to indicate an E/M service performed and it was a significant, separately indentifiable E/M service performed on the same day as another procedure/service |
| RBRVS | resource based relative value scale |
| CPT modifiers are published by the | American Medical Association |
| the hcpcs modifiers are level | 2 |
| level 1 modifiers are published by the | AMA |
| these level 1 modifiers where introduced in 2006 to indicate | performance measures inclusions and exclusions |
| modifiers explain | that a code has not changed in its definition but has been modified |
| what is an antidote to an incorrect payment rate? | accurate coding |
| to append a modifier to a claim, you should | review cpt and carrier guidelines for interpretation |
| level 2 modifiers are | published by the cms |
| cpt modifiers are | level 1 modifiers |
| modifiers always affect payment | false |
| category 3 codes were developed to report emerging technology | true |
| hcpcs level 2 modifiers are numeric | false |
| level 2 national codes are maintained by the american medical association | false |
| cpt performance measure are assigned an alphanumeric identifier with the letter f in the last field | true |
| when a surgical procedure is reported with a cpt code, each procedure is connected to a global period | true |
| when reporting modifier 62, only the primary surgeon must dictate an operative report | false |
| rbrvs is the acronym for resource based relative value system | true |
| performance measure modifiers are hcpcs level 1 modifiers | true |
| all insurance carriers including medicare and medicaid accept all cpt modifiers and the ama interpretation | false |
Created by:
PNSlagill