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Procedural
Chapter Review
| Question | Answer |
|---|---|
| To insure highest reimbursement make sure services are accurately reflected in the | codes and modifiers |
| A patient is considered new if they have not been to the practice for | 3 years |
| What are most commonly used codes | Evaluation and Management |
| Intentional unbundling is | fraud |
| HCPCS Level II was first created for | Medicare patients |
| Ins co. analysis of connection between diagnostic and procedural information for medical necessity is called | code linkage |
| Fraud is defined as | an act of deception used to take advantage of another person or entity |
| _________ will help minimize the risk of fraudulent coding and shows effort to follow coding regulations | compliance plan |
| Choosing the correct coding resource for codes is done by using | date of service |
| plus sign | add-on code |
| ___________ are used to show special circumstances for the service being billed | modifiers |
| National codes issued by CMS | HCPCS Level II |
| CPT is updated | January 1 every year |
| six main sections of CPT are | E/M, Anesthesia, Surgery, Radiology, Path and Lab, Medicine |
| In the introduction to the CPT manual you will find information about | prefixes and suffixes and word roots |
| CPT codes are described as | 5 digit numeric codes |
| HCPCS II codes are describes as | 5 characters letters or numbers or both |
| blue triangle means | code description has changed |
| add-on code | other procedures done with main procedure |
| # | code is out of numerical sequence |
| Appendix A | modifiers |
| Appendix D | add-on codes |
| when a procedure begins but is stopped or shortened this modifier is used | 52 |
| when a procedure takes much longer | 22 |
| Category II codes may include | tobacco cessation or weight reduction counseling |
| 3 R's of consultation | request, record (document), report |
| problem-focused, expanded problem-focus, detailed and comprehensive | levels of patient history |
| straightforward, low-complexity, moderate-complexity, high-complexity | medical decision making |
| self-limited complaint | common cold |
| subheadings in this begin with head and work down to foot | musculoskeletal |
| spleen and bone are found in | hemic/lymphatic |
| billing injections | 2 codes |
| where to start when coding surgical procedures | alphabetic index |
| code ranges in alphabetic index | should be checked individually |
| when there are two E/M codes in same visit | 25 |
| how many modifiers can be used | up to 4 |
| reimbursement is lower than the code the provider billed for | downcoding |
Created by:
Jbowen11
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