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CRIP Set 8
| Question | Answer |
|---|---|
| When is condition code 44 used on a ub04 form? | Used to identify conditions or events relating to the bill that may affect the processing of the claim. It was created to indicate what an inpatient admission order was changed to an outpatient status. It can only be on outpatient claim when the order was initially for inpatient services |
| What is the criteria to use condition code 44 on the claim? | Inpatient claim has not yet been submitted to Medicare, physician/hospitalreview determine inpatient not necessary, change inpatient status from inpatient to outpatient is made prior to discharge, documentation in the medical record agrees with status change, patient notified in writing of change, observation hours should not be billed unless physician ordered, |
| If patient's day meets condition code 44, how is the entire episode billed, as outpatient or inpatient? | As outpatient. |
| If the condition 44 requirements are not met. Only the inpatient part B charges can be billed. How would the type of Bill be? | 110 - no pay cl 121 - claim for charges within the admit and discharge dates 131 - claim for any charges that were previously added to the inpatient claim because of the 72-hour rule. |
| What is radiation oncology? | Do utilize this high energy ionizing radiation in the treatment of malignant neoplasms in certain non-management conditions |
| What is treatment planning for radiation oncology? | Planning in tumor mapping is needed to identify the location, extent, and volume of the tumors to be treated in all of the surrounding structures One-Time charge per course of therapy and only one plan should be billed per treatment course Physician is responsible for all technical aspects of the treatment planning process |
| When would dostmetry need to be recalculated? | Changes in a patient's weight or girth during the course of radiation treatment. Typical radiation therapy will require between 1:00 to 6:00 calculations. However, for the treatment of head, neck, prostate, hoskins disease they may require eight or more calculations |
| What is a special the dosimetry? | A service used to report measurements of radiation dose at a given point using special radiation monitoring. Measuring devices. Usually build once per port. When the doctor determines it is necessary to have a measurement of the amount of radiation that the patient actually received at a given point |
| Explain isodose plans | Needed to ensure treatment volumes received the prescribed dose of radiation. Calculated by qualified medical physicist using computer-based measurement of radiation beams that can report it. Be reported as simple, intermediate, or complex Typical treatment usually requires one to six plans. Might be used towards the end of treatment. Another plan might be documented |
| What is a porch in radiation oncology? | Are utilized when planning for a special beam considerations. Radiation oncologist has to document his/ her involvement in the planning and selection of the beam and they make final selection and initiation of the treatment process. |
| What are the different types of simple treatment devices for radiation oncology? | Bolus- simple, electronic cone for imrt, electronic cutout non- custom, eyeshield , hand block( 1- 2), superflab- uncut |
| What are the different types of intermediate ration oncology treatment devices? | Beam splitter block, bite block, bowlless- special, breastboard, cord block, hand block (3+), pituitary headquarter, stereotactic head frame, t-bar, testicle shield |
| What are the complex treatment devices used in radiation oncology | Alpha cradle, aquauplast, cerrovend, clamshell, compensator, conformal blocking, dental mold, electron cut out custom, i block internal, multi-leaf collimator, no shield, super flab- cut, reusable customized, TBI beam compensator- non-reusable, Vacloc or Vacuplast, wedge |
| If a patient has a combination of a wedge- compensator , a bolus, or a port block covering the same port. Should this be billed as a single complex treatment device or separate charges for each individual items? | Single complex treatment device |
| Are brachytherapy sources such as brachytherapy devices or seeds paid separately from Administration and delivery of brachialtherapy services? | Yes, therefore, provider should bill for the burgier therapy service in addition to the brachiotherapy services for which the sources were applied. Seed sources are generally billed and paid per source based on the number of units |
| In order for the hospital to bill for all of the original seats ordered, what must occur? | The seeds were not implanted in. The patient were not given and implanted into another patient, sees that we're not implanted were disposed of in coordinates with their handling requirements, the seeds used in the care of the patient, but not implanted, would not constitute more than a small fraction of the seeds actually implanted in the patient. For example, if only three or four seeds were not implanted. |
| If multiple brachytherapy services were performed on the same data service. How are these billed? | The first procedure is billed without a modifier. The second procedure in any others that were performed on the same data service date or billed with modifier 76 indicating that it was a repeated service by the same physician |
| Evaluation and management levels are separated in what two classifications | New patient and established patient |
| Three usual components of E&m services are | And expanded problem focused history And expanded problem focused exam Straightforward medical decision making |
| How does CMS define a new patient | An individual who has not received any professional services from the physician/ another physician of the same specialty who belongs to the same group practice within the previous 3 years. |
| How does CMS define an established patient? | An individual who has received professional services from the physician or another physician of the same specialty who belongs to the same group practice within the previous 3 years |
| If a patient leaves the ER after receiving tests and services ordered by the physician, but without receiving a medical screening exam, can the E&m code be reported | Yes |
| What is in a type A emergency department? | A hospital-based ER which is open 24 hours, 7 days a week and is licensed by the states and or held out to the public as a place that provides Care for emergency medical conditions on an urgent basis without requiring is scheduled appointment |
| What is a type B emergency department? | A licensed state ER but that is not open 24 hours a day. 7 days a week. Doesn't require an appointment |
| What are E&m components? | History Exam Medical decision making Counseling Coordination of care Nature of presenting problem Time spent |
| What are the exceptions for when an E&m level of service isn't based on history, exam, and medical decision making? | When more than 50% of the visit is time of counseling or coordination of care. For when this happens, time spent is a key or controlling factor to qualify for a particular level of E&m service. |
| What are the four elements that must be meant for obtaining the patient's history? | Chief complaint- statement that describes condition, problem, sign and symptoms. Reason for the patient being seen Review of symptoms, obtained by asking questions of signs and symptoms History of present illness- description of the patient's present illness from the first symptom/complaint to the most current Past family in or social history |
| What are the three types of review of symptoms? | Problem pertinent- inquiry about system directly related to the problem Extended- inquiry about the system related to the problem and two-9 additional symptoms Complete- inquiry about the system related to the problem plus a minimum of 10 additional systems |
| What are the elements of history of present illness? | Location, severity, duration, timing, quality, context, sign/ symptoms, modifying factors, two types brief- when one to three of the elements above are obtained or extended when four or more of the above elements are obtained |
| What are the two types of pass, family, and/ or social history reviews | Pertinent review- must document at least one item Complete review- a review of two or more history areas |
| What are the four types of exam s based on E&m levels? | Problem focused-limited review or exam of Expanded problem focused- a limited review or exam of body- includes a brief history in any problems that be pertinent to the review of the patient symptoms Detailed- a more extended reviewer exam of the body area and symptoms Comprehensive- a multi-system or complete exam of the body |
| What is the E&m component of medical decision making per CMS | The following factors should be considered when performing medical making decisions The number of diagnosis Complexity or amount of doc that is reviewed or needs to be reviewed Any risk or complications associated with the chief complaint of the patient? |
| What are the acep guidelines for type A emergency department? E&m level s in CPT code | Level I -99281- initial assess, no. Meds/tx, work note, recheck on wound, vaccine, etc Level. 2- 99282- level 1 asses+ lab. Test- vac, clean catch, admin of meds but not inject- appl of sling- simple proc- etc Level 3- 99283- level 1/2and + xrays- nebulizer- rec of ambulance, pt- etc Level four 99284- level 1-3 + multi assess, pelvic exam, sex exam w/o specimen collection, etc Level 5- 99285 -levels 1 through 4 plus o2, sexual assault with colle'5 Level 6- 99291, cardiac arrest, CPR, etc |
| If the start and stop times for an infusion are not documented in the medical record, should the level of care assigned be level 3 or level 4? | The patient should be assigned a level of care for. The documentation of the start and stop times are not required for the level of care determination |
| What are the hiccic codes for type B emergency department level of care? | Level one-g0380 Level two- g0381 Level 3- g0382 Level 4 - g0383 Level 5 - g0384 |
| What is the revenue code for trauma activation and the pick codes for the two trauma charges? | 68X With Critical Care service- g0390 appended Without critical care service, g0390 not appended |
| How are multiple emergency department visits in the same day billed? | With condition code G0 would be appended if the two visits are separate and distinct, regardless of diagnosis or condition treated. Claim will be returned if submitted without the condition code if two or more A&m services are billed for the same data service. If the two ER departments are not on the same claim then the condition code would only be on the second visit |
| What are some things to determine the E&m level for care for an OB patient? | If only there for one or more procedures, no e&m code on claims. Patient presents to labor and delivery for evaluation and medical service performed. Based on that then E&m would be reported If patient receives procedure during OB visit based on exam only. Report E&m if it is related to a different sign or symptom |
| What must happen to report an applicable CPT code for the casting, sprinting, and strapping procedures | The item must be created or custom fabricated. If applying a prefabricated off-the-shelf item like an aircast /postop boot, you would not report a separate CPT code for casting. This would be included in the level of service |
| What must be meant in order to report casting, splinting, or strapping? | Casting- use of hard materials such as fiberglass or plaster Strapping- application of overlapping strips of adhesive, plaster, tape, etc Splinting- use a device which has a hard surface such as plaster on one side of the limb in a soft material such as cotton around the entire limb |
| What is the difference between custom versus non-custom items? | Ocl is a plaster fabric that is wet and then shaped to the patient. The result is a custom splint, but the medical record documentation should State ocl to ensure that the splint is coded correctly. Well, some off-the-shelf items do not meet the definition of splint. The CPT code for the application of the splint is not reported unless that hospital actually fabricates. Customizing a prefabricated Sprint to fit the patient is not fabrication |
| What are some examples of fabricated splints that can be charged and coated if documented as ocl? | Volar splint, boxer splint, sugar tongue split, thumb spica splint, posterior ankle splint, ankle stirrup OCL, elbow splint, figure eight thumbs splint, teardrop splint, finger splint OCL, stir-up splint, aluminum foam, owner gutter splint, Mason Allen's blunt, Colles splint |
| What are some examples of prefabricated splints that you cannot bill separately and is included in the E&m charge? | Baseball, frog, aluminum, four prong, gutter finger, wrist splint, gel ankle splint, velcro, immobilizer, Cam Walker, Ace wrap, post-op shoe, Delco wrist splint, cervical collar, sling, buddy tape, rib belt |
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