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MED112 Chapter 6
| Question | Answer |
|---|---|
| What are CCI Edits | A Computerized system that identifies improper or incorrect CPT codes |
| CCI Modifier Indicator of 0 represent | The use of a CPT Modifier will not change the edit, or mutually exclusive code edits will not be bypassed |
| Medically Unlikely Edits | To identify clerical errors or services that require a modifier |
| Code Linkage ensures which of the following | Charges are for medically necessary services |
| OIG Work Plan Address | Sets forth various projects to address particular types of billing |
| Where can Billing Rules be found | Patient's medical insurance policies & Participation Contracts |
| CCI Modifier indicator of 1 means | A CPT modifier may be used to bypass an edit |
| Healthcare payers base their decisions on to deny or pay claims on | Diagnosis and procedure codes |
| MUEs are designed to | reduce errors on claims due to clerical entries |
| Claims may be denied due to a lack of medical necessity because | Reported services are not consistent with the diagnosis or do not meet generally accepted professional medical standards of care. |
| When is the OIG Work Plan issued | Annually |
| Reporting Items or services that are not actually documented but the coder assumes were performed is called | Assumption Coding |
| Major influence on private payers' code edits | Medicare CCI Edits |
| Using a procedure code that provides a higher reimbursement rate than the correct code | Upcoding |
| A payers review and reduction of a procedure code (Often E/M code) to lower level than reported by the provider | Downcoding |
| Which of the following are examples of compliance errors | Incorrect code selection & billing Practices, Errors related to medical necessity |
| How long is the postoperative period for Minor procedure | 0-10 days |
| How long is the postoperative period for Major procedure | 90 days |
| How long is the preoperative period for Minor procedure | Just the day of the procedure |
| How long is the preoperative period for Major procedure | One day |
| Meaning of Code Linkage | |
| Medicare's computer programs to profile average billing patterns for E/M Codes | Benchmarking |
| Example of truncaated coding | Diagnosis codes are not specific as possible |
| Modifier 25 | Significant, Separately Identifiable Evaluation and Management (E/M) Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service only for E/M Code |
| Subset of Modifier 59 | X Modifiers |
| Global periods are based upon | The Complexity of the procedure performed |
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