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Ch5Medical Insurance

Medical Insurance: An Integrated Claims Approach Process

Panel In CPT, a single code that groups laboratory tests that are frequently done together.
Professional Component The physician's skill, time and expertise used in performing a procedure.
Separate Procedure A procedure performed in addition to a primary procedure.
Category III Codes Temporary codes for emerging technology, services, and procedures.
Global Period The inclusion of pre- and postoperative care for a specified period in the charges for a surgical procedure.
Bundled Code Procedure code that groups related procedures under a single code.
Category II Codes CPT codes that are used to track performance measures
Add-On Code A secondary procedure that is performed with a primary procedure and that is indicated in CPT by a plus sign (+) next to the code.
Unlisted Procedure A service that is not listed in CPT and requires a special report.
Modifier A two-digit number indicating that special circumstances were involved with a procedure, such as a reduced service or a discontinued procedure.
T/F In Selecting correct procedure codes, that main text sections are first searched, and the code is then verified in the index. False
T/F Category II codes are not reported for payment. True
T/F In the CPT index, a see cross-reference must be followed. True
T/F The section guidelines summarize the unlisted codes for the section. True
T/F The phrases before the semicolon in a code descriptor define the unique entries, those after the semicolon are common. False
T/F Descriptive entries in parentheses are not essential to code selection. True
T/F A Category III code ends in a letter True
T/F Procedure codes are reported in order of increasing financial value for services performed on the same day. False
T/F For New patients, two of the three factors that are listed must be met. False
T/F Because it is an evaluation of a patient, a consultation is coded using E/M office service codes. True
A new patient has not received services from the physician or from another physician of the same specialty in the same group practice for: D. three years
When a physician asks a patient questions to obtain an inventory of constitutional symptoms and of the various body systems, the results are documented as the: A. past medical history
The abbreviation PFSH stands for: A. past, family, and/or social history
The examination that the physician conducts is categorized as: A. straightforward, low complexity, moderate complexity, or high complexity B. problem-focused, expanded problem-focused, detailed, or comprehensive
The 3 key factors in selecting an evaluation and management code are; D. history, examination, and medical decision making
CPT code 99382 is an example of: B. a preventive medicine service code
Anesthesia codes generally include: A. Preoperative evaluation and planning, normal care during the procedure, and routine care after the procedure.
Surgery codes generally include: B. Preoperative evaluation and planning, the operation and normal additional procedures, and routine care after the procedure.
When a Surgery section code has a plus sign next to it: C. It cannot be reported as a standalone code.
When a panel code from the Pathology and Laboratory section is reported: A. All the listed tests must have been performed.
List the 3 steps in the procedural coding process: 1. Determine procedure & services to report 2. Identify the correct codes 3. Determine the need for modifiers
List the 3 key components used to select E/M codes and the four levels each component has: 1. Patient documented history 2. Documented examination 3. Documented physician medical decision making.
What are E/M codes? They cover physician services that are performed to determine the best course for patient care.
Category I Code Five digit code with brief explanation of the procedure.
Modifier 26 Indicates to payer that physician did not perform all the work (just professional part).
Created by: crazedsmyle