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Insur. bill. & Code

Chapter 6

QuestionAnswer
Who developed HCPCS codes? CMS(centers for medicare services)
How often are CPT codes revised? annually(October)
What does CPT stand for? Current Procedural Terminology
How many levels of HCPC's are there? 3
How many digits are there in the CPT code? 5
What is inpatient status? FORMALLY admitted to Hospital or Healthcare facility for over night stay.
What is outpatient status? services received in an office, clinic,urgent care center,ER,or surgery center.
What is observation status? NOT FORMALLY admitted,on hold while a decision is made to discharge the patient based on conditions observed.
What is preventative medicine? services provided to prevent occurrence of illness, injury and disease.
How is preventative medicine categorized? by the patients AGE.
What are bundled services? services grouped together that are related to a procedure.
What criteria need to be met in order to bill 99211? Face to Face,Physician must be in office,separate service must be provided,proper documentation
What is a referral? transfer of total or specific care of patient from one physician to another. NOT A CONSULT.
What ways are referral's used/AKA? Can also be an authorization for a patient to receive services, typically with HMO members.
What is an Initial new patient consult? first visit by consulting doctor.
What is a Follow-up in patient consult? when doctor is asked to follow-up after patient is admitted but DOES NOT assume management of patient's condition.
What is a Confirmatory consult? Consulting Doctor offers an opinion about the treatment plan after a diagnosis ha been made.
What is an office/outpatient consult? When the patient is seen in the office by a specialist.
What is E/M(Evaluation&management)? services that the physician provides to evaluate patients that were previously referred to as office,hospital,or home visits.
What is a consult? when an opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness.
What is a Follow-up? when a patient comes back for a return visit after the initial visit.
How is a consult Vs. a Follow-up coded? Code Initial 1st, Code Established second.DO NOT USE FOLLOW UP CONSULT CODES,b/c patient is established. After the consultation is complete & the physician assumes management of the patient's condition.
What is a New Patient? has not been seen by group or provider within the past 3 years.
What is an Established patient? Has been seen by group or provider with the past 3 years
What is an Inpatient? someone who has been FORMALLY admitted to the hospital.
What are the contributory factors to level of service? Counseling;Coordination of Care;Time;Nature of presenting problem.
What are the key components used to ID the correct level of Service? History;Exam;Medical decision making.
How many key components need to be present to assign a code? New patient- 3of3 Established/Subsequent patient- 2of3
Created by: First Institute