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AR Chapter 6
Procedural Coding
| Question | Answer |
|---|---|
| evaluation & management (E/M services) | services physician provides to evaluate patients |
| key components need to be present to assign a code | ~ 3 of 3 for a new patient ~ 2 of 3 for an established patient (subsequent means the same as established) |
| key components used to ID the correct level of service | ~history ~examination ~MDM (medical decision making) |
| what are the contributory factors | ~counseling ~coordination of care ~time ~nature of presenting problem |
| new patient | have not received any professional services w/ in 3 years |
| established patient | have received professional services in the last 3 years |
| inpatient | formally admitted into the hospital |
| consult | when services are rendered by a doctor whose opinion is requested by another doctor to evaluate or treat a patients illness |
| follow-up | when the patient comes back after the consult |
| how to code consult & follow-up | under consultation section in CPT book |
| initial hospital new patient consult | 1st visit by consulting doctor |
| follow-up inpatient consult | when doctor is asked to follow up while the patient is admitted |
| confirmatory consult | consulting doctor offers an opinion about the treatment plan after dx has been made |
| office/outpatient consult | patient seen in office by a specialist |
| referral | total transfer of care of a patient from physician to another & when requesting an authorization for the patient to receive services |
| relative value unit | doctors are paid based on these |
| criteria needed to bill 99211 | ~face to face time, ~a physician must be in the office, ~seperate service must be provided, ~proper documentation |
| what is bundled services? | services grouped together related to a procedure (ex. panels) |
| preventative medicine | services provided to prevent, occurance of illness, injury, and disease |
| preventative medicine is catergorized | by the patients age |
| inpatient status | formally admitted into hospial or other health care facility for an overnight stay |
| outpatient status | service received in an office, clinic, urgent care center, ER, or surgery center |
| observation status | not formally admitted (on hold) while a decision is made to admit or discharge based on patients condition observed, Not considered INPATIENT at this point |
| how many digits are there in the CPT code? | 5 |
| what does CPT stand for? | current procedural terminology |
| how many levels of the HCPCS are there? | 3 |
| how often are CPT codes revised? | annually |
| who developed HCPCS codes? | CMS (Centers for Medicare and Medicaid Services) |
| emergency care | care for an unexpected medical condition or worsening of a condition that poses a threat to life, limb, or sight |
| critical care | intensive care provided in a variety of acute life threatening conditions requiring constant bed side attention by the physician |
| relative value unit formula | RVU x GAF x CF = medicare $ per service |
| counseling | discussion between physician and patient, family or both, regarding health concerns |
| modifier | gives a more accurate description of services rendered (2 digit code) |
| inpatient consultation 4 R's | ~request, ~render, ~report, and ~reason |
| observation status time length | 24 hours |
| T/F ~ could take up to 8 months for insurance companies to reimburse new codes? | T |
Created by:
maxphia32
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