Medical Insurance: An Integrated Claims Approach Process
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| Panel | In CPT, a single code that groups laboratory tests that are frequently done together.
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| Professional Component | The physician's skill, time and expertise used in performing a procedure.
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| Separate Procedure | A procedure performed in addition to a primary procedure.
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| Category III Codes | Temporary codes for emerging technology, services, and procedures.
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| Global Period | The inclusion of pre- and postoperative care for a specified period in the charges for a surgical procedure.
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| Bundled Code | Procedure code that groups related procedures under a single code.
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| Category II Codes | CPT codes that are used to track performance measures
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| 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.
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| Unlisted Procedure | A service that is not listed in CPT and requires a special report.
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| Modifier | A two-digit number indicating that special circumstances were involved with a procedure, such as a reduced service or a discontinued procedure.
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| T/F In Selecting correct procedure codes, that main text sections are first searched, and the code is then verified in the index. | False
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| T/F Category II codes are not reported for payment. | True
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| T/F In the CPT index, a see cross-reference must be followed. | True
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| T/F The section guidelines summarize the unlisted codes for the section. | True
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| T/F The phrases before the semicolon in a code descriptor define the unique entries, those after the semicolon are common. | False
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| T/F Descriptive entries in parentheses are not essential to code selection. | True
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| T/F A Category III code ends in a letter | True
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| T/F Procedure codes are reported in order of increasing financial value for services performed on the same day. | False
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| T/F For New patients, two of the three factors that are listed must be met. | False
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| T/F Because it is an evaluation of a patient, a consultation is coded using E/M office service codes. | True
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| 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
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| 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
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| The abbreviation PFSH stands for: | A. past, family, and/or social history
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| 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
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| The 3 key factors in selecting an evaluation and management code are; | D. history, examination, and medical decision making
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| CPT code 99382 is an example of: | B. a preventive medicine service code
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| Anesthesia codes generally include: | A. Preoperative evaluation and planning, normal care during the procedure, and routine care after the procedure.
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| Surgery codes generally include: | B. Preoperative evaluation and planning, the operation and normal additional procedures, and routine care after the procedure.
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| When a Surgery section code has a plus sign next to it: | C. It cannot be reported as a standalone code.
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| When a panel code from the Pathology and Laboratory section is reported: | A. All the listed tests must have been performed.
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| 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
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| 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.
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| What are E/M codes? | They cover physician services that are performed to determine the best course for patient care.
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| Category I Code | Five digit code with brief explanation of the procedure.
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| Modifier 26 | Indicates to payer that physician did not perform all the work (just professional part).
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