Medical Ethics - Ans-Standards of conduct based on moral principals. Acting within ethical behavior boundries means carrying out one's responsibilities with integrity, decency, respect, honesty, competence, fairness and
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Medical Ethics - Ans-Standards of conduct based on moral principals. Acting within ethical behavior boundries means carrying out one's responsibilities with integrity, decency, respect, honesty, competence, fairness and trust.
Compliance Regulations - Ans-Most billing related cases are based on HIPAA and the False Claims Act.
HIPAA is an acronym for - Ans-Health Insurance Portability and Accountability Act of 1996.
Category 1 CPT codes - Ans-Medical Procedures.
Category 2 CPT codes - Ans-Supplemental Codes for Performance Measures.
Category 3 CPT codes - Ans-Emerging Technologies.
Add on Codes - Ans-Used for procedures that are always performed during the same operative session, as another surgery in addition to the primary service/procedure and is never performed separately.
Anesthesia is found - Ans-00100-01999, 99100-99140.
Evaluation and Management (E&M) codes - Ans-Are listed first in the CPT manual because they are used by all the different specialties.
Brackets - Ans-Used to enclose synonyms, alternative wording or and explanatory phrase.
Bullets - Ans-Represents a new procedure or service code added since the previous edition of the manual.
Chief Complaint (CC) - Ans-The reason the patient came to see the physician.
Circle with a line through it (?) - Ans-Exemption from modifier 51.
CPT - Ans-Used to report services and procedures by physicians.
E&M codes - Ans-99201-99499
Guidelines are found - Ans-At the beginning of each section and used to provide specific coding rules for that section.
History (HX) - Ans-The set of information the physician gathers from the patient concerning his/her past.
History of Present Illness (HPI) - Ans-A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present.
Indented Codes - Ans-Listed under associate and stand alone codes.
E Codes - Ans-For durable medical equipment for use in home.
Level 1 codes - Ans-Codes found in the CPT manual.
Level 2 codes - Ans-National codes for the physician and non-physician service not found in the CPT Level 1.
Level 3 codes - Ans-Used locally or regionally and have been eliminated by the CMS since the implementation of HIPAA.
The List of Modifiers is found where in the CPT - Ans-Appendix A and in the front of the book.
Modifier 50 - Ans-Bilateral procedure.
Modifier 24 - Ans-Attach to E/M service code when service is provided during postoperative period to indicate that the service is not part of postoperative care and not included in the Surgical Package.
Modifier 26 - Ans-Provider only provided the professional component.
Modifier 51 - Ans-Used more than one procedure during the same surgical episode.
Modifier 57 - Ans-Modifier 57 is used on E/M services the day before or day of major surgery when the initial decision to perform the surgery is identified.
Modifier 78 - Ans-Physician must return to Operating Room to address complication stemming from initial procedure.
Modifier 79 - Ans-Procedure or service provided during postoperative period not associated with initial procedure.
Modifiers - Ans-Reporting indicators that indicate that the procedure or service has been altered by specific circumstance but has not changed in it's definition of code.
Parentheses - Ans-Used to enclose supplementary words, non-essential modifiers.
Past, Family and Social History (PFSH) - Ans-Consists of patients personal experiences with illnesses, surgeries, and injuries; Information of illnesses predominant in family' Patients educational background, occupation, marital status and other factors.
Pathology and Laboratory - Ans-80048-89356.
Plus sign indicates (➕) - Ans-Add on codes.
Radiology - Ans-77010-79999.
Review of Symptoms (ROS) - Ans-Inventory of the constitutional symptoms regarding the various body systems.
Stand Alone Codes - Ans-Contain full description to the procedure for a code.
Sideways triangle means ( ▶️ ) - Ans-Change in wording between triangles.
Bullet means - Ans-New procedure codes.
Circle with a line through it means - Ans-Modifier 51 exempt code.
Six sections of CPT - Ans-E&M, Anatomical Site, Condition or Disease, Synonym or Eponym, Abbreviation.
Three Components for E&M Codes - Ans-1.History, 2.Physical Exam, and 3.Medical Decision-Making.
Three Categories for E&M Codes - Ans-Category I: Procedures that are consistent with contemporary medical practice and are widely performed. Category II: Supplementary tracking used for performance measures. Category III: Temporary codes for emerging technology, services and procedures.
4 contributing factors for E&M Codes - Ans-New or existing patient, History, Physical Exam, Medical Decision making, Time spent can be a 5th factor.
Medicare Part A - Ans-Part A is hospital insurance provided by Medicare. Most people do not pay a premium for this coverage.
Medicare Part B - Ans-Part B is medical insurance to pay for medically necessary services and supplies provided by Medicare. (Doctors, Outpatient care, Physical and Occupational Therapist, etc.)
Medicare Part C - Ans-Part C is the combination of Part A and B. The main difference in Part C is that it is provided through private insurance companies approved by Medicare.
Medicare Part D - Ans-Part D is stand-alone prescription drug coverage insurance.
Medicaid - Ans-Free or low-cost health insurance coverage through the state.
Medicaid categorically needy - Ans-A distinction for individuals who fall into a specific category (or criteria) of mandatory Medicaid eligibility established by the federal government. These categories apply to every state Medicaid program.
Medicaid Medically Needy - Ans-Provide Medicaid to certain groups not otherwise eligible for Medicaid, must cover: ▪️Pregnant women ▪️Children under 18: States have option to cover: ▪️Children up to 21 ▪️ Parents and other caretaker relatives ▪️ Elderly ▪️ Individuals with disabilities.
Who is the Payer of Last Resort - Ans-Medicaid is always the payer of last resort.
Tricare - Ans-Health care program for Uniformed Service members, retirees and their families.
Tricare Standard - Ans-Option that provides the most flexibility to TRICARE-eligible beneficiaries. It is the fee-for-service option that gives beneficiaries the opportunities to see any TRICARE-authorized provider.
Tricare Extra (PPO) - Ans-A preferred provider option, rather than an annual fee, a yearly deductible is charged. Health care is delivered through a network of civilian health care providers who accept payments from CHAMPUS and provide services at negotiated, discounted rates.
Tricare Prime (HMO) - Ans-An HMO type plan in which enrollees receive health care through a Military Treatment Facilities PCM or a supporting network of civilian providers.
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