Coding - CPT Codes Questions with Certified Solutions

Coding - CPT Codes Questions with Certified Solutions CPT ✔✔current procedural terminology, owned by AMA lists procedures and services commonly performed by MD`s across the country types of CPT codes ✔✔category l cod ...

Coding - CPT Codes Questions with Certified Solutions CPT ✔✔current procedural terminology, owned by AMA lists procedures and services commonly performed by MD`s across the country types of CPT codes ✔✔category l codes category ll codes category lll codes category l codes ✔✔procedure codes found in the main body of CPT ,5 digits , no decimals , has descriptor category ll codes ✔✔used to track performance measures for a medical goal, alpha character for 5th digit category lll codes ✔✔temporary codes for emerging technology, services , and procedures, alpha character for 5th digit organization ✔✔main text, appendixes, and index assignment of correct procedure code ✔✔begins by reviewing the physician`s statements in the pt`s medical record types of Main Terms ✔✔1) name of procedure or service 2) name of organ/other anatomical site 3) name of the condition 4) synonym/eponym for the term 5) abbreviation for the term two codes ✔✔two codes either sequential or not, are separated by a comma, more than two by a hyphen cross reference ✔✔the cross reference "see" , is a mandatory instruction Main Text ✔✔after the index is used to point to a possible code, the main index is read to verify the selection of the code section guidelines ✔✔usage notes at the beginning of CPT sections, covers definitions and items unique to the section unlisted procedure ✔✔service not listed in CPT, those not completely described by any code in the section special report ✔✔note explaining the reasons for a new , variable or unlisted service how many appendixes in CPT ✔✔14 semi-colons, indentations ✔✔CPT uses a semicolon and indentations when a common part of the main entry applies to entries that follow , unique descriptors after the semicolon are not capitalized symbols for changed codes ✔✔bullet-indicates new procedure code triangle-indicates code descriptor has changed facing triangles-enclose new or revised text other than code descriptor bullet inside a circle-means that moderate sedation is a part of the procedure that the surgeon performs, billed in addition to the code lightening bolt -FDA approval pending, can`t be used yet add on code ✔✔procedure performed and reported in addition to a primary procedure primary procedure ✔✔most resource intensive CPT procedure during an encounter resequenced codes ✔✔CPT procedure codes that have been reassigned to another sequence,new code out of numerical sequence CPT modifier ✔✔two digit number used to communicate special circumstances involved with procedures that have been performed use of modifiers ✔✔some modifiers apply only to certain sections add-on codes cannot be modified codes that begin with a circle with a backlash cannot be modified with 51, multiple procedures what do modifiers mean ✔✔use of a modifier means that a procedure was different from the description in CPT , but not in a way that required a different code how are modifiers shown ✔✔adding a space and a two digit code to the CPT code technical component/TC ✔✔reflects the technician`s work and the equipment and supplies used in performing it professional component/PC ✔✔represents a physician`s skill, time, and expertise used in performing it steps for assigning correct code ✔✔1) review complete medical documentation 2)abstract the medical procedures from the documentation 3) identify main term for each procedure 4 ) locate main terms in the CPT index 5) verify the code in the CPT main index 6) determine the need for modifiers how are codes ranked for each day`s service ✔✔earliest date of service and highest to lowest rate of reimbursement E/M codes (evaluation and management) ✔✔codes that cover physician`s services performed to determine the optimum course of treatment for pt care structure of E/M codes ✔✔most codes in the E/M section are organized by the place of service , subsections for new vs established pts consultation ✔✔asking for the opinion of another MD referral ✔✔the PCP is sending the pt to another provider for specialized care steps to select an E/M code ✔✔1) determine category/subcategory based on place of service and pt status 2) determine extent of history that is documented 3) determine extent of exam documented 4) determine complexity of medical decision making documented 5) analyze requirements to report the service level 6) identify the service level based on the nature of the presenting problem, time , counseling & care coordination 7) verify documentation is complete 8) assign the code key components to select code from 3-5 digit code range ✔✔1) MD documented history 2) examination that was documented 3) medical decisions the MD documented history ✔✔HPI - history of present illness ROS - review of symptoms PMH - past medical history FH - family history SH - social history PFSH - histories documented after HPI as a group extent of examination ✔✔1) problem focus-limited exam of affected body area/system 2) expanded problem focused 3) detailed 4) comprehensive determining the complexity of medical decision making ✔✔1) straightforward 2) low complexity 3) moderate complexity 4) high complexity key component ✔✔factor documented for various levels of evaluation and management services analyzing the requirements to report the service level ✔✔the descriptor for each E/M code explains the standards for its selection , for office visits and most other services to new pt`s and initial visits , all 3 key components must be documented . if 2 are at a higher level and a third is below that level , the standard is not met . nature of the presenting problem ✔✔many descriptors mention two additional components : 1) how severe the pt`s condition is and 2) how much time the MD spends directly treating the pt. the severity of the presenting problem helps determine medical necessity counselling ✔✔counseling is a discussion with a pt regarding areas such as diagnostic results, instructions, education , not required to be documented as part of key components verifying that the document is complete ✔✔the documentation must contain the record of the MD`s work in enough detail to support the selected E/M code outpatient ✔✔patient who receives healthcare services in a hospital setting without being admitted emergency department services ✔✔when ER services are reported , whether the py is new or established is not applicable preventive medicine services ✔✔preventive medicine services are used to report routine physical examinations in the absence a pt complaint anesthesia codes ✔✔each anesthesia code includes the complete and usual services of an anesthesiologist structure of anesthesia codes ✔✔subsections are organized by body site , under each subsection the codes are arranged by procedures. The body-site subsections are followed by two other subsections: 1) radiological procedures and 2) other or unlisted procedures physical status modifiers ✔✔this modifier is added to anesthesia codes to report pt health status : P1-6 surgical package ✔✔includes all the usual services plus the operation itself . A complete procedure includes ; operation , anesthesia, and postoperative care all covered under a single code global surgery rule ✔✔combination of services included in a single procedure code global period ✔✔days surrounding a surgical procedure when all services relating to the procedure are considered part of that surgical package 2 types of services not included in surgical package codes ✔✔1) complications or recurrences that arise after the therapeutic surgical procedures 2) care for the condition for which a diagnostic surgical procedure is performed separate procedures ✔✔descriptor used for a procedure that is usually part of a surgical package but may also be performed seperately modifiers ✔✔a number of modifiers are commonly used to indicate special circumstances involved with surgical procedures bundling ✔✔using a single payment for two or more related procedure codes