Medical Insurance & Billing Ch.5

Which of the following are phrases commonly used with add-on codes? (Select all that apply.)

Each additional List separately in addition to the primary procedure

Which of the following is gathered in social history?

Marital status Employment Patient's age

______ is the practice of displaying CPT codes outside of numerical order in favor of grouping them according to the relationships among code descriptors.

Resequencing

Each section of the CPT manual begins with which of the following for the use of its codes?

Section guidelines

A main term in a CPT index may be followed by which of the following?

Subterms

The services for a _____ code are rendered real-time through interactive audio and/or video telecommunications system.

Telemedicine

Which of the following apply to a range of codes? (Select all that apply.)

The codes are separated by a comma. The codes do not have to be sequential.

Identify the correct statements related to section guidelines.

The guidelines cover definitions and items unique to the section. The guidelines include special notes about the structure of the section or the rules for its use. The guidelines list the subsections in which the notes occur and the notes begin those subsections.

Identify when the lightning bolt symbol is used in CPT.

The lightning bolt symbol indicates the codes cannot be used until approved. The lightning bolt symbol is used with vaccine codes that have been submitted to the FDA and are expected to be approved for use soon.

What is the purpose of the codes in the Evaluation and Management section?

To cover physicians' services that are performed to determine the best course for patient care

After the index is used to point to a possible code, the main text is read for which purpose?

To verify the selection of the code

Resequenced codes are listed how many times in CPT?

Twice

A _____ symbol indicates that the code's descriptor has changed

triangle

Identify the correct statements related to CPT.

CPT is a proprietary code set and is not available free to the public.

Which list is used to locate the appropriate place or type of service for E/M code selection?

E/M categories

Identify all the correct statements related to the evaluation and management codes (E/M codes).

E/M codes cover the complex process a physician uses to gather and analyze information about a patient's illness. E/M codes are often called the cognitive codes. E/M codes are listed first in CPT.

Which of the following describes straightforward decision making?

Minimal diagnoses options, a minimal amount of data, and minimum risk

_____ are used to communicate special circumstances involved with procedures that have been performed.

Modifiers

To justify the use of higher level E/M codes the provider must _____ specific clinical facts.

document

When using a modifier for a two part procedure the professional component (PC) indicates the _____ performed or reported the procedure.

physician

What is step 2 in the process of assigning CPT codes?

Abstract the medical procedures.

The _____ include special notes, rules, and structure about a CPT section in order to select the correct code.

guidelines

The presenting problem is of moderate to _____ severity.

high

When listing code ranges, more than two sequential codes are separated by a _____.

hyphen

_____ components are the factors documented for various levels of evaluation and management services.

key

The guidelines are located in each ____ of the CPT book.

section

Which of the following is the symbol for an add on code?

+

How many digits do CPT Category I codes contain?

5

Which of the following describes a history of a present illness?

A description of its development from the first sign or symptom to the present time

Which of the following is the symbol for an FDA approval pending code?

A lightning bolt

CMS has designated CPT codes as the standard for physician procedures that are paid by _____.

Medicare Medicaid Government insurance program

What is the correct definition of add-on codes?

Add-on codes describe secondary procedures commonly carried out in addition to primary procedures.

How are modifiers shown in CPT?

Adding a space and the two-digit code to the CPT code

The modifiers are listed in which appendix of CPT?

Appendix A

Which of the following are appendixes in CPT? (Select all that apply.)

Appendix D - Summary of CPT Add-on Codes Appendix A - Modifiers Appendix B - Summary of Additions, Deletions, and Revisions

What does the CPT book list?

Commonly performed medical procedures and services

Which of the following are among the three symbols used in CPT codes?

Bullet

Identify all the correct statements related to CPT modifiers.

CPT modifiers are two-digit numbers that may be attached to most five-digit codes. Modifiers are used to communicate special circumstances involved with procedures that have been performed.

Unlisted procedure codes are used for new services that have not yet been assigned which of the following types of codes in CPT? (Select all that apply.)

Category I Category III

Which of the following is a general multisystem examination or a complete examination of a single organ system?

Comprehensive

_____ requests and reports must be written documents that are placed in the medical record.

Consultation

_____ is a discussion with a patient regarding areas such as diagnostic results, instructions for follow up treatment , and patient education.

Counseling

Which of the following is correct in relation to counseling and E/M coding?

Counseling is mentioned as a typical part of each E/M service.

The CPT index contains which of the following information?

Descriptive terms that are listed in the sections of the codes

Which of the following are key components that must be documented for each E/M code? (Select all that apply.)

Detailed history Detailed examination Medical decision making

Which of the following apply to step 1 of the six steps of assigning CPT codes? (Select all that apply.)

Determine the place of service. Review the documentation. Decide which procedures were performed.

Which of the following statements are correct in regards to CPT symbols?

Facing triangles (two triangles that face each other) enclose new or revised text other than the code's descriptor. A triangle indicates that the code's descriptor has changed. A bullet indicates a new procedure.

Which of the following would be considered an established patient?

Family provider Another provider in same group

Where are codes for items that are used in medical practices but are not listed in CPT (such as supplies and equipment) found?

Healthcare Common Procedure Coding System

_____ is the information the physician received by questioning the patient about the chief complaint.

History

Which of following is the definition for HPI?

History of Present Illness

Which of the following must be sufficiently documented to determine medical necessity?

History, Exam, and Medical decision making

What is step 3 in the process of assigning CPT codes?

Identify the main term for each procedure.

Which of the following apply to step 4 of the six steps of assigning CPT codes? (Select all that apply.)

If the main term cannot be located in the index, the insurance specialist reviews the main term with the physician for clarification. When a code range is listed, read the code descriptors for all codes within the range indicated in the index. Locate the procedures in the index at the back of the CPT.

Which of the following statements relating to the three key components needed for reporting service levels is correct?

If two components are at a higher level and a third is below that level, the standard is not met.

Which of the following apply to step 2 of the six steps to assigning CPT codes?

Medical procedures must be taken from the visit documentation.

components are the factors documented for various levels of evaluation and management services.

Key

Which of the following describes low complexity decision making?

Limited diagnoses options, a small amount of data, and low risk

Which of the following are among the six steps for assigning CPT codes? (Select all that apply.)

Locate the main terms in the CPT Index. Determine the need for modifiers. Verify the code in the CPT main text.

Which of the following apply to step 3 of the six steps of assigning CPT codes? (Select all that apply.)

Main terms may be based on organ or body part. Identify the main term for each procedure. Main terms may be based on procedure or service.

Identify all the points about an illness that may be documented for the patient's HPI.

Modifying factors (any factors that alter the pain or symptom) Quality (type of pain or symptom, such as sudden or dull) Location (body area of the pain or symptom)

Which of the following apply to the place and type of service in E/M codes? (Select all that apply.)

Most codes in the E/M section are organized by the place of service, such as the office, the hospital, or a patient's home. A few codes in the E/M section are grouped by type of service.

Which of the following are types of main terms in the CPT index? (Select all that apply.)

Name of the procedure or service Name of the condition Abbreviation for the term

An unlisted procedure code is used for which of the following?

New procedures or procedures that have not been assigned a Category I or III code yet

Which of the following statements are correct regarding categories used in selecting place of service and patient status for E/M codes? (Select all that apply.)

Office visits, hospital services, and preventive medicine are E/M categories used to locate the place or type of service. Inpatient Services would be a subcategory of Hospital Services.

According to E/M coding, who is considered a "new patient"?

One who has not received any professional services from the provider within three years

Which of the following are examples of the types of information a patient's past history can contain? (Select all that apply.)

Operations Injuries Hospitalizations Major illnesses

The histories documented after the HPI are sometimes referred to with the abbreviation _____.

PFSH

Patients should provide a cause of death for which of the following deceased family members in a family history?

Parents

Which of the following is a consideration when abstracting documentation to select services to be reported?

Payer's policies

Which of the following send their suggestions for revisions to the CPT code to the AMA each year? (Select all that apply.)

Physicians Medical specialty societies State medical associations

_____ focused is a limited examination of the affected body area or system.

Problem

Identify three body systems about which information is collected for the review of systems (ROS).

Respiratory Constitutional symptoms Eyes

Which of the following apply to step 5 of the six steps of assigning CPT codes? (Select all that apply.)

Review the possible codes in the CPT section that the index entries point to. The codes to be reported for each day's services are ranked in order of highest to lowest reimbursement. Check section guidelines and any notes directly under the code, within the code descriptor, or after the code descriptor.

Which of the following is used to determine the CPT code?

Service Treatment Procedure

Which of the following are additional components to many descriptors in selecting E/M levels? (Select all that apply.)

Severity of the problem Time physician spends directly treating the patient

Which of the following are examples of the types of information collected about a patient's family members for the family history? (Select all that apply.)

Specific diseases Medical events Hereditary diseases Cause of death

The services for a _____ of 1 code are rendered real-time through interactive audio and/or video telecommunications system.

Telemedicine

Identify the correct guidelines for documenting evaluation and management codes.

The 1995 and 1997 Documentation Guidelines for Evaluation and Management Services

Which of the following apply to the published E/M guidelines? (Select all that apply.)

The 1997 Documentation Guidelines is more commonly used than the 1995 version. The medical practice should be clear about which set of guidelines, the 1995 or the 1997, it generally follows for E/M coding and reporting. CMS and most payers permit providers to use either the 1995 or 1997 E/M guidelines.

Which of the following apply to step 6 of the six steps of assigning CPT codes? (Select all that apply.)

The circumstances involved with the procedure or service may require the use of modifiers. The patient's diagnosis may affect whether a modifier is required.

Identify the two places resequenced codes are listed in CPT.

The code and its descriptor appear in a group of codes to which it is related. They are listed in their original numeric position.

Which of the following statements applies to the common descriptor?

The common descriptor begins with a capital letter, but the unique descriptors after the semicolon do not.

Which of the following are essential for the documentation under step 7 for E/M coding? (Select all that apply.)

The documentation must contain the record of the physician's work in detail. The history, examination, and medical decision making must be sufficiently documented.

Which of the following is true of the collection of a patient's past history?

The past history could contain data about other major illnesses and injuries.

Which of the following is true when coding an office visit?

There are five codes to choose from for an office visit with a new patient.

How many codes are listed for most types of service?

Three to five

What is step 5 in the process of assigning CPT codes?

Verify the code in the CPT main text.

Why does CPT use semicolons and indentions?

When a common part of a main entry applies to entries that follow

When is a range of codes shown?

When more than one code applies to an entry

During which of the following situations are modifiers used? (Select all that apply.)

When unusual difficulties occurred during the procedure When only part of a procedure has been done When a procedure has two parts: a technical and a professional component

Past history includes current medications, _____ , immunizations, and diet.

allergies

The CPT _____ of 1 makes the process of selecting the correct procedure code more efficient.

index

In order to report Telemedicine cods the provider must exchange enough information in order to meet the _____ components required as with a face to face encounter.

key

Family history reviews the _____ events in the patient's family.

medical

A(n) _____ is a number appended to a code to report particular facts.

modifier

The severity of the patient's condition is referred to as the _____.

nature of the presenting problem

The term any _____ services in the definition of new and established patients means the established category used for a patient face to face encounter with a physician.

professional

Using two or more modifiers with one code will _____.

provide the best description possible

An indented code uses a _____ to separate the common descriptor from the unique descriptor.

semicolon