Final Exam Review for Insur. Coding over Ch 7,8,10,11 and 12
E/M CPT codes need to best represent what 3 things?
1. Patient Type 2. Setting of service 3. Level of E/M services provided
3 things to ask before coding an E/M code:
1. What's the place of service? 2. What's the type of service? 3. What's the patient status?
True or False: The correct code assignment for a patient at a hospital who has a surgeon remove a 2.0 cm fibroma from the intramuscular area of the left foot is 28041-LT.
True
True or False: When choosing E/M codes know that the elements has to meet or exceeded what's documented.
True
True or False:Qualifying circumstances codes may be assigned for anesthesia services
True
True or False: AHA American Hospital Association and CMS Centers of Medicare and Medicaid Services both established the AHA clearinghouse to handle coding questions on established HCPCS usage.
True
True or False: AHA American Hospital Association publishes a Coding Clinic for HCPCS and ICD10CM.
True
True or False: At hospitals HCPCS codes are automatically assigned so in the physician office setting coding professionals take on a more active role in assigning HCPCS codes then the hospital setting.
True
True or False: CMS allows hospitals to create their own system for classifying visits.
True
True or False: Critical Care if less than 30 mins on a given date should be reported with an E/M service code?
True
True or False: Documentation requirements differ slightly for new versus established patients.
True
True or False: E/M codes are physician or hospital based.
True
True or False: It is important to note that the existence of an HCPCS Level II code doesn't necessarily indicate that it will be reimbursed.
True
True or False: Medicare does not accept consultations codes; instead, providers must report E/M office codes. Other payers may or may not accept the codes.
True
True or False: Not all E/M codes use new versus established patient in the coding selection.
True
Conscious sedation
Anesthesia that produces a level of consciousness that retains the pts ability to independently and continuity maintain an airway and respond appropriately to physical stimulation or verbal command.
Each type of history includes all or some of what elements?
(CC) Chief Complaint, HPI, ROS and PFSH
3 major types of Anesthesia
1. Local 2. Regional 3. General
What is the correct code and physical status modifier for anesthesia services for radical mastectomy with internal mammary node dissection; patient has diabetes mellitus well controlled with ADA diet.
00406- P2
What is the correct code assignment and physical status modifier for anesthesia services for heart transplant secondary to congenital heart defect; patient is 3 weeks old and requires a transplant to survive?
00580-P5, 99100, 99140
What is the correct code assignment for anesthesia services for ERCP?
00732
What is the correct code and physical status modifier for anesthesia services for cervical cerclage; patient is 25 years old and in good health.
00948-P1
What is the correct code assignment and physical status modifier for anesthesia services for open repair for malunion fracture of humerus; patient is 85 years old but healthy?
01744-P1, 99100
3 Key Components/Factors
1. History 2. Examination 3. Decision making
Step-by-Step Instructions for selecting E/M Codes
1. Identify the correct category of service. 2. Review specific notes and instructions for the selected category and subcategory. 3. Review narrative descriptors and apply definitions and supportive documentation for key components.
What is the correct code assignment for a patient at a hospital's outpatient surgery center seen for removal of 2.0 cm basal cell carcinoma of the left arm? The surgeon excised the lesion with 0.5 cm margins around the diameter of the skin tumor?
11603
What is the correct code assignment for a patient seen in the emergency department for facial lacerations? The on-call plastic surgeon performed simple repairs on 3.0 cm laceration on the forehead, a 2.8 laceration of the left upper eyelid and a 1.0 cm laceration of the right upper eyelid?
12014
Established patients always require how many key elements to be met?
2 of 3
What is the correct code assignment for a patient at a hospital who is seen for a displaced distal left fibular fracture who has a surgeon perform an open reduction with internal fixation?
27792-LT
New patients always require how many key elements to be met?
3 of 3
What is the correct code assignment for laparoscopic cholecystecomy with cholangiography?
47563
What is the correct code assignment and anatomic site modifier for a 35- year-old male patient seen at the hospital outpatient center where the surgeon performs a laparoscopic herniorrhapy for a recurrent left inguinal hernia?
49651- LT
What is the correct code assignment for a patient at a local hospital has a gynecologist performed a total abdominal hysterectomy with bilateral salpingo- oophorectomy (uterus 260 gr). The pathological diagnosis was submucous leimyoma of the uterus?
58150
What is the correct code assignment for a pregnant patient at a hospital who is in her second trimester who has polyhydramnios who has a physician perform an amniocentesis?
59001
A new patient is seen in the physician's office after falling and injuring her knee. The physician performed a problem-focused history, expanded problem focused examination, and the decision-making was straightforward. What is the correct E/M code?
99201
A new patient was seen in the physician's office for abdominal pain. The physician performs a comprehensive history and examination. Medical Decision- making is of moderate complexity. What is the correct E/M code?
99204
What's the correct code assignment for an established patient with hypertension visits a physician's office performed by a nurse doing a blood pressure check?
99211
An established patient is seen in the outpatient clinic for dizzy spells. The physician performs an expanded focused history, detailed examination and medical decision-making is of moderate complexity. What is the correct E/M code for this service?
99214
Dr. Gerald provides preventive medicine services to an established 45-year old patient who is in good health and has no complaints. Dr. Gerald obtains a comprehensive history and examination, and counsels the patient on proper diet and exercise. What is the correct E/M code?
99396
Qualifying circumstances
Add-on codes used to indicate operative conditions and/or unusual risk factors
Anesthesia codes are arranged by:
By anatomical body site and then surgical procedure performed
When Coding for a New Patient
Code to the lowest level
When Coding for a Established Patient
Drop the lowest level and code to the next lowest level
True or False: A patient seen by his primary care physician in January for flu- like symptoms who returns the following July for a skin infection is considered a new patient.
False
True or False: A patient who is seen by their primary care doctor then 2 years later is seen by a cardiologist for the first time at the same office is considered an established patient.
False
True or False: All seven of the following are considered key components in selecting an E/M level of service: history, examination, medical decision-making, coordination of care, counseling, nature of presenting problem and time.
False
True or False: An anesthesiologist's history and physical examination are separately reportable with an E/M code in addition to the anesthesia code for the same day of service?
False
True or False: CPT definitions are suitable for hospital services in ED.
False
True or False: Edema of the legs or arms is a ROS.
False
True or False: Just the AMA American Medical Association provides input through the Editorial Advisory Board not AHIMA.
False
True or False: Reverse Shoulder Replacement is the same as Shoulder Disarticulation.
False
True or False: The correct code assignment a patient at the hospital's ambulatory surgery center gets a diagnostic colonoscopy to determine the reason for abnormal bowel movements. Using a snare, the physician removed a benign polyp of the cecum is 45388.
False
True or False: The correct code assignment for a patient at a hospital who presents with a right breast mass, who has ultrasound guidance, and a localization wire inserted and a percutaneous breast biopsy was performed is 19085-RT.
False
True or False: The correct code assignment for a patient at a hospital who has surgeon perform a cystourethroscopy for insertion of a urethral stent for stricture is 52332.
False
True or False: The correct code assignment for expanded problem focused history or examination with moderate decision-making is 99214.
False
True or False: The review of systems requires the physician to perform a physical examination.
False
E/M services are used for:
For billing on Professional (cognitive) services provided by the physician and supervised non physician during hospital, office visits, SNF visits and consultations.
When can anesthesia time be reported?
For reimbursement of services if preferred by the local carrier.
True or False: The AMA and CMS developed documentation guidelines for use with the CPT code book.
True
Spinal Anesthesia
Injection into subarachnoid space
Epidural Anesthesia
Injection to epidural space in spine
(ROS) Review of Systems
Inventory of 1 to 14 body systems obtained by the physician through a serious of questions seeking to identify signs or symptoms that a pt is experiencing or has experienced.
Physician fee schedule look-up tool
It's an online software program used to identify pricing information for carriers by a HCPCS code.
HPI elements
Location, Duration, Severity, Timing, Quality, Associated signs and symptoms, Context, and Modifying factors.
Local Anesthesia
Method that involves an injection of a numbing agent directly into the area of the body, which will block pain in minor procedures.
Regional Anesthesia
Method that involves an injection, but the anesthetic is applied to a larger area of body surface. This type of technique is often used for procedures on hands, feet, arms and legs.
General Anesthesia
Method that requires that the anesthetic be administer IV or by inhalation. The patient is unconscious during surgery.
Modifying Factor
Must include not only the steps the patient has taken to try to alleviate the problem but also the effects of these steps on the patient.
Key factors when assigning codes for Preventative Medicine Services Codes:
New or established patient Age, Services reflect age and gender appropriate history/exam
Services that National codes are designed to report:
Physician and no physician services such as drugs, chiropractic services, dental procedures, durable medical equipment and other selected procedures.
Services that largely depend on the age of the patient:
Preventative Medicine Services
How do you report anesthesia services for multiple surgical procedures during the same session?
Report the most complex procedure code and also report the time for all the procedures combined
Anesthesia time is counted by:
Should begin with preparation of the pt by the anesthesiologist for induction of anesthesia and end when the anesthesiologist no longer is in attendance.
Key factor when selecting a critical care code:
Time which is reported once per date
True or False. A patient who is seen by a primary care doctor at Lone star office and then is seen 5 months later by an allergist who also works at Lone star office is considered a new patient.
True
True or False: A patient who is seen by his primary care physician (Dr. Smith) in July for sever headaches, and when the patient returns in 4 weeks sees Dr. Jones for a follow up visit is considered an established patient.
True
True or False: A problem-focused history involves a chief complaint and brief history of the present illness or condition of the patient.
True
True or False: The National codes are published annually.
True