CDEO Chapter 7 Exam Questions With 100% Correct Answers 2024, Exams of Advanced Education

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CDEO Chapter 7 Exam Questions With 100% Correct Answers 2024 RBRVS - Correct Answer-Resource-Based Relative Value Scale RBRVS System - Correct Answer-Established by Medicare to reimburse physicians based on CPT code submitted for reimbursement RVU - Correct Answer-Each CPT code has an assigned relative value unit which, when multiplied by conversion factor and a geographic region allowance , creates the reimbursement for the medical service the CPT code represents RVU Components - Correct Answer-1) Physician work- time, skill, training, and intensity of service provided 2) Practice Expense - reflects the cost of ancillary personnel, supplies, and overhead 3) Professional Liability Malpractice Insurance pg. 1 professoraxe l Using RBRVS - Correct Answer-CMS annually publishes Physician Fee Schedule information on its website and posts the formula for calculating physician fee schedule amounts. Physician Fee Amounts - Correct Answer-vary depending on facility vs non-facility Facility Practice RVU - Correct Answer-expenses include services performed in emergency rooms , hospitals, SNFs, nursing homes, ASC. Non Facility RVUs - Correct Answer-include services performed in non-hospital owned physician practices and privately owned practices. GPCI - Correct Answer-Geographic Practice Cost Index Geographic Prctice Cost Index - Correct Answer-is used to realize the varying cost based on geographic location CF - Correct Answer-Converstion Factor pg. 2 professoraxe l Global Fee Includes - Correct Answer-Preoperative visits beginning eith the day before the day of surgery Intraoperative services that are a usual and necessary part of a surgical procedure All additional medical or surgical services required of the physician within 90 days of the surgery due to complications that do not require additional trips to the operating room Related follow-up visits made within the 90-day postoperative period Post surgical pain management by the surgeon Any related supplies, services, procedures normally required for surgery Global Fee Includes - Correct Answer-Medicare will only cover postoperative complications that require a return to the operating room . pg. 5 professoraxe l Procedure rooms and minor treatment are not considered operating rooms. Status Indicators - Correct Answer-Surgical CPT Codes have global surgery status indicators assigned based on risk factors associated with medical procedures. Status Indicators - Correct Answer-can be found on the National Physician Fee Schedule Relative Value File 000 - Correct Answer-Endoscopies or minor procedures with preoperative and postoperative relative values on the day of the procedure only are reimbursable Evaluation and management services on the same day of the procedure are generally not payable. 010 - Correct Answer-Minor procedures with preoperative relative values on the day of the procedure and postoperative relative values during a 10-day postoperative period are reimbursable services . pg. 6 professoraxe l Evaluation and management services on the day of the procedure and during the 10-day postop period are not reimbursable. 090 - Correct Answer-Major procedures with one day preoperative period and 90 day postoperative period are a component of global package of major procedure. Evaluation and management services on the day prior, day of, and 90 day postoperative period are not reimbursable. MMM - Correct Answer-Maternity codes; the usual global period concept does not apply XXX - Correct Answer-The global concept does not apply to this code eg. E/M Services, Anesthesia, Laboratory, Radiology Procedures YYY - Correct Answer-These are unlisted codes . They are related to another service and are always included in the global period of the primary service. pg. 7 professoraxe l Correct modifier use is crucial for accurate reimbursement. Failure to use modifiers can lead to lost revenue or inappropriate overpayment Common Surgical Coding Errors - Correct Answer-Failure To Report Imaging Guidance: Imagining guidance is bundled in many procedures- but not all. Review the coding guidelines and parenthetical notes for instructions to report imagine guidance, when appropriate. Common Surgical Coding Errors - Correct Answer-Incorrect Reporting of Units: Pay attention to the code description to determine if the procedures can be performed multiple time when applicable. Review of the MUE for the code will prevent you from reporting incorrect units. Modifiers - Correct Answer-provide addtional info about the service/procedure indicating service/procedure has been altered but the definition of the code has not changed. pg. 10 professoraxe l CDEOs require a firm understanding of proper modifier use and its impact on claims payment - especially in post payment audit. Used properly modifiers can break the global package, when the care warrants it. Modifier 24 Unrelated E/M by the Same Provider or Other qualified healthcare professional during a postoperative period - Correct Answer-is appended to E/M service for an unrelated reason during a postoperative period Some private payers allow modifier 24 with post-operative complications treated in the office, unless there is a specific procedure to report the service. Medicare does not allow the use of modifier 24 for treatment of post-operative complications during the post-op period because treatment of complications not requiring additional trips to the operating room are considered part of the global surgery payment Modifier 25- Significant, separately identifiable E/M service by the same physician or other qualified healthcare professional on the same day of service/procedure - Correct Answer-To pg. 11 professoraxe l determine if this modifier is appropriate, it can be helpful to show the documentation can be separated into two distinct visits. According to CMS, and E/M service that is separate and distinct from a minor procedure or endoscopic procedure with a 0-10 day post-op period and no pre-op period are reportable with this modifier appended Modifier 25 Audit Concerns - Correct Answer-* Appending the modifier on the minor procedure, instead of the E/M code. * Documentation does not support a separate E/M. Most providers do not realize there is a component factored into the RVU value for every procedure. The E/M service must be above the typical pre-op work including the risks and benefits of the procedure. * Various interpretations/guidance from payers regarding proper use. It is crucial to review the payer policies for the services being audited. This includes proper modifier use. pg. 12 professoraxe l In either case, the subsequent procedure or service is either related to the underlying problem/diagnosis that prompted the itnitial surgery, or anticipated at the time the surgeon performs the initial surgery (or both). In other words, the patient's condition, rather than the results of a previous surgery, dictates the need for additional procedures. This modifier according to the NCCI policy, may be reported when a diagnostic endoscopy leads to an open procedure. Modifier 77 Repeat Procedure BY ANOTHER PHYSICIAN or other qualified healthcare professional - Correct Answer-is reported when a service is repeated the same date of service by A DIFFERENT provider. Without a modifier, the payer will assume that the service was billed twice in error, which will result in a denial for a duplicate. Modifier 76 Repeat Procedure by the same physician or other qualified healthcare professional - Correct Answer-is reported pg. 15 professoraxe l when a service is repeated the same date of service by THE SAME provider Without a modifier, the payer will assume that the service was billed twice in error, which will result in a denial for a duplicate. Modifier 78 - Unplanned return to the operating room by the same physician or other healthcare professional following initial procedure for a related procedure during the postoperative period - Correct Answer-is reported during the global period to indicate the patient required an unplanned procedure usually a complication This modifier requires a return to the operating room Modifier 79 - Unrelated procedure or service by the same physician or other healthcare professional during the postoperative period - Correct Answer-will begin a new global period for the unrelated procedure Global Surgical Package - Correct Answer-the services included may be furnished in any service location that is: pg. 16 professoraxe l A Hospital An Ambulatory Surgical Center A Physician Office Modifier 50 - Correct Answer-Indicates bilateral procedure Modifier 50 Bilateral Procedure - Correct Answer-"unless otherwise identified in the listings, bilateral procedures that are performed at the same operative session should be identified by adding modifier 50 to the appropriate five digit code" Payers differ on how to submit bilateral procedures. Some ask that you submit the code as one line item on the claim form with modifier 50 appended to it; others may request two line items with modifier 50 on the second line; or they may want two line items using HCPCS Level II modifier RT and/or LT Modifier 50 - Correct Answer-It is not appropriate to submit 2 line items, or to use modifiers LT/RT instead of a modifier 50 under OPPS pg. 17 professoraxe l Subset of Modifier 59 - Correct Answer-XE - Separate Encounter, a service that is distinct because it occurred during a separate encounter Subset of Modifier 59 - Correct Answer-XS - Separate Structure, a service that is distinct because it was performed on a separate organ/structure Subset of Modifier 59 - Correct Answer-XP - Separate Practitioner, a service that is distinct because it was performed by a different practitioner Subset Modifier 59 - Correct Answer-XU - Unusual Non- overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service Modifier 57 - Correct Answer-is appended to an E/M code when the decision to perform a major is made on the day of surgery or the day before surgery. This modifier is appended to the E/M code not the surgical code. pg. 20 professoraxe l 3 Day Payment Window - Correct Answer-When a patient has Medicare Part A Coverage all outpatient diagnostic services provided to that patient within 3 days prior to admission are considered included in the Part A payment and are not billed separately as outpatient services. 3 Day Payment Window - Correct Answer-When Part A covers admission the hospital may bill outpatient diagnostic services only if they are not related to admission. 1 Day Payment Window - Correct Answer-Some facilities are subject to this window instead of the 3 day payment window: Psychiatric Hospitals Inpatient rehabilitation hospitals Long-term care hospitals Children's Hospitals pg. 21 professoraxe l Cancer Hospitals Modifier 57 - Correct Answer-Do not append when the E/M is performed on the day of a minor surgery. The more appropriate modifier is 25 if the documentation supports a separately identifiable E/M and minor procedure. HCPCS Modifiers - Correct Answer-are a combination of two alpha characters or one alpha and one numeric character The # of modifiers is quite large compared to CPT modifiers PFS - Correct Answer-Physician Fee Schedule GPCI - Correct Answer-Geographic Practice Cost Index pg. 22 professoraxe l