Understanding E/M Coding, CPT, ICD-10, and Medicare Billing in Private Practices, Exams of Computer Science

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24 - Answer What modifier is commonly used if a provider performs an unrelated office visit during a post operative period? Patient encounter documented using a certified EHR system - Answer PQRS measure G8477 refers to what? Zonules - Answer What are radially arranged natural fibers in the eye that suspend the crystalline lens from the ciliary body and hold it in position? face down/ palm down - Answer Prone Nine - Answer For an E&M service, what is the minimum number of elements required by the Documentation Guidelines for a Detailed Physical Exam? No - Answer Does Medicare have standard guidelines physicians must follow for the "written interpretation of medical findings?" No - Answer Is it a federal requirement to do self audits of patient charts and coding in private practices? within - Answer -endo vertical body plain, divides the body into front & back sections - Answer coronal like - Answer -oid face up/palm up - Answer supine A company that a provider contracts with to transmit claims legally and safely between the provider and the insurance companies - Answer What is an e-claim clearing house? Intacs - Answer What are surgically implanted plastic half rings that change the shape of the cornea? A written policy between the individual (policy holder) and health plan (payer) - Answer What is medical insurance? Qualified Medicaid Beneficiary- limited benefits - Answer What is "QMB" Medicaid? For indicating which lid is involved. E1= Upper left eyelid, E2= Lower left eyelid, E3= Upper right eyelid, E4= Lower right eyelid - Answer What are the four "E" modifiers used for?

4 - Answer How many "E" modifiers are there? 19 - Answer On the CMS 1500, what box is designated to provide additional information to the payer? behind, back - Answer -retro Reason for the encounter and assessment, medical plan and date, and legible identity of the observer - Answer The documentation of each patient encounter should include which items(s): across, through - Answer trans- No - Answer Is it acceptable for a staff person to correct a CPT or ICD-10 code on a route slip or claim without the consent of the doctor? Medical Decision Making, Examination, and History - Answer What are the Key Components of E and M Coding? 51 - Answer What modifier is used if two non bundled surgical procedures are performed on the same eye at the same visit? 24 - Answer What modifier should you use on the office visit if a patient comes in with allergic conjunctivitis during their global post-op period? Resource-Based Relative Value Scale - Answer What does RBRVS stand for? Counseling, Coordination of Care, Presenting Problem, and Time - Answer List the Contributory Factors of E and M Coding The date the eyewear is dispensed - Answer When billing for post cataract eyewear through Medicare, what is the date of service? at or near front surface of the body - Answer anterior or ventral Surgeon - Answer Whose name goes in Box 17 in the HCFA 1500 when billing for co-managed cataract post op care? Government sponsored insurance plans - Answer What are Medicaid, Medicare, TRICARE and CHAMPVA types of? In 2011 - Answer When did PQRI name change to PQRS? below - Answer inferior breathing - Answer -pnea away from - Answer -ab hemorrhage - Answer -orrhagia

Yes, in many states and often is age dependent - Answer Does MQMG Medicaid pay for refraction and eyeglasses? growth - Answer -plasia 25 modifier on the visit code to indicate it was separate from the procedure and RT or LT on the procedure - Answer When billing a 99212 and 65435, which code requires a modifier? flow or discharge - Answer -orrhea The comprehensive ophthalmological service has different required elements than the intermedicate - Answer What separates a 92012 from a 92014? Paralysis - Answer -plegia Coding - Answer What is the process of reviewing the medical record and assigning the appropriate numerical code(s) to accurately describe the patient encounter? A non-participating provider - Answer What do you call a doctor, within your practice, that has not signed a contract with an insurance company? outside - Answer ecto, exo same - Answer ipsi- side - Answer lateral middle - Answer meso- abnormal condition of - Answer -osis toward - Answer ad- farthest from center - Answer distal PQRI (now PQRS) established a financial incentive for eligible health care professionals to participate in a voluntary quality reporting program - Answer What is PQRS (Formally PQRI)? weakness - Answer -paresis surrounding - Answer peri- Volume 3 of the ICD-10 - Answer A classification system for surgical, diagnostic, and therapeutic procedures (alphabetic index and tabular list) is found in what publication?

Some payers permit billing these together with the 59 modifer on the 92134 - Answer Can 92250 and 92134 be billed on the same day? Yes - Answer Can you bill for a medical condition that another doctor is currently managing, i.e. glaucoma? Haptics - Answer What are the arms of an intraocular lens, which holds it in place once inserted inside the eye? Location, Severity, Quality, Timing, Duration, Context, Modifying Factors, Associated Signs and Symptoms - Answer What are the eight elements of the History of Present Illness (HPI)? H04.123 - Answer What is the primary code used for Dry Eye? Past, Family, Social History - Answer What does the acronym PFSH mean? 90 days - Answer How many days is the global period for cataract extraction surgery? after, beyond, transformation - Answer meta- It is a complete listing of the reason codes on your Medicare remittance advice - Answer What is the ANSI guide book for? Volume 1 of the ICD-10 - Answer A list of the disease code numbers in tabular form is found in what publication? middle - Answer medial Yes - Answer Does Medicare consider and approve of UV protections? upon - Answer epi tumor - Answer -oma below, under - Answer infra- New patient is one who hasn't received any professional services from the physician or another physician of the same specialty in the same group practice within the last 3 years. - Answer When is an encounter considered a new patient visit? American Medical Association - Answer What does AMA stand for? at or near back surface of the body - Answer Posterior or dorsal 11 - Answer What is the "place of service" (POS) code for the office? Yes - Answer If your doctor chooses not to participate in n insurance plan, can you have the patient pay in full and file on their behalf?

2 - Answer How many PQRS measures are related to macular degeneration? Yes - Answer Can you charge the patient (post cataract surgery) for the overage on a progressive lens? To report the disease state, signs, and/or symptoms that are germane to the service(s) provided - Answer What are ICD-10 Codes used for? disease of - Answer -apathy For reporting a reduced service - Answer What would you use a 52 modifier for? Yes - Answer If you are regularly performing careful documentation and billing and coding, should you still be prepared for an audit? To accommodate more specific coding for procedures - Answer Why have the ICD- 10 systems changed? Z96.1 Presence of Intraocular lens - Psuedophakia (if patient has an intraocular lens)

• Answer When filing for post operative cataract eye glasses, what diagnosis should be used? Determination of refractive state - Answer What service is coded using CPT code- 92015? Endocrine - Answer What system does diabetes falls under? Performing Provider - Answer When the patient is seen by a doctor within a group practice, what is the doctor who cared for the patient called? above - Answer superior yes, but it should be document on the record - Answer Can a doctor decide not to charge the patient portion due to severe financial burden on the patient? American Public Health Association - Answer What does APHA stand for? True - Answer True or False: The CPT and ICD codes reported on the health insurance claim form or billing statement should be supported by the documentation in the medical record? No - Answer Will Medicare pay for a "routine" eye exam? results in sharp vision at distance, intermediate, and near - Answer What is the benefit of progressive addition lenses? Red - Answer What color has the longest wave length? the flatter the lens - Answer the longer the radius of curvature of a contact lens

Matches the visual field of the examiner and patient. - Answer What is a characteristic of confrontation visual field screening? measure visual acuity - Answer when a patient presents with ocular irritation, what should be done first? Upward movement - Answer Function of Superior Rectus Place the concave side of the lens against the lens stop - Answer How do you find the back vertex power of a lens? Most are related to aging, and are caused by protein clumping. - Answer Cataracts are: Greyish/yellowish opaque colored ring around peripheral cornea of both eyes. - Answer Arcus Senilis: Open sore on the cornea typically caused by infection needing urgent medical treatment. - Answer Corneal Ulcer Retinoblastoma - Answer Rare type of eye cancer occurring almost exclusively in young children that develops in the retina focuses images on the retina - Answer lens controls the size of the pupil - Answer iris an eye shield with several small holes that allow light rays to reach the retina without the interference of optical problems of the eye - Answer Pinhole Visual Acuity a clinical test mainly used for assessing a patient's degree of binocular vision and binocular single vision - Answer Worth's Four Dot test (W4LT) used to subjectively detect and measure a latent, manifest, horizontal or vertical strabismus for near and distance. The test is based on the principle of diplopic projection - Answer Maddox rod test is: used to determine if there is a heterotropia or tropia, which is a manifest strabismus or misalignment that is always present. The first eye is covered for approximately 1- seconds. As this eye is covered, the uncovered eye is observed for any shift in fixation. - Answer cover testing is: the smallest detectable depth difference that can be seen in binocular vision - Answer Stereoscopic acuity, aka stereoacuity, is Yes - Answer Can you charge the patient (post cat sx) for the overage on a progressive lens?

Surgeon - Answer Whose name goes in Box 17 in the HCFA 1500 when billing for co-managed cat PO care? Evaluation and Management - Answer What does E/M stand for? Explanation of Benefits - Answer What is an EOB? Current Procedural Terminology, 4th edition - Answer What does CPT-4 mean? True - Answer True or False, The PQRS Measure 139 (Comprehensive Preoperative Assessment for Cataract Surgery w/ IOL Placement) can be filed only by the cat surgeon? American Optometric Association - Answer What does AOA stand for? 10 days - Answer What is the post-op period for closure of punctum, by plug? World Health Organization - Answer What does WHO stand for? To the carrier for DMEPOS for your region/area - Answer Where should the claim be sent when billing for post cataract eyeglasses? Yes - Answer If your doctor chooses to be a non-participated provider, can the patient be charged amounts over insurance approval limits? No - Answer May a participating Medicare provider charge the patient more than the limiting charge for covered services? Yes - Answer Are ICD-10 codes needed to provide medical necessity because the CPT codes alone are not enough? No - Answer Does the CPT system identify and report medical dx? Frames - Answer What is the HCPCS material code V2020? H52.11 OD H52.12 OS H52.13 OU - Answer What is the ICD-10 code for myopia? Chief complaint (CC), History of present illness (HPI), Review of systems (ROS), and Past, family and/or socal history (PFSH) - Answer Which are some or all of the elements each type of history includes? CC, HPI, ROS, PFSH (Chief Complaint/History of Present Illness/Review of Systems/ Patient-Family-Social History) - Answer What are the four elements of patient history? Review of Systems - Answer Which of the following is NOT an element of the HPI: Description of location, review of systems, quality, severity or timing?

Five digit alphanumeric codes beginning with A-V - Answer What are HCPCS CPT Procedure Codes? Same cat code used by the surgeon - Answer What dx is used for filing for cat sx? Caruncle - Answer What is a small, red portion of the corner of the eye that contains modified sebaceous and sweat glands? All 12 ophthalmic and both psychiatric (mental status) elements - Answer How many Examination Elements must be documented for a 99205 or 99204 code? Signed ABN is on file - Answer What does the use of modifier GA mean? Minimal, Low, Moderate, High - Answer What are the four possible risk categories in E/M coding? No, unless required by doctor or clinic - Answer Is it mandatory for all workers to initial their entries in patients' charts? GW - Answer What modifier is used for patients on hospice care? (When a provider is NOT related to the diagnosis for which a patient has been enrolled in hospice. GV - Answer Modifier used when a physician IS providing a service that is related to the diagnosis for which a patient has been enrolled into hospice. Problem focused, expanded problem focused, detailed, and comprehensive - Answer What are the levels of the physical examination in E/M services? International Classification of Diseases, 10th edition, Clinical Modification - Answer What does ICD-10-CM stand for? This is typically a contracted fee that the insurance company sets and provider accepts as full payment for covered services - Answer What is an "approved amount" noted on the EOB? Hyphema - Answer What is blood in the anterior chamber, such as following blunt trauma to the eyeball? A detal of what you filed to an insurance company, what they approved of for payment, and the amount of payment that is the patient's responsibility - Answer What three pieces of information does an EOB provide? Upper right eyelid - Answer What does modifier E3 represent? American Medical Association - Answer Who develops and publishes CPT codes? Documented history of physical findings and that other non-invasive tx were tried and found unsatisfactory prior to recommending the closure of punctum by plug -

Answer What documentation does Medicare require for consideration of reimbursement for punctal plug insertion? Heathcare Common Procedure Coding System - Answer What does HCPCS stand for? 55 & Rt or Lt (depending on the eye done) - Answer When billing cat PO care, which modifiers would you use on the 66984? Phacoemulsification - Answer What is the use of ultrasonic vibration to shatter and break up a cataract, making it easier to remove? E & M (99000 series) or General Ophthalmological Services (92000 series) - Answer What are the two types of codes used for biling eye care visits? Yes - Answer Can a practitioner or provider charge the patient for deluxe lens overages? None (No primary insurance over Medicare) - Answer When billing Medicare what should be listed on line 11 of the CMS 1500? Yes - Answer Can Medicare preform a higher level audit, and request/demand staff to not leave the premises? Yes, if you know the doctor is doing so. - Answer Are you liable if the provider is having you bill fraudulently? No - Answer Should H43.39 vitreous floaters be billed to Medicare annually for retinal photos if they remain unchanged? No - Answer Can you bill Medicare for fundus photography if no retinal pathology is known to be present prior to the photos? Yes - Answer Is the Advance Beneficiary Notice of Non-coverage (ABN) used to notify patients that Medicare may not pay for a service? History, examination, and Medical decision making - Answer What are the 3 key components in selecting the level of E/M services? proximal - Answer Nearest to center sagittal - Answer vertical body plane, divides body into equal R & L sides Transverse - Answer horizontal body plane, divides the body into top & bottom sections mono; uni - Answer one bc - Answer two

tri - Answer three quadr- - Answer four hex,- sex- - Answer six diplo- - Answer double ambi- - Answer both aniso- - Answer unequal dys- - Answer bad, painful, difficult eu- - Answer good, normal hetero - Answer different fourteen - Answer How many systems are listed in the Review of Systems (ROS)? homo- - Answer same hyper- - Answer excessive, above hypo- - Answer deficient, below iso- - Answer equal, same mal- - Answer bad, poor megalo- - Answer large algia- - Answer pain asthenia - Answer weakness emia - Answer blood -iasis - Answer condition of Medicaid Qualified Medicare Beneficiary - Answer What is "MQMB" Medicaid? -lytic - Answer destroy, break down Twice/day - Answer What does "BID" mean? -lysis - Answer destruction, break down -itis - Answer inflammation

The date the surgeon has recorded in the patient's record for relinquishing care to the co-managing doctor. - Answer Under the post operative global period, what will determine when the patient begins their care under a co-managing doctor? 92004 - Answer What code do you use when a comprehensive ophthalmological service is done on a patient not seen in the office for over three years? Eyes are more sensitive to UV damage following cat sx - Answer Why are pts often prescribed ultraviolet protection with their eyeglass lenses following cat sx? Items that are not part of the basic lens cost, approved frame cost; deluxe lens features like A/R coating - Answer If a patient chooses to pay for them, what items can be added to their eyeglasses? A concise statement describing the symptom, problem, condition, diagnosis, physician-recommended return, or other factor that is the reason for the encounter, usually stated in the patient's own words. - Answer How is the Chief Complaint described by Medicare? GA - Answer If you have an ABN signed, which modifier do you use for post-cat gls.? 1P - Answer What is the category II modifier for exclusion due to medical reasons? Health Insurance Portability and Accountability Act - Answer What does Hipaa stand for? Centers for Medicare and Medicaid Services - Answer What does CMS mean? 10 - Answer How many codes are there for reporting office and other outpatient visits? Some have zero days post op and others have ten days - Answer How many days of PO do minor procedures have covered? Day 1= one day after sx - Answer What iwll be the starting date for Day One of the 90 days for counting PO care? Products, supplies, and services NOT included in the CPT - Answer What are HCPCS codes used for? No - Answer Is WNL an acceptable documentation on the medical record? No - Answer Can you balance bill a patient for contractual obligations? Varies among Medicare carriers; most commonly four times per year - Answer How many times per year can perimetry be performed on a Medicare patient with uncontrolled glaucoma? 90 days - Answer What is the post-op period for a yag laser capsulotomy?

Four - Answer How many HPI elements must be document for a Comprehensive History? Ten or more - Answer How many ROS must be documented for a Comprehensive History? In order to support payment of a claim, services must be medically necessary and reasonable for dx, tx of condition, illness, or injury and the services;l may not be elective, experimental, or performed for convenience of the pt - Answer What is "Medical Necessity" or "Reasonable and Necessary"? Yes - Answer Is 92133 a bilateral code? An identifying number that will make sure the claim gets sent to the correct insurance company - Answer What is a payer identification number when sending an insurance claim electronically? Bill the base fee for the lens using v2203 or V2303 and cost of the add ons using V2781 - Answer How should the lens be billed on a progressive lens? No - Answer Is it allowed for an office to regularly write off the pts co-pay, deductible or pt responsibility? toward - Answer ad- For reporting a reduced service - Answer What would you use a 52 modifier for?