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CPT coding questions with correct answers
Category I codes - Answer Procedures or services identified by a five-digit CPT code and organized within the six sections. Main body of the CPT code book. Arranged in numeric order, with one exception the evaluation and Management section. parenthetical notes in the CPT code book indicate that a _______ - Answer code should not be reported with another code or codes. The triangle in CPT code book is used for? - Answer A revised code The + sign beside a CPT code indicates: - Answer Identifies add-on codes, for procedures that are performed at the same time and by the same surgeon The facing triangles in the CPT code book mean what? - Answer Contains new or revised text Telemedicine - Answer the remote diagnosis and treatment of patients by means of telecommunications technology. Preservice work is? - Answer paper work completed prior to the start of sadation. what paper work is completed prior to sadation? - Answer 1. Complete history with special focus on previous anesthesia or sedation.
- Family history of family sadation
- Summary of current medications and drug allergies
- Physical exam of mouth, jaw, throat, neck, airway, chest, lungs, heart and circulation.
- Vital signs
- Review of pre-sadation testing
- Immediate pre-sadation assessment prior to first sedation dose.
- Intiation f IV access and fluids maintain to access.
- reassessment form
- Consent form P1 thru P6? - Answer classification of physical status in anesthesia patients. intraservice work(time) - Answer begins with the administration of the sadative and ends when the procedure is completed, the patient is stable for recovery status and the physician providing sadation ends personal continuous face-to-face time with the patient. in order to be required intraservice in sadation it must include these: - Answer 1. Ordering/ or adminisering the sadative.
- Requires face-to-face time with the patient.
- Requires monitoring patient response to the sadative including periodic assessment of the patient, administration of additional doses as needed, monitoring oxygen saturation, heart rate and blood pressure. postservice work in sadation: - Answer any additional work done after the intraservice time. like extra face-to-face time. during the wake-up time. talking with the family is also an example. this is not coded. SOAP - Answer Subjective, Objective, Assessment, and Plan layout in the medical record from the physician.
-32 Mandatef services modifier - Answer used when required by a third-party payer, court, or other authory to perform the procedure. Second surgical opinion. -99 Multiple Modifiers - Answer Used when more than four modifiers required on a single CPT code. -GA Modifier - Answer used to allow the provider to bill the patient if medicare does not pay for the service. medical necessity not met usually. -GZ Modifier - Answer indicates an unsigned ABN and that services are expected to be denied.(Physician can not bill the patient). ABN stand for what in medical coding? - Answer Advance Beneficiary Notice Anatomic site modifiers are used on all sites except for the _____. - Answer Skin CPT modifier 50 - Answer must be used for bilateral procedures!!!! Evaluation and Management modifiers: - Answer used for encounters when procedures are not performed. An example is an H&P. Surgical/ procedural modifiers: - Answer Used when the surgical procedure is altered in a way that could affect its reimbursement. -24 modifier - Answer unrelated e/m (Evaluation and management code) service by the same physician during a postoperative period
-25 modifier - Answer Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service. -32 modifier - Answer mandated services -57 modifier - Answer Decision for surgery -al modifier - Answer Principal physician of record or attending physician (Medicare) When all services included in the global package are not performed by the same physician, than a _________ is required. - Answer modifier anesthesia modifiers are? - Answer Billed and coded by the anesthesologist's office, separate from the codes of the surgeon. -53 modifier - Answer discontinued procedure -26 modifier - Answer professional component -76 modifier - Answer repeated procedure or service. -90 modifier - Answer reference (outside) lab -91 modifier - Answer medical necessity repeat test sample during the same encounter.
Medical Decision Making in the evaluation and management service - Answer The physician's thought process in making decisions for there patient. -25 modifier - Answer two procedures done on the same visit by the same doctor. -57 modifier - Answer decision for surgery modifier 95 - Answer service provided remotely CMS-1500 - Answer Universal claim form for insurance submission 837P - Answer The electronic version of the CMS-1500 form. Officially known as the ASC x12N 837P Physicians are paid for CPT code? - Answer True physicians ate not paid for diagnosis codes, but they are required to explain________ - Answer The reason for the encounter or why services were provided. There must be at least one diagnosis code on every claim, to get a paid claim. Parent code or stand alone code is? - Answer the main code that has a full description of the procedure The common descriptor is the_________ - Answer The shared portion of the code before the semicolon. It is shared with the indented codes.
What is shared with the indented codes? - Answer The common descriptor. Everything before the semicolon. resource based relative value scale - Answer reimbursement to physicians according to the relative value of the service provided. Medicare Physician Fee Schedule (MPFS) - Answer The RBRVS-based allowed fees that are the basis for Medicare reimbursement. relative value unit (RVU) - Answer A factor assigned to a medical service based on the relative skill and time required to perform it. Medicare Physician Fee Schedule database - Answer contains the fees National Coverage Determination (NCD) - Answer National medical necessity and reimbursement edit check for Medicare on specific services, procedures or technologies. Medicare Physician Fee Schedule (MPFS) - Answer The RBRVS-based allowed fees that are the basis for Medicare reimbursement. relative value unit (RVU) - Answer A factor assigned to a medical service based on the relative skill and time required to perform it by medical staff. Resource-Based Relative Value Scale (RBRVS) - Answer reimbursement of physician services, it is posted in the MPFS. Ambulatory payment classifications (APC's) - Answer A system of outpatient hospital reimbursement based on procedures rather than diagnoses.
the insurance company to make sure that there is not a permanent or temporary code that can be used. HCPCS codes are made up of? - Answer A letter followed by four numbers. When a patient has Medicare or Medicaid report the? - Answer HCPCS code If a patient has insurance other than Medicare or Medicaid report the? - Answer CPT code Category I codes - Answer Procedures or services identified by a five-digit in length and are the main body of the CPT code book. Evaluation and Management codes describe? - Answer physician encounters such as an office visit. They are the most. commonly used CPT codes. Codes in the CPT code book appear in? - Answer numerical order resequenced codes are? - Answer Codes that have been added to the CPT code book, which are with related procedures, but may have a different numbering sequence. What is an unlisted procedure? - Answer used when a unique procedure is preformed and usually ends in 99. It must accompany a detailed report from the physician describing the procedure to determine payment. Category II - Answer They are optional codes that can be used for performance measurements.
Category III - Answer temporary codes for data collection and tracking and the use of merging technology. These codes are not billable. level of service - Answer used to describe the complexity orlength of service provided to the patient based on the presenting problems, the history, the examination, and the medical decision making. in the E/M the sections are decided into - Answer categories and subcategories, rather than subsections and subheadings. 1995 documentation guidelines (DGs) - Answer gives general principles of medical documentation and guidelines for documenting the history, examination, and medical decision making components of E/M services. you can only use the DG 1995 or DG 1997, but both - Answer True The DG 1997 - Answer delineate single organ systems, the DG 1995 does not. Specialists prefer the DG 1997. The first step in coding an E/M service is? - Answer To know the setting. Where was service provided. Transfer of Care - Answer The consulting physician assumes management of a patient's care for one or more problems or conditions. concurrent care - Answer care being provided by more than one physician, at the same time for different conditions or different aspects of the same condition. There is no code or modifier used for concurrent care.
