ch 5 study guide

what does plus sign symbol mean

add on code to original code

what does black circle (bullet) mean

new procedure code

what is professional component

- the part of the service done by healthcare provider,

such as interpreting a test result, performing exam, or giving consultation

what is E/M

Evaluation and Managemnet Codes

- procedure codes that cover physicians' services performed to determine the optimum course for patient care

what is DME

Durable medical equipment

- term for reusable physical supplies

- ex: hospital beds, wheelchairs

what is ROS

review of system

- provider's method To gather pt medical history by asking questions about body systems to identify symptoms the pt may be experiencing

what is CLIA - what do they do?

clinical laboratory improvement amendments; law that establishes quality standards for clinical laboratory testing

- Ensures accuracy and reliability and timeliness

what is OSHA - what do they do

Occupational safety and health administration: federal agency within US dept. Of labor

- assures america's workers have safe and healthful working conditions free from unlawful retaliation

what are modifiers

- 2 digit number

- used to communicate special circumstances involved with procedures that have been performed

- Applies to cpt and hcpcs codes

3 Key Factors (components) in selecting the level of an E/M code -

history, examination, medical decision making (MDM)

What do you need to know to determine the range of the E/M code? -

location

what is consultation

Service performed by a physician to advise a requesting physician about a patient's condition and care

what is a referral

act of sending a pt to another specialist

what are preventabtive exams

annual doctors appointment designed to detect health issues early and prevent illness

what is a panel

In CPT, a single code grouping laboratory tests that are frequently done together.

what is HCPCS

Healthcare Common Procedural Coding System -

Procedure codes for Medicare claims, made up of CPT codes (Level I) and national codes (Level II).

what is category I codes

Procedure codes found in the main body of CPT

(Evaluation and management, Anesthesia, Surgery, pathology and Laboratory, Radiology, and Medicine)

What are Category II codes?

Optional CPT codes that track performance measures for a medical goal such as reducing tobacco use.

What are category III codes?

Temporary codes for emerging technology, services, and procedures that are used instead of unlisted codes when available

4 types of examinations that providers perform as coded in the E/M codes.

Which is the least complex?-

The most complex?-

Problem focused, Expanded problem focused, detailed, comprehensive

Which is the least complex?- Problem focused

The most complex?- Comprehensive

4 levels of MDM

Straightforward, low, moderate, high

CPT codes report the following:

medical services.

surgical procedures.

diagnostic procedures.

4 steps in CPT coding-

1. Determine Main term,

2. look up main term in index and get clue code,

3. verify code in cpt to get correct code,

4. determine modifiers if needed

DX codes - are there fees attached to these codes? How about CPT?

Dx does NOT have a fee, CPT DOES