Chap 19: Procedural Coding

To ensure reimbursement at the highest allowed level, CPT codes must:

include codes and modifiers that reflect the services preformed.

The most frequently used CPT codes are the

Evaluation and management

For reporting and evaluation and management code, CPT considers a patient to be “new” if the patient has not received professional services from any provider in the medical practice within the past ___ years (s).

Three

When unbundling is done intentionally to receive more payment than is allowed, the claim is likely to be considered ____.

Fraudulent

A healthcare provider who practices under false qualifications or credentials is guilty of ____.

Fraud

Medical offices usually have a(n) ____ to help minimize the risk of fraud by discovering and correcting coding and billing problems.

Compliance plan

The Healthcare Common Procedure Coding System (HCPCS) was originally developed for use in coding services, such as durable medical equipment, for ____.

Medicare patients

A medical provider bills separately for a comprehensive metabolic panel and a quantitative glucose test, which is normally included in the metabolic panel. This is an example of which of the following fraudulent coding and billing practices?

Reporting services at a higher level than was carried out.

When a patient has no symptoms of a disease and the provider preforms the tests for that disease at the patient's request, the provider has committed which of these fraudulent coding and billing practices?

performing procedures not related to the patient's conditions

Billing for a moderate level evaluation and management service when only a simple BP check and injection were carried out is an example of ____.

reporting services at a higher level than carried out

There is a question concerning a claim for a procedure submitted last year. Where will you look to double-check codes in question?

Last year’s CPT

A plus sign (+) is used to indicate ___

add-on codes

Modifiers to CPT codes indicate

that some special circumstances applies to the service

The CPT is updated and new codes are provided for use beginning ____.

annually on January 1

Which of the following is not of the six main sections in the CPT manual?

physical therapy

Which of the following best describes the CPT code format?

5-digit numeric code

to complete the description for a CPT code that has not indented description you should?

refer to the description for the previous CPT code to compete the description

What symbol appears next to codes that are new since the last CPT revision?

red dot

What symbol appears next to a code that appears out of numerical sequence?

pound (#) sign

If a code description has changed since the last revision of the CPT manual, what symbol is placed next to the CPT code?

blue triangle

When coding CPT procedures, an add-on code will describe _____.

other procedures done in addition to the main procedure

Dr. Moore is scheduled to perform a routine removal of a mole from Ralph's left shoulder under local anesthesia. Dr. Moore has injected the local anesthetic and is about to begin the procedure when Ralph suddenly has a panic attack and states, "I just can't handle this!" Dr. Moore halts the procedure. When you code for this procedure, which of the following modifiers will you use?

52: Reduced Services

Dr. Breckell is scheduled to perform a cyst removal on Haley's right hand. After he begins the procedure, he notices that the cyst is much larger than anticipated and is involved with nerves and ligaments in the right thumb. Complete cyst removal takes 30 minutes longer than expected. Which modifier would you use to describe this special circumstance?

22: increased procedural services

The period of time that is covered for follow-up care after surgery is called the ____ period

global

An _____ patient is the one that has been seen by any providers in the same specialty of the medical practice within the past three years.

established

____ codes are the most frequently used of all CPT codes because they are used by all practitioners in any medical specialty.

E/M

The use of a(n) ____ with a CPT code shows that some special circumstances applies to the service or procedure the practitioner performed.

modifier

You will locate procedure codes in the __ manual

CPT

The HCPCS ____ codes are more commonly known as CPT codes

Level I

AN example of an HCPCS Level ____ code is E0781, for an ambulatory infusion pump

2 or II

Each procedure or service performed on or for a patient during a patient encounter is reported on healthcare claims using a(n) ___ code.

CPT (Current Procedural Terminology Code)