🌟Medical Insurance Management- CH 14

Electronic coding programs are considered an essential tool; however, to reduce possible errors which of the following should be used?

National Correct Coding Initiative edits

what are the effects of downcoding?

Lower charges and physician receives lower payments

What is meant by over-utilized CPT codes?

Codes that are up-coded frequently

After selecting an anesthesia code, what does the medical assistant do next?

Select a modifier to indicate the patient’s status

Which codebook is used to code services, including products, supplies, and drugs?

HCPCS Level II Coding

In the CPT codebook, what is the term for a code with a triangle beside it?

Revised code

Name the effects of upcoding?

Audits and penalties

In the CPT codebook where are vaccines are found?

Medicine section

What is the E/M section in CPT used to code?

Office and hospital visits

In the CPT codebook, what is the term for a code with a bullet (solid circle) beside it?

New code

Per CMS, what is the length of time between patient visits before a patient is classified as a new patient at their next visit?

Three years

What is a standard code set?

Codes developed by CMS and mandated by HIPPA

What is the term for days that follow major surgery and are included in the price of the surgery (surgical or global package)?

Follow-up days

What is the purpose of the Current Procedural Terminology code book? (CPT)

Uses medical and surgical terminology to accurately describe professional services to correct codes can be assigned to receive payment from insurance carriers

What is the function of computer-assisted coding (CAC)?

Automatically assigns codes to clinical procedures and services

What is the plus (+) sign used to indicate?

An add-on code

Where is a complete list of modifiers with descriptions located in the CPT manual?

Appendices

What is the term for a situation in which a similar service is provided to a hospital patient by more than one physician on the same day?

Concurrent care

What is the term for frequent tests organized together in the Pathology and Laboratory Section?

Panels

After reviewing the medical notes, the medical assistant is unclear as to which CPT code to use. Which action would the medical assistant take?

Tactfully ask the provider to explain the notes when they are available

What is unbundling?

Breaking down a procedure into separate billable codes to increase reimbursement

What are the effects of upcoding and unbundling

Practices that are considered fraud and may lead to an audit and costly penalties

How will the medical assistant bill if a Medicare patient scheduled for surgery is seen for a preoperative visit one day before they are admitted to the hosptial?

Do not bill for the E/M service, it is included in the global package

What is the purpose of bundling procedures for surgery?

To include most surgical expense, including pre and post operative care in one procedure code for the surgery being performed

Computer-assisted coding software converts words and phrases entered about a patient’s condition and treatment into which type of data that must be checked and edited by a professional coder?

Codes