medical Coding

which level of healthcare common procedural coding system(HCPCS) includes codes that identify products, supplies, and services not includes in current procedural terminology (CPT)

Level II

as a result of meidcare modernization act of 2004 new revised and deleted healthcare common procedural coding system (HCPCS)/ current procedural terminology (CPS) codes must be implemented every year on which date

Janurary 1

assigning a procedure code that does not match patient documentation for the purpose or increasing reimbursement is known as

upcoding

where in the CPT manual would you find information about modifiers

Appendix A

the AMA defines medical necessity as services or procedures that a prudent physician would provide to a patient in order to prevent diagnose or treat an illness, injury, or disease or the associated symptoms in a manner that is

In accordance with the generally accepted standard of medical practice

when records are reviewed by third party payers if a procedur is not documented, it

is considered to never have been performed

The CPT manual uses symbols to indicate specific information about code numbers for example the + symbol stands for

Add on code

which of the following would not be required in utilizing medical necessity guidelines

reviewing the family history section of the progress notes

which of the following statements is true regarding HCPCS level II codes

level II codes were developed to identify products and supplies for which there are no CPT codes

level II codes are composed of one alpha and four numeric characters

level II G codes are temporary codes for procedures/professional services

all of the above

international classification of diseases (ICD) codes are descriptive of the

Presenting disease or condition

upcoding can result in

serious fines and penalties

when coding the primary reason for the office visit is listed first and the other reasons are listed in what order

order of important

HCPCS level I codes are known as

CPT or current procedural terminology

in the international classification of disease , 9th revision clinical modifications (ICD-9-CM) remained in use in the united states until september 30th of what year

2015

who publishes CPT codes

THE AMA or American Medical association

A ______ is used to inform third-party payers that circumstances for a particular code have been altered

Modifier

which of the following statements is not true when using HCPCS level II codes

the search for the correct HCPCS code begins in the tabular list

Which HCPCS level II codes are temporary codes for procedures services and supplies

G codes

when coding procedures and diagnoses you isolate the main term form the providers statement assessment or description for the services provided and then look it up in the

index

in 2019 the penalty per violation of the federal anti-kickback statue was

102,522 per violation

services performed in the office are generally selected on a patients encounter in the EMR by the

provider

a payer practice in which a reported evaluation and management service is reduced to a lower level based strictly on the diagnosis code reported is known as

Downcoding

the MAIN RULE to remember of the ICD coding rules, which says that the reason for the patient visit(encounter) is coded FIRST is known as

Reason rule

Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded)

Musculoskeletal system

38100-38999

hemic and lymphatic system

60-240: Thyroidectomy total or complete

endocrine system

insertion of tissue expanders for other than breast including subsequent expansion

integumentary system

39560 resection ,diaphragm with simple repair

mediastinum and diaphragm

30000-32999

respiratory system

59000-59899

maternity care and delivery

insertion of a new or replacement of permanent pacemaker with transvenous electrodes

cardiovascular system

follicle puncture for oocyte retrieval, any method

female genital system

51040 cytostomy with/without drainage

urinary system

40490-49999

digestive system

biopsy, prostate, needle or punch, single or multiple any approach

male genital system

pathology and laboratory

80047-89398

medicine

90281-99199,99500-99607

radiology

70010-79999

anesthesiology

00100-0019999,99100-99140

evaluation and management (E/M)

99202-99499

surgery

10021-69990

morbidity

defined as the frequency of the appereance of complications following a surgical procedure or other treatment

seventh

A, D or S are used for this character extension

tabular list

an alphanumeric classification system

category of the diagnosis

what the first three characters designate

X

if a code requires seven characters has fewer than six use place holder

brackets

is/are used to enclose synonyms, alternative wording or explanation in the tabular list

sequela

meaning a pathological condition resulting from prior injury disease or attack

related etiology

what characters four through seven designate

a problem where the risk of morbidity without treatment is high to extreme: there is moderate to high risk of mortality without treatment; or high probability of severe prolonged function impairment

High Severity

A problem that may not require the presence of the licensed providers supervision

minimal

a problem where the risk of morbidity without treatment is moderate there is moderate risk of mortality without treatment uncertain prognosis or increased probability of prolonged function impairments

moderate severity

a problem where the risk of morbidity without treatment is low, little to no risk without treatment, full recovery

low severity

a problem that runs a definite and prescribed course is transient in nature and is not likely to permanently alter health status

self limited or minor

patient jane morgan moved to the area and has not been seen a provider at NVHA before

new patient

he was seen before by the DR 4 year ago

new patient

patient was seen 30 months ago

established patient

patient was seen by the doctor 120 months ago and is beeing seen by the doctors assistant today

New patient

patiient was seen by the doctor today but saw a different doctor last week in urgent care

established patient

identify the main term in the index

CPT AND ICD

code each problem to he highest level of specificity available in the classification

ICD

analyze the providers statement or description for the service provided and isolate the main term

CPT

Never code directly from index

CPT AND ICD

code the minimum number of diagnoses that fully describe the patients care receved on that visit

ICD

sequence codes correctly so that it is possible to understand the chronology of events

ICD

the reason for patient visit is coded first

ICD

check for any relevant subterms under the main termm

CPT AND ICD

review all descriptions of codes listed for main terms and subterms to be sure the correct code is selected

CPT and icd

code correctly and completely any diagnosis level of this procedure that affects the care influences the health status or is a reason for treatment on that visit

ICD and icd

level of history obtained

key component

counseling

contributory factor

coordination of care

contributory factor

level of examination performed

key component

degree of medical decision making involve

key component

nature of the presenting problem

key factor