Medical Coding and Insurance Claims

Medical Insurance: An Integrated Claims Approach Process Question Panel Professional Component Separate Procedure Category III Codes Global Period Bundled Code Category II Codes Add-On Code Unlisted Procedure Modifier T/F In Selecting correct procedure codes, that main text sections are first searched, and the code is then verified in the index. T/F Category II codes are not reported for payment. T/F In the CPT index, a see cross-reference must be followed. T/F The section guidelines summarize the unlisted codes for the section. T/F The phrases before the semicolon in a code descriptor define the unique entries, those after the semicolon are common. T/F Descriptive entries in parentheses are not essential to code selection. T/F A Category III code ends in a letter T/F Procedure codes are reported in order of increasing financial value for services performed on the same day. T/F For New patients, two of the three factors that are listed must be met. T/F Because it is an evaluation of a patient, a consultation is coded using E/M office service codes. A new patient has not received services from the physician or from another physician of the same specialty in the same group practice for: When a physician asks a patient questions to obtain an inventory of constitutional symptoms and of the various body systems, the results are documented as the: The abbreviation PFSH stands for: The examination that the physician conducts is categorized as: Answer In CPT, a single code that groups laboratory tests that are frequently done together. The physician's skill, time and expertise used in performing a procedure. A procedure performed in addition to a primary procedure. Temporary codes for emerging technology, services, and procedures. The inclusion of pre- and postoperative care for a specified period in the charges for a surgical procedure. Procedure code that groups related procedures under a single code. CPT codes that are used to track performance measures A secondary procedure that is performed with a primary procedure and that is indicated in CPT by a plus sign (+) next to the code. A service that is not listed in CPT and requires a special report. A two-digit number indicating that special circumstances were involved with a procedure, such as a reduced service or a discontinued procedure. False True True True False True True False False True D. three years A. past medical history A. past, family, and/or social history A. straightforward, low complexity, moderate complexity, or high complexity B. problem-focused, expanded problem-focused, detailed, or comprehensive The 3 key factors in selecting an evaluation and management code are; CPT code 99382 is an example of: Anesthesia codes generally include: Surgery codes generally include: When a Surgery section code has a plus sign next to it: When a panel code from the Pathology and Laboratory section is reported: D. history, examination, and medical decision making B. a preventive medicine service code A. Preoperative evaluation and planning, normal care during the procedure, and routine care after the procedure. B. Preoperative evaluation and planning, the operation and normal additional procedures, and routine care after the procedure. C. It cannot be reported as a standalone code. A. All the listed tests must have been performed. 1. Determine procedure & services to report 2. Identify the correct codes 3. Determine the need for modifiers 1. Patient documented history 2. Documented List the 3 key components used to select E/M codes and examination 3. Documented physician medical decision the four levels each component has: making. They cover physician services that are performed to What are E/M codes? determine the best course for patient care. Category I Code Five digit code with brief explanation of the procedure. Indicates to payer that physician did not perform all the Modifier 26 work (just professional part). List the 3 steps in the procedural coding process: