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CPT and HCPCS codes are used in what type of healthcare setting? - ✔✔Hospital outpatient, physician offices CPT is - ✔✔current procedural terminology HCPCS is - ✔✔healthcare common procedure coding system Who publishes CPT (Level I HCPCS)? How often is it updated? When is it updated? - ✔✔AMA publishes cpt, it is updated annually, on Jan. 1 of each year CPT Category 1 codes consist of: - ✔✔Anesthesia, Evaluation and management, surgery, radiology, pathology and laboratory, medicine What are Category 2 CPT codes for? What does the Category 2 code consist of? - ✔✔Performance Measures consist of 4 numbers followed by a capital F, such as 1000F What are Category 3 CPT codes for? What does the Category 3 code consist of? - ✔✔New & Emerging Technology
consist of 4 numbers followed by a capital T, such as 2000T What are modifiers Why are they used? - ✔✔Supplementary Codes to provide additional information to a code What is a HCPCS level II code used to report? What does the HCPCS level II code consist of? - ✔✔Are used for supplies, DME, injectable substances, dental and chiropractic as well as orthotics Structure: J1885 - capital letter followed by 4 numbers What are HCPCS level II codes also called? - ✔✔National codes Who developed the HCPCS level II codes? How often are they updated? When are they updated? - ✔✔Developed by CMS, they are updated yearly update Jan NCCI - ✔✔National Correct Coding Initiative What does the National Correct Coding Initiative edits do? - ✔✔Helps CMS to detect inappropriate codes submitted on claims
Ø (Null symbol) - ✔✔exemptions to modifier 51 (Pending symbol) - ✔✔product pending FDA approval
- ✔✔Out of numerical sequence code
○ - ✔✔Recycled/reinstated code modifier - 51 - ✔✔multiple procedures - used by Physicians ONLY What about modifier - 66? - ✔✔Surgery Team - Physicians use ONLY modifier - 59 - ✔✔distinct procedural service. Used by BOTH Physician and Hospital What all does the CPT definition of a surgical package include? - ✔✔1. Decision to perform procedure; E/M encounter
- Surgical procedure
- Anesthesia
- Immediate postoperative care, including dictation of operative notes and talking to family and other physicians
- Orders
- valuation of the patient in the post-anesthesia recovery area
- Typical post-operative follow-up care What is the definition of a "separate procedure"? - ✔✔Coded when a procedure is performed independently and not in conjunction with another procedure; a modifier, such as 59 (distinct services) ,may be added to explain special circumstances What 3 questions need to be answered prior to assigning the appropriate wound repair code? - ✔✔1. What type of repair is being performed; simple, intermediate, or complex?
- What site or body part is involved, and what is the extent of the wound?
- What is the length of the repair (in centimeters)? Excision of a lesion with an adjacent tissue transfer? - ✔✔1 Code Lesion excision is included with the the adjacent tissue transfer code When is it appropriate to assign an application of casts and strapping code? - ✔✔1. To identify replacement of a cast or strapping during or after the period of normal follow-up care
- To identify an initial service performed without any restorative treatment or stabilization of the fracture, injury, or dislocation and/or to afford pain relief to the patient
This rule is applicable unless the excision code narrative includes the phrase with or without biopsy. In this case only excision is assigned - ✔✔It would be appropriate to append the biopsy code with modifier 59. In GI coding, if a biopsy code uses the terminology "with biopsy, single or multiple," would you use the code multiple times if 4 biopsies were taken? - ✔✔Only 1 code , regardless of the number of times In Radiology, what is the difference between the Professional component and the technical component? - ✔✔*professional component includes supervising the procedure, reading and interpreting the results, and documenting the interpretation in a report *technical component includes performance of the actual procedure and expenses for supplies and equipment. *technical component; HCPCS level ll modifier that indicates only the technical component was provided For ultrasounds that have "complete" or "limited" ultrasound codes, where would a person find out what is included in the examination? - ✔✔in the notes preceding the codes
When physician billing for laboratory, what is considered a complete test? - ✔✔-Complete test is ordering test, obtaining the sample, handling the specimen, performing the actual test or procedure, and analyzing and interpreting the results. What is the difference between qualitative and quantitative - ✔✔qualitative = looking to see if something is there quantitative = amount of something that is there (to say how much ) If you have not performed all tests included in a specific panel in the laboratory section, is it appropriate to assign that panel code? If not, what should be done? - ✔✔NO then you code what test that was done and not the panel if not all of the test was done in that panel What is used to select the correct surgical pathology code? - ✔✔specimen When referencing Evaluation and Management codes, what factors are considered when determining the level of Medical Decision Making? - ✔✔Key Components to E/M Level of Service;
- History
- Examination
- Medical Decision Making Complexity CONTRIBUTORY FACTORS E/M Level of Service;
Established = patient who has received professional services from the physician or any other physician of the same specialty in the same practice group within the past 3 years. POS - ✔✔place of service TOS - ✔✔time of service At minimum, how many codes are required for administration of a vaccination? - ✔✔Administration code Toxoid/ actual vaccine code When reporting therapeutic IV infusions and injections, if the time documented 15 minutes or less, what should be coded? What about if the time documented is 20 minutes? - ✔✔If it is less than 15 minutes then code as a injection not infusion If more then 15 minutes then code as infusion When coding infusions, injections and hydrations, can you have more than one "initial" code? - ✔✔no When coding fracture repairs, what does "manipulation" mean? - ✔✔reduction, Means that it being moved to the proper place to reset the fracture
What modifiers must be listed with anesthesia codes to distinguish between various levels of complexity of the anesthesia service provided? - ✔✔P codes P1-P What is the purpose of the Medicare Outpatient Code Editor? - ✔✔weed out incomplete and incorrect claims
- Simplify the Medicare outpatient pymnt system
- Decrease the Medicare beneficiaries share of the pymnt
- Encourage efficiency in providing hosp outp services What does upcoding mean? Give an example - ✔✔Practice of purposely assigning a code to receive additional or increased payment
- Coding to a higher degree of work than was actually done, as in wound repair should have just been simple but then code for intermediate instead What does unbundling mean? Give an example - ✔✔Practice of using multiple codes when the services should be represented with a single code
- As in a hysterectomy code 58150, instead they code the resection of the different body parts separately When determining Anesthesia charges, what is the amount of time that is considered 1 time unit?
- ✔✔15 minutes
►◄ left and right arrows before and after a section of text indicates what? - ✔✔Indicates text changes from previous edition If a Category III code exists for a procedure that lacks a specific code in the CPT manual, should you use the Category III code, or an unlisted code? - ✔✔Use the Category III code. Under what circumstances are minor procedures coded as separate procedures? - ✔✔When only procedure performed, Or, with another procedure on a different site. Or, when unrelated to major procedure. What is a global period? - ✔✔The period of time following each surgery that is included in the surgery package and is established by the third party payer. What is a major surgery global period? - ✔✔Usually 90 days. What is a minor surgery global period? - ✔✔Usually 10 days. Medicare has a 0 or 10 day global period. Who decides what is included in a surgical package (bundle)? - ✔✔Third party payers What do Medicare's "Correct Coding Initiative" edits specify? - ✔✔What is in a surgical package (bundle).
Are all surgical packages the same? - ✔✔No, they vary by payer. Are minor surgical procedures bundled in a surgical package? - ✔✔No, preoperative and postoperative services are reported separately. Is general anesthesia bundled in a surgical package? - ✔✔No, it is billed separately by the anesthesiologist. When a minor surgery is performed in the doctor's office such as a needle biopsy, what do you code for? - ✔✔Procedure (biopsy); Supplies(surgical tray) What is billed separately in a minor procedure during an office visit and why? - ✔✔A surgical tray (needles, suture materials, wipes, drugs) is billable as a separate line item because it contains items that are not typically required for an office visit. 99070 CPT, Medicine section - ✔✔Code for a surgical tray. (note: Medicare bundles into procedure) A4550 HCPCS - ✔✔Code for surgical tray. (note: not separately reported to Medicare)
Benign - ✔✔non-malignant I&D, only reference the Skin subterm when there's no specific location - ✔✔Main term will b abscess subterm site or finger. Always reference the specific location of the abscess Debridement codes r based on depth, body surface, condition and some codes 4 location - ✔✔Eczema Debridement of 10% of body surface or less, u code, use add-on code each additional 10%. Debridement based on depth of tissue removed & surface area of the wound - ✔✔1 wound, report the depth of the deepest level of tissue removed. When it's multiple wounds, sum the surface area off the wound at the same depth. Do not combine sums of different depths. all lesion excisions include a Simple Closure - ✔✔the Simple Closure should not be coded. They are included in with the E/M vistit. Avulsion - ✔✔a tearing away of tissue from a body part. Bleeding may be heavy. It is possible that the torn tissue may be surgically reattached.
if physician uses adhesive strips to close the wound - ✔✔use 99201-99499. The more simple procedure would b billed an eval code rather than a procedure code. Do Not ill for would repair if adhesive strips r the only method utilized to close the woud. simple repair - ✔✔woud superficial, involving primarily epidermis or dermis, or subcu without significant involment of deeper structures & requires simple one layer closure intermediate repair includes addition requirements of simple repair - ✔✔layered closure of one or more of the deeper layers of subcu. Also intermediate repair physician performed a single-layered closure that requred extensive debridement. Complex Repair, includes wounds requiring more than layered closure - ✔✔complex repair code is most complicated surgical repair that a physican will perform on the integumentary system Add up the lengths of wounds from the same classification, simple, intermediate or complex, - ✔✔if the anatomic sites r grouped together in the CPT manual. this allows to bill for multiple wound repairs using one CPT code. Dr. performed a Simple Repair of a 2.5 cm abrasion on the neck & a simple repair of a 3.4 cm laceration on the back, then the length of these Wounds may be added up and billed as 1 simple repair.. - ✔✔12002 pertains to the scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet). Therefore, the neck and trunk (back is part of the trunk) r grouped together. The CPT now directs you to add up the lengths of the simple repairs and code
