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49 Cards in this Set
- Front
- Back
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Who published the CPT?
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AMA
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When was CPT developed?
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1966
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Why was CPT designed?
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To meet reporting & communication needs to physicians
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What is used as the standard for outpatient and ambulatory care procedural coding and reimbursement?
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CPT
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Which healthcare setting uses ICD–10–PCS
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Hospital Inpatient services
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What is made up of a series of alphabetical codes with code descriptions that represent very specific illnesses and injuries?
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ICD–10–CM
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What provides a system for coding medical procedures performed in the inpatient departments of hospitals?
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CPT
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This applies to services provided by physicians and other medical providers in hospital–based outpatient departments, physicians offices, and other ambulatory settings...
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HCPCS
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How often is the CPT codebook updated?
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annually by January 1st
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How many digits are in Category I codes?
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5
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How are the codes in Category I arranged?
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In numerical order within each section
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What are known as CPT Supplementary codes?
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Category II & III and modifiers
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This category of codes provides supplementary tracking codes that are designed for use in performance assessment and quality improvement activities...
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Category II codes
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How many characters are in Category II codes?
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5
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Category II codes always end in what letter?
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F
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Which Category includes temporary codes that represent emerging medical technologies, services, and procedures that have not yet been approved for general use by the FDA and are not otherwise covered by CPT codes?
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Category III
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Category III codes always end in which letter?
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T
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What is meant to support the medical necessity of procedures that might not otherwise qualify for reimbursement?
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Modifiers
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How often are Cateogry III codes updated?
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semiannually; every January 1st and July 1st
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What are used to report additional info about any unusual circumstances under which a procedure was performed?
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2 character modifier codes
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What letter does anesthesia modifiers always begin with?
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P
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Who developed HCPCS?
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CMS
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Who developed the ORIGINAL version of the HCPCS?
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HCFA
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Who administers the Medicare and Federal portion of the Medicaid program?
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CMS
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What is level I of HCPCS composed of?
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CPT codes
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Which level of HCPCS is used by physicians to report services such as hospital visits, procedures, radiology, supervisory services, and other medical services?
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Level I
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Which level of HCPCS is composed of medical equipment?
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Level II
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Who devloped Level I of HCPCS?
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AMA
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Who developed level II of HCPCS?
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CMS
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Which level of HCPCS are provided for inject–able drugs, ambulance services, prosthetic devices, and other services?
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Level II
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How mnay characters are made up of Level II codes?
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5; first is a letter the other 4 are numbers
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How often are HCPCS level II codes updated?
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Annually; every January 1st
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Who developed ICD–10?
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WHO
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Who developed ICD–10–CM?
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NCHS
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What is the determination that a service or procedure is reasonable and necessary for the diagnosis or treatment of an illness or injury?
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Medical necessity
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Who established the federal regulations that govern Medicare?
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Social Security Act of 1965
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Which part of Medicare pays for the cost of the hospital and facility care?
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Part A
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Which part of Medicare pays for Physician services and durable medical equipment?
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Part B
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What is used for streamlining and standardizing health insurance claims & establishing an approved list of code sets?
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HIPPPA
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How must claim forms be submitted?
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Electronically
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What standards do the claim forms follow?
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Those developed by ASC
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What version of standards do claim forms go by?
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5010 version
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Which claim form is used primarily by hospitals for both outpatient and inpatient services?
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UB–04
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Which claim forms are used by Medicare part A?
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UB–04
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Medicare policies include two types of coverage limits, what are they?
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National coverage decisions (NCD)
Local coverage decisions (LCD) |
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On the claim form CMS–12500, what field identifies the ICD–10–CM codes?
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Field 21
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What codes are used in hospital outpatient services?
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CPT & HCPCS
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WHat codes are used in physicians offices?
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CPT & HCPCS
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What are the 6 main sections that make up category I CPT?
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1. Evaluation & Management
2. Anesthesia 3. Surgery 4. Radiology 5. Pathology & Lab 6. Medicine |
