Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
119 Cards in this Set
- Front
- Back
|
Number of key components required of new patient office visits.
|
3 of 3
|
|
|
Problem Focused History
|
Brief HPI
No ROS No PFSH |
|
|
Brief HPI
|
1 to 3 elements
|
|
|
Expanded Problem Focused History
|
Brief HPI
1ROS No PFSH |
|
|
Detailed History
|
Extended HPI
2-9 ROS 1 of 3 PFSH |
|
|
Extended HPI
|
4 HPI Elements or status of 3 problems
|
|
|
Problem Focused PE
|
1-5 Bullets
|
|
|
Expanded Problem Focused PE
|
6-11 Bullets
|
|
|
Detailed PE
|
12 Bullets
|
|
|
Comprehensive PE
|
2 Bullets from each of 9 systems
|
|
|
Number of data pts from review and/or ordering labs
|
1
|
|
|
Number of data pts from review and/or ordering xray
|
1
|
|
|
Number of data pts from review and/or ordering medical tests (PFT's, EKG, echo, cath)
|
1
|
|
|
Number of data pts from discussing tests with MD
|
1
|
|
|
Number of data pts from reviewing any image, tracing, or specimen
|
2
|
|
|
Number of data pts from ordering old records
|
1
|
|
|
Number of data pts from summarizing old records
|
2
|
|
|
Number of problem pts from new problem in which follow up is planned
|
4
|
|
|
New problem in which no further follow up is planned
|
3
|
|
|
Classification of Topotecan
|
Topotecan is a Camptothecin (Plant Alkaloid)
(topo I inhibitor) |
|
|
Number of data pts from review and/or ordering labs
|
1
|
|
|
Number of data pts from review and/or ordering xray
|
1
|
|
|
Number of data pts from review and/or ordering medical tests (PFT's, EKG, echo, cath)
|
1
|
|
|
Number of data pts from discussing tests with MD
|
1
|
|
|
Number of data pts from reviewing any image, tracing, or specimen
|
2
|
|
|
Number of data pts from ordering old records
|
1
|
|
|
Number of data pts from summarizing old records
|
2
|
|
|
Number of problem pts from new problem in which follow up is planned
|
4
|
|
|
Number of problem pts from new problem in which no further follow up is planned
|
3
|
|
|
Number of problem pts from self-limited or minor illness/injury
|
1
|
|
|
Number of problem pts from established problem, not controlled
|
2
|
|
|
Number of problem pts from established problem, stable
|
1
|
|
|
Risk Level
-One self limited problem (e.g., cold, insect bite) |
Minimal Risk
|
|
|
Risk Level
-2 self-limited problems -1 stable chronic illness -acute uncomplicated illness -OTC drugs |
Low Risk
|
|
|
Risk Level
-Mild exacerbation of 1 chronic -2 stable chronic illnesses -undiagnosed new problem -acute illness with systemic symptom -prescription drug mgmt |
Moderate Risk
|
|
|
Risk Level
-Severe exacerbation of chronic -illness threatening life or body function -abrupt change in neuro status -parenteral controlled substances -decision for DNR or de-escalate care -drugs requiring intensive monitoring for toxicity |
High Risk
|
|
|
99201
|
New Patient
Hx=PF PE=PF MDM=SF |
|
|
Straight Forward Medical Decision Making
|
1 problem pt
1 data pt minimal risk |
|
|
Low Medical Decision Making
|
2 problem pts
2 data pts low risk |
|
|
Moderate Medical Decision Making
|
3 problem pts
3 data pts moderate risk |
|
|
High Medical Decision Making
|
4 data pts
4 problem pts High Risk |
|
|
How many dimension are required in determining the level of medical decision making?
|
2 out of 3
prob pts data pts risk level |
|
|
99202
|
new patient
Hx=epf PE=epf MDM=sf |
|
|
99203
|
new patient
Hx=det PE=det MDM=low |
|
|
High Medical Decision Making
|
4 data pts
4 problem pts High Risk |
|
|
How many dimension are required in determining the level of medical decision making?
|
2 out of 3
prob pts data pts risk level |
|
|
99202
|
new patient
Hx=epf PE=epf MDM=sf |
|
|
99203
|
new patient
Hx=det PE=det MDM=low |
|
|
99204
|
new patient
Hx=comp PE=comp MDM=moderate |
|
|
99205
|
new patient
Hx=comp PE=comp MDM=high |
|
|
99212
|
Hx=pf
PE=pf MDM=sf |
|
|
99213
|
Hx=epf
PE=epf MDM=low |
|
|
99214
|
Hx=det
PE=det MDM=moderate |
|
|
99215
|
Hx=comp
PE=comp MDM=high |
|
|
99231
|
hospital progress
Hx=pf PE=pf MDM=sf/low |
|
|
99232
|
hospital progress
Hx=epf PE=epf MDM=moderate |
|
|
99233
|
hospital progress
Hx=det PE=det MDM=high |
|
|
if a npp bills under own number what is the rate of reimbursement?
|
85 percent
|
|
|
Can a npp bill incident to if the patient isn't an established patient?
|
no
|
|
|
If there is no face to face time between md and patient can npp bill service as incident to?
|
No. Service must be billed under npp if the md shares no face time with the patient.
|
|
|
Modifier GE
|
reported when a service is performed by a resident without the presence of a teaching physician under the primary care exception. This exception is not allowed for specialists.
|
|
|
Modifier GC
|
reported when a service is performed in part by a resident under the direction of a teaching physician
|
|
|
Which codes are used for a new patient office visit?
|
99201-99205
|
|
|
Which codes are used for an est. patient office visit?
|
99211-99215
|
|
|
Which codes are used for initial observation care?
|
99218-99220
|
|
|
Which codes are used for initial hospital care?
|
99221-99223
|
|
|
Which codes are used for subsequent hospital care (progress notes)?
|
99231-99233
|
|
|
Which codes are used for observation or inpatient care services?
|
99234-99236
|
|
|
Codes for emergency department services?
|
99281-99285
|
|
|
codes for initial nursing facility care?
|
99304-99306
|
|
|
Codes for subsequent nursing facility care?
|
99307-99310
|
|
|
Codes for domiciliary, rest home, or custodial care (new patient)?
|
99234-99238
|
|
|
codes for domiciliary, rest home, or custodial care?mi
|
99334-99337
|
|
|
codes for home services (new patient)?
|
99341-99345
|
|
|
Codes for home services (est patient)?
|
99347-99350
|
|
|
Critical Care
|
99291 reports the first 30-74 minutes, and 99292 reports additional 30 minutes beyond first 74 (x1 or x2 or x3, etc.)
|
|
|
Pre‐existing conditions that do not require significant additional work
are included can be billed as preventive care. True or False |
True
|
|
|
Abnormality or significant additional work for a problem bill with appropriately documented E/M code appended with modifier 25appended with modifier 25
|
Preventive Care Visit
|
|
|
Preventive Care Codes with OBGYN issues
|
• Female– G0101 Pap, pelvic, and breast exam• 7 out of 11 elements must be met (LMRP)
– Q0091 Smear; obtaining, conveying; – 99381‐99395 if a complete exam performed |
|
|
24 Modifier
|
Unrelated E/M by the same physician during a postoperative
period |
|
|
25 modifier
|
Significant separately identifiable E/M service by same physician on same day of procedure or other service
|
|
|
51 Modifier
|
Multiple procedures
– Other than E/M – Performed on same day, same session, or same provider |
|
|
59 Modifier
|
Used to identify procedures/services that are not normally reported together, but are appropriate under the
circumstances |
|
|
Professional Component
|
26 ‐ Professional component
– Physician interpretation reported separately |
|
|
Technical Component
|
TC ‐ Technical component
– 66 percent of fee |
|
|
Surgery Guidelines Global Package
|
– Global package
• Day of or before surgery; E/M service • Local anesthesia • Typical postoperative period |
|
|
Surgery Guidelines, Complications
|
Complications
• E/M services billed (modifier 24 if unrelated) 20 • Procedures in the office with modifier |
|
|
ECG
|
93000 Electrocardiogram, routine ECG with at least 12 leads;
with interpretation and report • 93005 tracing only, without interpretation and report • 93010 interpretation and report only |
|
|
Anthrocentesis
|
The documentation should include:
– the patient’s history – any extenuating circumstances – the specific diagnosis codes – the drugs injected (separately billable) – the specific sites of each injection – the medical necessity for giving the injections 25 – the expected outcome of the treatment |
|
|
Immunization
|
Administration is the giving of the substance
• Codes for administration service based on route: 90465‐90474 – Some are add‐on (+) codes • Reported with a code for the substance administered |
|
|
3 Categories of Wound Repair
|
Three categories of repairs:
• Simple (12001‐12021) • Intermediate (12031‐12057) • Complex (13100‐13160) |
|
|
wound repair selected on the basis of
|
--Complexity of repair
29 – – Site of laceration or wound – Length of the wound repair |
|
|
Simple Wound Repair
|
Used when the wound is superficial
• Includes: – Local anesthesia – Chemical or electro‐cauterization of wounds not closed • Closure with adhesive strips is included in E/M service • 10‐day Medicare global policy |
|
|
Intermediate Repair
|
• Includes repair of epidermis, dermis or subcutaneous tissue
without involvement of deeper structures • Requires layer closure of one or more of the subcutaneous tissue and non‐muscle fascia • Includes single layer closure of wounds – Requiring extensive cleaning 31 – Removal particulate matter |
|
|
Complex Repair
|
Includes repair of wounds requiring more than a layered
closure – Scar revision – Debridement – Extensive undermining – Stents or retention sutures |
|
|
Complex Repair coding issues
|
• Repaired wound should be measured in centimeters prior to
injection of anesthetic agent • If there are multiple wound repairs in the same category, add the lengths in centimeters of all – Add the sum of the lengths together – Report as single item |
|
|
Coding Issues for Multiple Wounds
|
• When multiple wounds are repaired and more than one
classification is involved: – List most complicated as primary procedure – Append modifier 51 to all subsequent repair classifications • 10‐day Medicare global period • Multiple surgery reduction rules apply |
|
|
Injection Codes when injection is the only service provided
|
When a covered injection is the only service provided, the physician
should bill: – The procedure code for the administration – The procedure J code for the drug |
|
|
Injection Codes when in the course of an E/M service
|
--The procedure code for an E/M service
– The procedure (JXXXX) code for the drug – Check payer contracts to see if the administration is billable. For 35 patients covered by Medicare, do not report the administration. • Must accept assignment for covered drug Injections |
|
|
Injection, 96372
|
96372 – Therapeutic, prophylactic or diagnostic injection
(specify substance or drug); subcutaneous or intramuscular |
|
|
Injection, 96373
|
96373 – intra‐arterial
|
|
|
Injection, 96374
|
96374 – intravenous push
|
|
|
Injection, 96375
|
96375 – each additional sequential intravenous push of a new substance/drug
|
|
|
Medicare and Pneumonia Vaccine
|
Pneumonia
– PPV administered one time per lifetime for persons at risk for pneumonia |
|
|
Medicare and Flue Vaccine
|
– Covered every year
– Will pay for 2nd vaccination if proven medical necessity Does not require a physician to be present 37 – – Does not need physician order |
|
|
90655, Vaccine
|
90655 ‐ Influenza virus vaccine, split virus, preservative free, when administered to children 6‐35 months of age, for intramuscular
use |
|
|
90656, Vaccine
|
90656 ‐ Influenza virus vaccine, split virus, preservative free, when
administered to 3 years and older, for intramuscular use |
|
|
90657, Vaccine
|
90657 ‐ Influenza virus vaccine, split virus, when administered to children 6‐35 months of age, for intramuscular use
|
|
|
90658, Vaccine
|
90658 ‐ Influenza virus vaccine, split virus, when administered to 3 years and older, for intramuscular use G0008 ‐ Administration of influenza virus vaccine
|
|
|
Vaccine, Diagnosis Code
|
Diagnosis Code
V04.81 ‐ Need for prophylactic vaccination and inoculation against other viral diseases |
|
|
Vaccine, Pneumonia Procedure Code
|
90732 Pneumococcal polysaccharide vaccine, 23‐valent, adult or
immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use G0009 Administration of pneumococcal vaccine when no physician fee schedule service on the same day |
|
|
Vaccine, Diagnosis Code, steptococcus pneumococcus
|
Diagnosis Code
V03.82 Need for prophylactic vaccination against streptococcus 39 pneumoniae (pneumococcus) |
|
|
Cerumen Removal
|
Bundled into NCCI when performed the same day as the E/M
service • 69210 ‐ Removal impacted cerumen (separate procedure), one or both ears • Inherently bilateral |
|
|
Welcome to Medicare Visit
|
HCPCS code G0402
– Initial Preventive Physical Examination (IPPE) • Face‐to‐face visit services limited to new beneficiary – during the first 12 months of Medicare enrollment – after January 1, 2005 |
|
|
Lesion Removal
|
• 11200 ‐ Removal of skin tags, multiple fibrocutaneous tags,
any area; up to and including 15 lesions • +11201 ‐ each additional ten lesions, or part there of (List separately in addition to code for primary procedure) |
|
|
Surgery, Integumentary
|
• 17000‐17004 ‐ Destruction of premalignant lesions (eg, actinic keratoses)
• 17110 ‐ Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement) of benign lesions other than skin tags or cutaneous vascular lesions; up to 14 lesions |
|
|
Trigger Point Injections
|
• 20552 Injection(s); single or multiple trigger point(s), 1 or 2
muscle(s) • 20553 Injection(s); single or multiple trigger point(s), 3 or more muscle(s) |
|
|
Venipuncture
|
36415 – Collection of venous blood by venipuncture
|
|
|
Radiology
|
• Codes determined by anatomic site
• Number of views • Types of views |
