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65 Cards in this Set
- Front
- Back
The ____ _____ refers to the HIPAA National Provider Identifier |
NPI NUMBER |
|
ICD-9-CM code(s) are entered in block ____________ |
21 |
|
T OR F
Block 1 on the CMS-1500 claim form can have multiple X's to reflect multiple insurance payers for a patient |
False |
|
To document a referring physician's name on the CMS-1500 form, what is entered in block 17? |
National Provider Identifier (NPI) |
|
Block 24 H. is used when the patient has what type of insurance coverage? |
Medicaid
|
|
A maximum of ____ CPT or HCPCS codes can be entered on the CMS-1500 claim form |
6 |
|
The National Uniform Claim Committee (NUCC) number will replace all ____ ____ ___ ____ |
previous provider legacy numbers |
|
T or F
To identify the assignment of patients, the phrase "signature on file" is used. |
True |
|
T or F
Block 19 on the CMS-1500 form may be used to enter multiple CPT modifiers when more than four modifiers are required on the claim. |
true |
|
What agency or body approved the new version of the CMS-1500 claim form? |
National Uniform Claim Committee (NUCC)
|
|
T or F
When a patient sees a specialist per his or her own judgment or on the advice of family members, it is referred to as a consult. |
False |
|
CPT modifiers ____ be used on physician's office claims |
can |
|
T or F
In the medical office, the superbill should only contain CPT codes for E/M services |
false |
|
The highest level of an E/M office visit is a level _ |
5 |
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The code range for new patient office visit E/M codes begins with code 99201. How many levels of E/M codes are there for this type of patient seen in the office? |
5 |
|
Which of the following is typically not present on a insurance superbill? - Codes for minor procedures - Information in field 19 reserved for local use - Immunization codes - Injection codes
|
Information in field 19 reserved for local use |
|
A level _ E/M code is the highest level |
5 |
|
Maria Perez is seen in the office for a follow-up visit due to her chronic medical condition of asthma. Dr. Wilson assigns a level 2 to the E/M service on Ms. Perez's encounter form. What CPT code does that correspond to? |
99212
|
|
Mr. Edwards is an established patient in the office of Dr. miller and Dr. Cohen. On today;s visit, the superbill for Mr. Edwards reflects a level 3 office visit. What CPT code does this correspond to? |
99213 |
|
Susan Mathews is seen in consult by Dr. Fisher. Dr. Fisher documents a detailed history, detailed exam, and medical decision making of a low complexity level. The physician assigns a level 3 consult code on the superbill. What CPT code would be billed? |
99243 |
|
99201-99205 |
Office visit for New patients |
|
99211-99215 |
Office visit for Established patients |
|
99241-99245 |
Consultation codes for office encounters |
|
99221-99223 |
Initial hospital care |
|
99251-99255 |
Initial patient consultation in hospital |
|
99231-99233 |
Subsequent hospital care aka follow ups |
|
99291 -99292 |
Critical care codes 99291 (30 - 74 min) 99292 (additional up to 30 min after first 74) |
|
99238-99239 |
Hospital discharge codes 99238 (30 min or less) 99239 (more than 30 min) |
|
T or F
An intermediate care facility is a type of inpatient hospital facility |
False |
|
Final examination, discussion of hospital stay, and instructions on continuing care are all types of ____________ services |
discharge |
|
Readmission of a patient to a nursing facility would correspond to the CPT code range of 99304 to ______ |
99306
|
|
This term is used when a physician provides E/M services to patients in the hospital |
Inpatient
|
|
T or F
An initial hospital care code can be used more than once during a patient's hospital stay |
False |
|
A physician documents 60 minutes of discharge day management for a patient leaving an intermediate care facility. What CPT code should be assigned? |
99316
|
|
Code 99291 is assigned to a patient for critical care services. This means that a minimum of _____ minutes of critical care time was provided to this patient |
30 |
|
The term ____________ is used to refer to services provided to a patient in the hospital |
Inpatient |
|
T or F
When determining what critical care code to assign, it is important to consider that time spent for the care of the patient as documented by the physician |
true |
|
Which code is a level 5 E/M code used for a consult visit in a hospital setting |
99255 |
|
99304-99306 |
Initial care of a patient for admission, or readmission, to a facility |
|
99307-99310 |
Subsequent care in a facility |
|
99315-99316 |
discharge services from a facility 99315 (30 min or less) 99316 (more than 30 min) |
|
Which fields of the CMS_1500 form require information about the patient and insured? |
1-13 |
|
Which fields require information about the physician or supplier? |
14-33 |
|
Where on the CMS-1500 form are the name and address of the payer placed? |
Upper right-hand side of the claim form |
|
T or F
The term "signature on file" or "SOF" is acceptable in all blocks requiring a signature? |
True |
|
What is the purpose of the shaded fields in Block 24d on the CMS-1500 form? |
They are the location for reporting supplemental information |
|
Why was the NPI developed |
It was designed to replace all previously existing legacy numbers so that the physician is identified universally by all payers with the number |
|
From which 2 forms is data extracted to prepare a claim? |
The patient registration form and the superbill |
|
What is the difference between an office visit code and a consult code for the office? |
An office visit code is used by all types of physicians. Occasionally a primary care provider will use a consult code for surgical clearance. Consult codes are typically used by specialists. |
|
What is the only difference between new patient and established patient office visit codes? |
The fourth digit in each code |
|
Define
Office visit |
an encounter in the physician's office |
|
Define
Referred |
Patient is sent to a specialist for evaluation and testing |
|
Define
Specialist |
Physician who concentrates on a particular area of medicine |
|
What is normally not found on a superbill that may present a challenge for the biller? |
Modifiers |
|
Define
Inpatient |
a patient who has been admitted to a hospital |
|
Define
Initial hospital care |
the first hospital inpatient encounter with a patient by admitting physician |
|
Define
Subsequent hospital care |
care provided to a patient following the initial hospital care (per day) |
|
Define
Critical Care |
direct delivery by a physician of medical care for a critically ill or critically injured patient |
|
Define
Discharge |
the patients release from the hospital |
|
Define
Nursing Facility |
a facility that provides continuous medical supervision 24 hours/day, includes nursing care services in addition to food, shelter, and personal care |
|
Define
Intermediate care facility |
an institution that provides health related care and services to individuals who do not require the degree of care and treatment that a hospital or nursing facility is designed to provide |
|
Define
Long term care facility |
a facility that provides medical service and assistance to patients over an extended period of time and is designed to meet the medical, personal, and social needs of the patient |
|
Which evaluation and management codes are based on time |
Critical care and discharge service |
|
List 3 vital organ systems involved in billing for critical care services |
renal, hepatic, shock |
|
Why is it important for the medical biller to become familiar with inpatient, critical care, and nursing facility codes? |
Catching coding errors made by physician that would affect timely reimbursements |