Medical Billling 567

Front 1

The ____ _____ refers to the HIPAA National Provider Identifier

Back 1

NPI NUMBER

Front 2

ICD-9-CM code(s) are entered in block ____________

Back 2

21

Front 3

T OR F

Block 1 on the CMS-1500 claim form can have multiple X's to reflect multiple insurance payers for a patient

Back 3

False

Front 4

To document a referring physician's name on the CMS-1500 form, what is entered in block 17?

Back 4

National Provider Identifier (NPI)

Front 5

Block 24 H. is used when the patient has what type of insurance coverage?

Back 5

Medicaid

Front 6

A maximum of ____ CPT or HCPCS codes can be entered on the CMS-1500 claim form

Back 6

6

Front 7

The National Uniform Claim Committee (NUCC) number will replace all ____ ____ ___ ____

Back 7

previous provider legacy numbers

Front 8

T or F

To identify the assignment of patients, the phrase "signature on file" is used.

Back 8

True

Front 9

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.

Back 9

true

Front 10

What agency or body approved the new version of the CMS-1500 claim form?

Back 10

National Uniform Claim Committee (NUCC)

Front 11

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.

Back 11

False

Front 12

CPT modifiers ____ be used on physician's office claims

Back 12

can

Front 13

T or F

In the medical office, the superbill should only contain CPT codes for E/M services

Back 13

false

Front 14

The highest level of an E/M office visit is a level _

Back 14

5

Front 15

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?

Back 15

5

Front 16

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

Back 16

Information in field 19 reserved for local use

Front 17

A level _ E/M code is the highest level

Back 17

5

Front 18

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?

Back 18

99212

Front 19

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?

Back 19

99213

Front 20

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?

Back 20

99243

Front 21

99201-99205

Back 21

Office visit for New patients

Front 22

99211-99215

Back 22

Office visit for Established patients

Front 23

99241-99245

Back 23

Consultation codes for office encounters

Front 24

99221-99223

Back 24

Initial hospital care

Front 25

99251-99255

Back 25

Initial patient consultation in hospital

Front 26

99231-99233

Back 26

Subsequent hospital care aka follow ups

Front 27

99291 -99292

Back 27

Critical care codes

99291 (30 - 74 min)

99292 (additional up to 30 min after first 74)

Front 28

99238-99239

Back 28

Hospital discharge codes

99238 (30 min or less)

99239 (more than 30 min)

Front 29

T or F

An intermediate care facility is a type of inpatient hospital facility

Back 29

False

Front 30

Final examination, discussion of hospital stay, and instructions on continuing care are all types of ____________ services

Back 30

discharge

Front 31

Readmission of a patient to a nursing facility would correspond to the CPT code range of 99304 to ______

Back 31

99306

Front 32

This term is used when a physician provides E/M services to patients in the hospital

Back 32

Inpatient

Front 33

T or F

An initial hospital care code can be used more than once during a patient's hospital stay

Back 33

False

Front 34

A physician documents 60 minutes of discharge day management for a patient leaving an intermediate care facility. What CPT code should be assigned?

Back 34

99316

Front 35

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

Back 35

30

Front 36

The term ____________ is used to refer to services provided to a patient in the hospital

Back 36

Inpatient

Front 37

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

Back 37

true

Front 38

Which code is a level 5 E/M code used for a consult visit in a hospital setting

Back 38

99255

Front 39

99304-99306

Back 39

Initial care of a patient for admission, or readmission, to a facility

Front 40

99307-99310

Back 40

Subsequent care in a facility

Front 41

99315-99316

Back 41

discharge services from a facility

99315 (30 min or less)

99316 (more than 30 min)

Front 42

Which fields of the CMS_1500 form require information about the patient and insured?

Back 42

1-13

Front 43

Which fields require information about the physician or supplier?

Back 43

14-33

Front 44

Where on the CMS-1500 form are the name and address of the payer placed?

Back 44

Upper right-hand side of the claim form

Front 45

T or F

The term "signature on file" or "SOF" is acceptable in all blocks requiring a signature?

Back 45

True

Front 46

What is the purpose of the shaded fields in Block 24d on the CMS-1500 form?

Back 46

They are the location for reporting supplemental information

Front 47

Why was the NPI developed

Back 47

It was designed to replace all previously existing legacy numbers so that the physician is identified universally by all payers with the number

Front 48

From which 2 forms is data extracted to prepare a claim?

Back 48

The patient registration form and the superbill

Front 49

What is the difference between an office visit code and a consult code for the office?

Back 49

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.

Front 50

What is the only difference between new patient and established patient office visit codes?

Back 50

The fourth digit in each code

Front 51

Define

Office visit

Back 51

an encounter in the physician's office

Front 52

Define

Referred

Back 52

Patient is sent to a specialist for evaluation and testing

Front 53

Define

Specialist

Back 53

Physician who concentrates on a particular area of medicine

Front 54

What is normally not found on a superbill that may present a challenge for the biller?

Back 54

Modifiers

Front 55

Define

Inpatient

Back 55

a patient who has been admitted to a hospital

Front 56

Define

Initial hospital care

Back 56

the first hospital inpatient encounter with a patient by admitting physician

Front 57

Define

Subsequent hospital care

Back 57

care provided to a patient following the initial hospital care (per day)

Front 58

Define

Critical Care

Back 58

direct delivery by a physician of medical care for a critically ill or critically injured patient

Front 59

Define

Discharge

Back 59

the patients release from the hospital

Front 60

Define

Nursing Facility

Back 60

a facility that provides continuous medical supervision 24 hours/day, includes nursing care services in addition to food, shelter, and personal care

Front 61

Define

Intermediate care facility

Back 61

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

Front 62

Define

Long term care facility

Back 62

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

Front 63

Which evaluation and management codes are based on time

Back 63

Critical care and discharge service

Front 64

List 3 vital organ systems involved in billing for critical care services

Back 64

renal, hepatic, shock

Front 65

Why is it important for the medical biller to become familiar with inpatient, critical care, and nursing facility codes?

Back 65

Catching coding errors made by physician that would affect timely reimbursements