How often is the International Classification of Diseases updated?
Every ten years
Which type of codes are designated with the 1 symbol and are found in Appendix D of the CPT code book?
Add-on
The Healthcare Common Procedure Coding System (HCPCS) is comprised of two levels. Level II codes are:
national codes
HCPCS Level II ____ codes identify injectables that are provided to patients in an office or outpatient setting.
3
The HPCPS Level II manual has two sections. When the description is found in the Index, the code or codes should be verified by looking in the:
tabular list.
CPT codes 00100-01999, and 99100-99140 represent:
anesthesiology.
In some instances, a specific procedure or service might need to be slightly altered, and if this is the case, instructions and Appendix A explain the use of:
modifiers
When an unlisted code is reported, what must also be sent so that the payer can determine what was performed and then determine the appropriate reimbursement?
a copy of the operative note
What type of codes are related to medical services as opposed to surgical services?
Evaluation and management
If a service is not documented within the medical record, then:
it should not be coded.
Use of ICD-10-CM codes establishes the _____ or the services and procedures provided to the patient.
medical necessity
Which of the following is a general rule for assigning CPT codes?
Always cross-reference the code or codes found in the index with the actual code descriptions.
Title XVIII of the Social Security Act, Section 1862 (a) (1) (A) states "No payment may be made under Part A or Part B for expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." This is known as which of the following?
Medical necessity
Which of the following is true about Volume I of the ICD-10-CM manual?
It is a tabular list, organized into 22 chapters.
Which of the following is true about the ICD-10-CM code format?
It contains 3-7 characters.
Anyone knowingly submitting a false claim or creating a false record or statement to receive payment from the federal government will be fined a civil penalty of not less than $5,500 and not more than ____ per false claim submitted.
11,000
specificity
detailed, providing more specifies
unbundling
reporting multiple codes for a service when there is one code that will report the entire service.
HCPCS
comprised of CPT and National codes
Upcoding
reporting a higher level code than is appropriate for the service that was rendered resulting in higher reimbursement
Primary diagnosis
the reason for the patient visit
sequenced
relation to the intensity and level of service provided
reimbursement
this is based on the codes that are submitted
reason rule
reason for patient visit (encounter) always coded first
modifier
inform third-party payers that circumstances for that paticular code have been altered
general equivalence mapping
crosswalks designed to make the transition to ICD-10-CM/PCS somewhat smoother
downcoding
A payer practice in which a reported evaluation and management service is reduced to a lower level based strictly on the diagnosis code reported
key components
...
comorbidity
other issues the patient presents with
contributory factors
time, nature of presenting problem, counseling, and coordination of care
bundle
the arbitrary practice of some insurance carriers to group codes, by which they either ignore additional codes reported on a claim and reimburse one of the lesser codes
carrier
company who provides the insurance policy