CDEO Study Guide with Complete Solutions

HEDIS - ANSWER-Healthcare Effectiveness Data and Information Set HIPAA - ANSWER-Health Insurance Portability and Accountability Act MPFS - ANSWER-Medicare National Physician Fee Schedule Multiple procedure rule - ANSWER-The highest value code is paid at 100%. The second highest value code is paid at 50%. Each additional code is paid at 25%. Add on codes are exempt from the multiple procedure rule. They are paid at 100%. Bullet symbol - ANSWER-Indicates new procedures and services added to the CPT book. Triangle symbol - ANSWER-Indicates that the description of the code has been revised Opposing horizontal triangles - ANSWER-Indicates new and revised text, other than in procedure descriptors Forbidden symbol - ANSWER-Identifies codes that are modifier 51 exempt and exempt from the multiple procedure rule Bull's-eye symbol - ANSWER-Identifies codes that include moderate sedation. When this is located next to a code, moderate sedation can not be reported separately. Unlisted procedure code - ANSWER-These are reported when an existing CPT code does not describe the procedure. To facilitate these claims, provide the operative report and suggest an appropriate fee. Chief complaint - ANSWER-The reason for the encounter. A CC is required for every encounter except a preventive service. If the CC is missing, you are to report CPT code 99499: Unlisted E&M service. "Follow up" can not be the reason for the visit