CPMA Exam Chapter 3 Study Guide with Verified Solutions

CPMA Exam Chapter 3 Study Guide with Verified Solutions Accurate reimbursement begins with - Answer-accurate coding and rules that vary by payer The CPT codebook contains - Answer-instructions, coding guidelines, parenthetical notes, and symbols to provide guidance for proper coding. Not all payers follow CPT coding guidelines. - Answer-An auditor must be able to apply payer variations to the CPT guidelines during an audit, and must communicate the differences in a way that will make sense to the provider. Add-on codes - Answer-Listing found in Appendix D in the CPT codebook Add-on code are carried out in addition to the primary procedure Add-on codes are never reported alone, and always accompany specific primary procedure codes. There is a parenthetical note following the add-on code to indicate the associated primary code(s) EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024. Page 2/6 When the list of associated add-on codes is too extensive, - Answer-there will not be a list of applicable primary codes in a parenthetical note following the add-on code All add-on codes are - Answer-exempt from the multiple procedure concepts (modifier 51) See Appendix A Multiple surgical procedure reduction is applied when - Answer-multiple procedures are performed during the same operative session. The highest valued code is paid at 100% The 2nd highest valued code is paid at 50%. And each additional procedure is paid at 25% If a claim exceeds five line items, payers may evaluate for special pricing The fee schedule for add-on codes already accounts for - Answer-the reduction, and the payment is made at 100% EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024. Page 3/6 The Medicare National Physician Fee Schedule (MPS) Relative Value File is useful for - Answer-determining if procedures are subject to the multiple procedure payment reduction. If there is a "0" in the Multiple Procedure column, the procedure is not subject to the multiple procedure payment reduction If there is a "2" in the multiple procedure column, the procedure is subjected to the multiple procedure payment reduction. The Medicare National Physician Fee Schedule (MPS) Relative Value File contains information for - Answer-global days, RVUs, assist surgeon appropriate, etc ALL AUDITORS should use this during the audit process. A triangle symbol located to the left of a code indicates that - Answer-the description of the code has been revised. Details of the revision are found in Appendix B of the CPT codeboo