CDEO Chapter 7 Questions With Complete Solutions
000 Correct Answers Endoscopies or minor procedures with
preoperative and postoperative relative values on the day of the
procedure only are reimbursable
Evaluation and management services on the same day of the
procedure are generally not payable.
010 Correct Answers Minor procedures with preoperative
relative values on the day of the procedure and postoperative
relative values during a 10-day postoperative period are
reimbursable services .
Evaluation and management services on the day of the
procedure and during the 10-day postop period are not
reimbursable.
090 Correct Answers Major procedures with one day
preoperative period and 90 day postoperative period are a
component of global package of major procedure.
Evaluation and management services on the day prior, day of,
and 90 day postoperative period are not reimbursable.
1 Day Payment Window Correct Answers Some facilities are
subject to this window instead of the 3 day payment window:
Psychiatric Hospitals
Inpatient rehabilitation hospitals
,Long-term care hospitals
Children's Hospitals
Cancer Hospitals
3 Day Payment Window Correct Answers When a patient has
Medicare Part A Coverage all outpatient diagnostic services
provided to that patient within 3 days prior to admission are
considered included in the Part A payment and are not billed
separately as outpatient services.
3 Day Payment Window Correct Answers When Part A covers
admission the hospital may bill outpatient diagnostic services
only if they are not related to admission.
Additional Columns Correct Answers in addtion to the global
surgery status indicators, there are additional columns to
indicate the percentage of payment for the pre-operative,
postoperative, intraoperative components of the global package.
This info is useful for reviewing surgeries,
The number of global days assigned to a code will help the
CDEO in knowing services that are part of the surgical package
not billed and paid separately. Also, it is important to monitor
the global days to make sure that when the global period is over,
services are billed and paid correctly.
, Auditing Modifier 22 Correct Answers When auditing a
provider look for trends for abuse of this modifier. For example,
does the provider have a high number of denials for services
reporting this modifier, or does the provider report it
consistently with the same procedure code.
CF Correct Answers Converstion Factor
Common Surgical Coding Errors Correct Answers Coding
from the Operative Note Headers:
Failure to read the entire note will lead to coding errors. The
headers are a good place to start, but the full description of the
procedure will provide more detailed information to make the
correct code and modifier selection.
Common Surgical Coding Errors Correct Answers Failure To
Report Imaging Guidance:
Imagining guidance is bundled in many procedures- but not all.
Review the coding guidelines and parenthetical notes for
instructions to report imagine guidance, when appropriate.
Common Surgical Coding Errors Correct Answers Failure to
support medical necessity:
Review LCD/NCD and private payer policy to determine the
diagnoses that support medical necessity.
000 Correct Answers Endoscopies or minor procedures with
preoperative and postoperative relative values on the day of the
procedure only are reimbursable
Evaluation and management services on the same day of the
procedure are generally not payable.
010 Correct Answers Minor procedures with preoperative
relative values on the day of the procedure and postoperative
relative values during a 10-day postoperative period are
reimbursable services .
Evaluation and management services on the day of the
procedure and during the 10-day postop period are not
reimbursable.
090 Correct Answers Major procedures with one day
preoperative period and 90 day postoperative period are a
component of global package of major procedure.
Evaluation and management services on the day prior, day of,
and 90 day postoperative period are not reimbursable.
1 Day Payment Window Correct Answers Some facilities are
subject to this window instead of the 3 day payment window:
Psychiatric Hospitals
Inpatient rehabilitation hospitals
,Long-term care hospitals
Children's Hospitals
Cancer Hospitals
3 Day Payment Window Correct Answers When a patient has
Medicare Part A Coverage all outpatient diagnostic services
provided to that patient within 3 days prior to admission are
considered included in the Part A payment and are not billed
separately as outpatient services.
3 Day Payment Window Correct Answers When Part A covers
admission the hospital may bill outpatient diagnostic services
only if they are not related to admission.
Additional Columns Correct Answers in addtion to the global
surgery status indicators, there are additional columns to
indicate the percentage of payment for the pre-operative,
postoperative, intraoperative components of the global package.
This info is useful for reviewing surgeries,
The number of global days assigned to a code will help the
CDEO in knowing services that are part of the surgical package
not billed and paid separately. Also, it is important to monitor
the global days to make sure that when the global period is over,
services are billed and paid correctly.
, Auditing Modifier 22 Correct Answers When auditing a
provider look for trends for abuse of this modifier. For example,
does the provider have a high number of denials for services
reporting this modifier, or does the provider report it
consistently with the same procedure code.
CF Correct Answers Converstion Factor
Common Surgical Coding Errors Correct Answers Coding
from the Operative Note Headers:
Failure to read the entire note will lead to coding errors. The
headers are a good place to start, but the full description of the
procedure will provide more detailed information to make the
correct code and modifier selection.
Common Surgical Coding Errors Correct Answers Failure To
Report Imaging Guidance:
Imagining guidance is bundled in many procedures- but not all.
Review the coding guidelines and parenthetical notes for
instructions to report imagine guidance, when appropriate.
Common Surgical Coding Errors Correct Answers Failure to
support medical necessity:
Review LCD/NCD and private payer policy to determine the
diagnoses that support medical necessity.
