CDEO STUDY GUIDE
Congestive Heart Failure - Correct Answers -A chronic condition in which the heart
doesn't pump blood as well as it should.
Hypertension - Correct Answers -A condition in which the force of the blood against the
artery walls is too high.
HEDIS - Correct Answers -Healthcare Effectiveness Data and Information Set
HIPAA - Correct Answers -Health Insurance Portability and Accountability Act
MPFS - Correct Answers -Medicare National Physician Fee Schedule
Multiple procedure rule - Correct Answers -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 - Correct Answers -Indicates new procedures and services added to the
CPT book.
Triangle symbol - Correct Answers -Indicates that the description of the code has been
revised
Opposing horizontal triangles - Correct Answers -Indicates new and revised text, other
than in procedure descriptors
Forbidden symbol - Correct Answers -Identifies codes that are modifier 51 exempt and
exempt from the multiple procedure rule
Bull's-eye symbol - Correct Answers -Identifies codes that include moderate sedation.
When this is located next to a code, moderate sedation can not be reported separately.
Unlisted procedure code - Correct Answers -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 - Correct Answers -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.
, HPI - Correct Answers -Description of the development of the patient's illness from the
list of signs or symptoms, or from the previous encounter, to the present. The provider
must document the HPI. There are 8 elements of the HPI.
Location - Correct Answers -Anatomical place, position, or site of the chief complaint.
Quality - Correct Answers -Characteristics about the problem, such as how it looks or
feels.
Severity - Correct Answers -A degree or measurement of how bad it is.
Duration - Correct Answers -How long the chief complaint has been occurring, or the
time when the complaint occurred,
Timing - Correct Answers -Measurement of when or at what frequency they noticed the
complaint.
Context - Correct Answers -What the patient was doing, their environmental factors, the
circumstances surrounding the complaint.
Modifying factors - Correct Answers -Anything that makes the problem better or worse
Associated signs and symptoms - Correct Answers -Associated secondary complaints.
Three chronic conditions - Correct Answers -The HPI can also be calculated based on
documentation of the status of three chronic or inactive conditions
ROS- Review of Symptoms - Correct Answers -An account of the body systems
obtained through a series of questions seeking to spot signs or symptoms the patient
may be experiencing. This can be documented by the provider or staff.
Fraud - Correct Answers -CMS defines as making false statements or misrepresenting
facts to obtain an underserved benefit or payment from a federal healthcare program.
Examples on page 3 of study guide
Abuse - Correct Answers -CMS defines as an action act results in unnecessary costs to
a federal healthcare program, either directly or indirectly. Examples on page 3 of study
guide
Federal False Claims Act (FCA) - Correct Answers -SEE PAGE 3 STUDY GUIDE FOR
A-G QUALIFICATIONS **(page 4, first full paragraph states: the FCA is violated by
submitting a false claim with knowledge that it is false; however, the act states that a
violation may occur even if here is not intent to defraud). DOES NOT apply to claims,
records, or statements made under the IRS code of 1986.
Congestive Heart Failure - Correct Answers -A chronic condition in which the heart
doesn't pump blood as well as it should.
Hypertension - Correct Answers -A condition in which the force of the blood against the
artery walls is too high.
HEDIS - Correct Answers -Healthcare Effectiveness Data and Information Set
HIPAA - Correct Answers -Health Insurance Portability and Accountability Act
MPFS - Correct Answers -Medicare National Physician Fee Schedule
Multiple procedure rule - Correct Answers -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 - Correct Answers -Indicates new procedures and services added to the
CPT book.
Triangle symbol - Correct Answers -Indicates that the description of the code has been
revised
Opposing horizontal triangles - Correct Answers -Indicates new and revised text, other
than in procedure descriptors
Forbidden symbol - Correct Answers -Identifies codes that are modifier 51 exempt and
exempt from the multiple procedure rule
Bull's-eye symbol - Correct Answers -Identifies codes that include moderate sedation.
When this is located next to a code, moderate sedation can not be reported separately.
Unlisted procedure code - Correct Answers -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 - Correct Answers -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.
, HPI - Correct Answers -Description of the development of the patient's illness from the
list of signs or symptoms, or from the previous encounter, to the present. The provider
must document the HPI. There are 8 elements of the HPI.
Location - Correct Answers -Anatomical place, position, or site of the chief complaint.
Quality - Correct Answers -Characteristics about the problem, such as how it looks or
feels.
Severity - Correct Answers -A degree or measurement of how bad it is.
Duration - Correct Answers -How long the chief complaint has been occurring, or the
time when the complaint occurred,
Timing - Correct Answers -Measurement of when or at what frequency they noticed the
complaint.
Context - Correct Answers -What the patient was doing, their environmental factors, the
circumstances surrounding the complaint.
Modifying factors - Correct Answers -Anything that makes the problem better or worse
Associated signs and symptoms - Correct Answers -Associated secondary complaints.
Three chronic conditions - Correct Answers -The HPI can also be calculated based on
documentation of the status of three chronic or inactive conditions
ROS- Review of Symptoms - Correct Answers -An account of the body systems
obtained through a series of questions seeking to spot signs or symptoms the patient
may be experiencing. This can be documented by the provider or staff.
Fraud - Correct Answers -CMS defines as making false statements or misrepresenting
facts to obtain an underserved benefit or payment from a federal healthcare program.
Examples on page 3 of study guide
Abuse - Correct Answers -CMS defines as an action act results in unnecessary costs to
a federal healthcare program, either directly or indirectly. Examples on page 3 of study
guide
Federal False Claims Act (FCA) - Correct Answers -SEE PAGE 3 STUDY GUIDE FOR
A-G QUALIFICATIONS **(page 4, first full paragraph states: the FCA is violated by
submitting a false claim with knowledge that it is false; however, the act states that a
violation may occur even if here is not intent to defraud). DOES NOT apply to claims,
records, or statements made under the IRS code of 1986.
