Chapter 47: Medical Coding Questions and Answers scored A

Chapter 47: Medical Coding Questions and Answers scored A What are three reasons for the development of procedure codes? - ANS- To justify medical services by correlating procedures to diagnosis, to collect statistics about treatments, to help physicians and insurance companies set fees. How and when were the CPT and HCPCS coding systems developed? - ANS- CPT codes were first published in 1966 by the American Medical Association and focused on surgical procedures, but they have been expanded to cover most medical and surgical procedures. HCPCS Level II codes, which were developed in the 1980s, encompass additional procedures covered by Medicare Part B, including medication, and are used for Medicare coding. What are Level I HCPCS codes? Level II codes? - ANS- Level I HCPCS codes are the current CPT codes. Level II codes are additional codes used for procedures, injections, and durable medical equipment covered by Medicare. What are the six sections of the CPT manual? - ANS- E/M Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology and Laboratory, Medicine. What are Category II codes? Category III codes? - ANS- Category II codes are optional codes used to track performance. Category III codes are temporary codes used to report services that reflect new technology. What is a modifier, and how is it used? - ANS- A modifier is an addition to a CPT code that gives additional information about the procedure that was done. It may be added to the original code following a hyphen, or it may be written as a separate five-digit number that begins with 099. What are several pieces of information that may be significant when looking up a procedure in the index? - ANS- Location, size of a lesion, method of performing a procedure or surgery, amount of time allotted for a treatment, complexity of the procedure or service. What types of services are covered in the Evaluation and Management section of the CPT manual? - ANS- Examinations of patients, other services related to determining what is wrong with a patient, coordinating services. Identify seven factors that affect the level of service when identifying evaluation and management (E/M) codes. - ANS- History; physical examination; complexity of medical decision making; amount of time spent with the patient; nature of the patient's problem; need for coordination of care; need for counseling and/or teaching. What factors must be considered when determining a code in the E/M section of the CPT manual? - ANS- Factors to be considered include where the service was provided, whether the patient was an established patient or new patient, and the level of service provided to the patient. The level of service takes into account the complexity of the history, physical examination, medical decision making, and amount of time spent with the patient; the nature of the patient's problems; and the patient's need for coordination of care or counseling. Differentiate between a problem-focused medical history and a detailed history. - ANS- A problem-focused medical history addresses the chief complaint with a brief history of the present illness. A detailed medical history includes an extended history of the present illness and review of systems beyond those covered in the chief complaint. Family history related to the chief complaint is also reviewed. Differentiate between an expanded problem-focused physical examination and a comprehensive examination. - ANS- An expanded problem-focused physical examination includes examination of the affected body system and at least one other body system that might be symptomatic. A comprehensive physical examination examines several body systems or is a complete examination of one body system (such as a complete neurologic examination). What factors influence the level of medical decision making? - ANS- Number of problems the patient has, complexity of the problems, number of body systems involved. If patient problems interact or are severe, medical decision making is usually at a higher level of complexity. How are anesthesia services reimbursed? - ANS- According to a formula that includes a base unit value for each code (B), the amount of time that the anesthesiologist manages the patient (T), and modifying units based on the patient's age and physical status multiplied by a geographic factor. What is a physical status modifier, and how are physical status modifiers used in relation to anesthesia services? - ANS- A physical status modifier indicates the patient's condition at the time anesthesia was administered. More skill and attention are necessary to provide anesthesia services when a patient's condition is unstable. What services are included in a code for surgical services (surgical package)? - ANS- One evaluation/management visit that occurs after the decision for surgery has been made either on the day before or the day of surgery; local or topical anesthesia or a digital nerve block; immediate postoperative care; writing of orders; evaluation of the patient in the recovery room; typical follow-up postoperative care. What are the four subsections of the Radiology section of the CPT manual? - ANS- Diagnostic radiology; diagnostic ultrasound; nuclear medicine; radiation oncology. When coding for a cardiac panel, can the coder use a separate code for each test in the panel if all tests were done? Why or why not? - ANS- Only one code can be used for a panel (group of laboratory tests ordered together). The rationale is that the tests are run together as a single test using automated equipment, which requires only the time and effort of one test. How does the medical office code for a blood test for a cardiac panel if the specimen was drawn in the office by the medical assistant (MA) and sent out to the hospital laboratory for testing? - ANS- The medical office charges for and includes a code for the venipuncture (36415), but the laboratory charges and codes for the blood test. What types of procedures are included in the Medicine section of the CPT manual? - ANS- Codes for specialized types of diagnostic testing (such as electrocardiograms) and treatments (such as immunizations, infusion therapies, and chemotherapy).