CDEO Study Guide with Complete Solutions

CDEO Study Guide with Complete Solutions Congestive Heart Failure - Answer️️ -A chronic condition in which the heart doesn't pump blood as well as it should. Hypertension - Answer️️ -A condition in which the force of the blood against the artery walls is too high. HEDIS - Answer️️ -Healthcare Effectiveness Data and Information Set HIPAA - Answer️️ -Health Insurance Portability and Accountability Act MPFS - Answer️️ -Medicare National Physician Fee Schedule Multiple procedure rule - Answer️️ -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 - Answer️️ -Indicates new procedures and services added to the CPT book. Triangle symbol - Answer️️ -Indicates that the description of the code has been revised Opposing horizontal triangles - Answer️️ -Indicates new and revised text, other than in procedure descriptors ©SOPHIABENNETT EXAM SOLUTIONS_2024/2025 Monday, September 2, 2024 12:59 PM Page | 2 Forbidden symbol - Answer️️ -Identifies codes that are modifier 51 exempt and exempt from the multiple procedure rule Bull's-eye symbol - Answer️️ -Identifies codes that include moderate sedation. When this is located next to a code, moderate sedation can not be reported separately. Unlisted procedure code - Answer️️ -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 - Answer️️ -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 - Answer️️ -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 - Answer️️ -Anatomical place, position, or site of the chief complaint. Quality - Answer️️ -Characteristics about the problem, such as how it looks or feels. Severity - Answer️️ -A degree or measurement of how bad it is. Duration - Answer️️ -How long the chief complaint has been occurring, or the time when the complaint occurred, Timing - Answer️️ -Measurement of when or at what frequency they noticed the complaint. Context - Answer️️ -What the patient was doing, their environmental factors, the circumstances surrounding the complaint. ©SOPHIABENNETT EXAM SOLUTIONS_2024/2025 Monday, September 2, 2024 12:59 PM Page | 3 Modifying factors - Answer️️ -Anything that makes the problem better or worse Associated signs and symptoms - Answer️️ -Associated secondary complaints. Three chronic conditions - Answer️️ -The HPI can also be calculated based on documentation of the status of three chronic or inactive conditions ROS- Review of Symptoms - Answer️️ -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 - Answer️️ -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 - Answer️️ -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) - Answer️️ -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 appl