CDEO STUDY GUIDE WITH COMPLETE
SOLUTION
Congestive Heart Failure - answerA chronic condition in which the heart doesn't pump blood as
well as it should.
Hypertension - answerA condition in which the force of the blood against the artery walls is too
high.
HEDIS - answerHealthcare Effectiveness Data and Information Set
HIPAA - answerHealth Insurance Portability and Accountability Act
MPFS - answerMedicare National Physician Fee Schedule
Multiple procedure rule - answerThe 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 - answerIndicates new procedures and services added to the CPT book.
Triangle symbol - answerIndicates that the description of the code has been revised
Opposing horizontal triangles - answerIndicates new and revised text, other than in procedure
descriptors
Forbidden symbol - answerIdentifies codes that are modifier 51 exempt and exempt from the
multiple procedure rule
, Bull's-eye symbol - answerIdentifies codes that include moderate sedation. When this is located
next to a code, moderate sedation can not be reported separately.
Unlisted procedure code - answerThese 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 - answerThe 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 - answerDescription 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 - answerAnatomical place, position, or site of the chief complaint.
Quality - answerCharacteristics about the problem, such as how it looks or feels.
Severity - answerA degree or measurement of how bad it is.
Duration - answerHow long the chief complaint has been occurring, or the time when the
complaint occurred,
Timing - answerMeasurement of when or at what frequency they noticed the complaint.
Context - answerWhat the patient was doing, their environmental factors, the circumstances
surrounding the complaint.
SOLUTION
Congestive Heart Failure - answerA chronic condition in which the heart doesn't pump blood as
well as it should.
Hypertension - answerA condition in which the force of the blood against the artery walls is too
high.
HEDIS - answerHealthcare Effectiveness Data and Information Set
HIPAA - answerHealth Insurance Portability and Accountability Act
MPFS - answerMedicare National Physician Fee Schedule
Multiple procedure rule - answerThe 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 - answerIndicates new procedures and services added to the CPT book.
Triangle symbol - answerIndicates that the description of the code has been revised
Opposing horizontal triangles - answerIndicates new and revised text, other than in procedure
descriptors
Forbidden symbol - answerIdentifies codes that are modifier 51 exempt and exempt from the
multiple procedure rule
, Bull's-eye symbol - answerIdentifies codes that include moderate sedation. When this is located
next to a code, moderate sedation can not be reported separately.
Unlisted procedure code - answerThese 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 - answerThe 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 - answerDescription 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 - answerAnatomical place, position, or site of the chief complaint.
Quality - answerCharacteristics about the problem, such as how it looks or feels.
Severity - answerA degree or measurement of how bad it is.
Duration - answerHow long the chief complaint has been occurring, or the time when the
complaint occurred,
Timing - answerMeasurement of when or at what frequency they noticed the complaint.
Context - answerWhat the patient was doing, their environmental factors, the circumstances
surrounding the complaint.
