QME Forms Questions with Correct Answers
Form 100
Unrepresented IW- addressing PD- Questionnaire
Form 101
Unrepresented IW- addressing PD- Request for Rating
Form 111
Unrepresented IW- No PD- Finding Summary
Form 120
Psych pt request notes sent to doc rather than self
Form 121
Notes too unsafe to go to patient
Form 109
Unavailable
Form 110
Apt notification, w/in 5 days of making
Form 112
Extension (15 days good cause / 30 days results) <5 days before due
Modifier 92
PTP
Modifier 93
Form 100
Unrepresented IW- addressing PD- Questionnaire
Form 101
Unrepresented IW- addressing PD- Request for Rating
Form 111
Unrepresented IW- No PD- Finding Summary
Form 120
Psych pt request notes sent to doc rather than self
Form 121
Notes too unsafe to go to patient
Form 109
Unavailable
Form 110
Apt notification, w/in 5 days of making
Form 112
Extension (15 days good cause / 30 days results) <5 days before due
Modifier 92
PTP
Modifier 93
