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CPB > 5&6 > Flashcards

5&6 Flashcards

CPT and HCPCS

1
Q

A drug is only available in 100 unit size bottles (J0585) and is administered at 70 units to a patient. How is the discarded drug coded?

A

J0585-JW x 30. The JW is the modifier for discarded drugs followed by the units discarded.

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2
Q

During a 90 day postoperative period, what can still be billed?

A

Any exacerbations, recurrences, other diseases or complications that result in a return to the operating room. Everything related to the procedure (90 day major surgery) is not separately billable in the 90 day period.

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3
Q

During a lesion excision, a 7.5 cm intermediate repair is performed on the right leg and a 2.5 cm intermediate repair is performed on the right arm. How is this coded?

A

Lesion excision or repair in the same anatomic section (trunk, extremities, etc.) and complexity are added together and coded. In this case a total of 10 cm would make this a single code of 12034.

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4
Q

How do you code if multiple procedures are performed in a single surgical episode?

A

The major (most complex) procedure is reported, additional procedures are reported with modifier 51 attached.

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5
Q

How does a set of lab tests qualify for a “panel” code?

A

Only if the exact tests listed in the panel are performed. Otherwise, the panel with the greatest number of tests is coded and additional tests are reported individually.

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6
Q

If a patient is seen by another provider of the same specialty and subspecialty during the same visit to a facility, how is it reported?

A

The second provider reports it as a subsequent service.

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7
Q

If more than one surgical procedure is performed during a single anesthetic, how is that coded?

A

The code that describes the most complex procedure (highest unit value) is reported. The remaining procedures are reflected in the increased time the anesthesia services were provided.

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8
Q

In a CPT description, what is the information before a semicolon?

A

It is considered the common procedure. After the semicolon is the alteration to the common procedure which is what the indented codes are.

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9
Q

In CPT, what are category 2 codes and how are they identified?

A

They are primarily performance measures and their last character is an F.

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10
Q

In CPT, what are category 3 codes and how are they identified?

A

They are temporary codes for emerging technology and procedures and their fifth character is a T.

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11
Q

Moving a patient from one location to another is considered a transfer to a new stay. What transfers are NOT considered a new stay?

A

Moving from observation to inpatient. Moving from nursing facility to skilled nursing facility.

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12
Q

Radiology codes are divided into 2 components, what are they?

A

Modifier TC (technical component) for the taking of the image, and the professional component (interpreting the image) marked with modifier 26.

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13
Q

What are the 3 Medicare postoperative global period designations?

A

0 day, 10 day(minor surgery) and 90 day(major surgery).

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14
Q

What defines an established patient?

A

A patient that has received face to face services from the same physician or another physician of the exact same specialty and subspecialty within the same group practice within the last 3 years.

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15
Q

What do HCPCS K codes represent?

A

Durable medical equipment medicare administrative contractors (DME MAC).

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16
Q

What do HCPCS Q codes represent?

A

Drugs, biologicals and other types of medical equipment.

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17
Q

What do the 6 “P” HCPCS modifiers mean when used for anesthesia?

A

Normal healthy patient (P1), patient with mild systemic disease (P2), patient with severe systemic disease (P3), patient with severe systemic disease that is a constant threat to life (P4), a moribund patient not expected to survive the operation (P5), a brain dead patient whose organs are being removed for donor purposes (P6).

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18
Q

What do the HCPCS G codes represent?

A

Healthcare procedures that are not coded in CPT.

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19
Q

What do the HCPCS H codes represent?

A

Separate mental health codes for state Medicaid agencies.

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20
Q

What do the HCPCS modifiers E1 - E4 mean?

A

Upper left eyelid (E1), lower left eyelid (E2), upper right eyelid (E3), lower right eyelid (E4)

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21
Q

What do the HCPCS modifiers F5 - F9 mean?

A

Right hand thumb (F5), right hand second digit (F6), right hand third digit (F7), right hand fourth digit (F8), right hand fifth digit (F9).

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22
Q

What do the HCPCS S codes represent?

A

Drugs, services and supplies for which there are no national codes. ONLY for private payers NOT for Medicare.

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23
Q

What do the HCPCS T codes represent?

A

Used by Medicaid to identify items with no permanent national codes. NOT for Medicare.

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24
Q

What do the HCPCS temporary C codes designate?

A

Items that may qualify for pass-through payments under the Hospital Outpatient Prospective Payment System (OPPS).

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25
Q

What does E/M stand for?

A

Evaluation and management

26
Q

What does NOT qualify as a radiological study with contrast?

A

Oral and rectal contrast.

27
Q

What does the circle with a line through it represent in CPT?

A

It designates a code that is exempt from modifier 51.

28
Q

What does the CPT anesthesia modifier AA mean?

A

Services performed personally by an anesthesiologist.

29
Q

What does the CPT anesthesia modifier AD mean?

A

Supervision by a physician, more than 4 concurrent anesthesia procedures.

30
Q

What does the CPT anesthesia modifier GC stand for?

A

Service has been performed in part by a resident under the direction of a teaching physician.

31
Q

What does the CPT anesthesia modifier QK mean?

A

Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individuals.

32
Q

What does the CPT anesthesia modifier QX mean?

A

CRNA service with medical direction by a physician.

33
Q

What does the CPT anesthesia modifier QY stand for?

A

Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist.

34
Q

What does the CPT anesthesia modifier QZ mean?

A

CRNA service without medical direction by a physician.

35
Q

What does the HCPCS modifier A1 mean?

A

Principal physician of record.

36
Q

What does the HCPCS modifier CC mean?

A

Procedure code change

37
Q

What does the term “separate procedure” mean in CPT?

A

A code for a procedure that is usually performed as part of a larger procedure, but in this case was performed by itself.

38
Q

What is contained in CPT appendix A?

A

Modifiers for CPT level 1 and 2 codes.

39
Q

What is correct procedure for coding an add-on code?

A

Add on codes MUST be coded with the appropriate parent code. Modifier 51 is not needed with add on codes.

40
Q

What is IA short for?

A

Intra-arterial, drug given into an artery.

41
Q

What is IM short for?

A

Intramuscular, drug injected into muscle.

42
Q

What is INH short for?

A

Inhaled solution, drug taken by breathing in.

43
Q

What is IT short for?

A

Intrathecal, drug given into subdural space of the spinal cord.

44
Q

What is IV short for?

A

Intravenous, drug given into a vein.

45
Q

What is MAC?

A

Monitored anesthesia care. Patient is under light or no sedation, can respond to stimuli and maintain their airway. Service is monitored by an anesthesia provider.

46
Q

What is OTH short for?

A

Other routes of administration, such as suppositories or catheter injections.

47
Q

What is SC short for?

A

Subcutaneous administration, drug injected just under the skin.

48
Q

What is the code range for anesthesia in CPT?

A

00100 - 01999

49
Q

What is the correct procedure for coding from the HCPCS table of drugs.

A

Make sure you are coding for the correct drug (penicillin, etc.) that you are coding for the correct administration (IA, IV, etc.) and that you code for the correct amount (15 mg, or with a x2, x3, etc if needed to reach the correct amount).

50
Q

What is the difference between general and regional anesthesia?

A

General is a drug induced loss of consciousness. Regional is loss of sensation in a body region.

51
Q

What is VAR short for?

A

Various routes of administration, such as into joints, cavities tissues or topical applications.

52
Q

What qualifies as an initial service?

A

The first face to face visit by a provider.

53
Q

What three requirements must be met to qualify as a consultation?

A
  1. Services must be requested by another provider. 2. The consulting provider must render an opinion or recommendation or decide to accept responsibility for ongoing care. 3. The consulting provider must respond to the requesting provider with a written report.
54
Q

When a provider is acting on call how is the visit classified in terms of patient status?

A

It is classified based on the provider who is not available.

55
Q

When coding from the surgical section of the CPT, what is important to always do?

A

Read the section guidelines and parenthetical instructions as they add rules and complexity beyond the basic number coding.

56
Q

When is it acceptable to report radiological global service without a modifier?

A

When the provider owns the equipment and provides the interpretation.

57
Q

When is it appropriate to use modifier 50?

A

When the EXACT same service is performed on the L and R sides of the body and the code does not specify it is bilateral or unilateral.

58
Q

When should you code from HCPCS rather than CPT?

A

If the most accurate description is in HCPCS or the billing is for Medicare.

59
Q

Where do you look to determine the global period (global days)?

A

In the Medicare Physician Fee Schedule.

60
Q

Which modifiers are used exclusively for postoperative procedures performed by different providers?

A

Modifiers 54, 55 and 56

CPB (5 decks)

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