Billing Codes

Question 1

ICD-10 Code Format (Intl. Classification of Disease)

Answer 1

7 digits: category(1-3), anatomic site/severity (4-6), extension (7)
ex: S83.522A

Question 2

HCPCS code format & example (Healthcare Common Procedure Coding System)

Answer 2

5 digits, alpha-numeric
ex: E1030

Question 3

CPT code format & example (Current Procedural Terminology)

Answer 3

5 digits, numeric
“97161”

Question 4

Initial Eval.: low complexity code

Answer 4

97161

Question 5

Re-evaluation code

Answer 5

97164

Question 6

Hot/Cold Packs code

Answer 6

97010

Question 7

Ultrasound code

Answer 7

97035

Question 8

Therapeutic Exercise code

Answer 8

97110

Question 9

Neuromuscular Re-education code

Answer 9

97112

Question 10

Gait Training code

Answer 10

97116

Question 11

Manual Therapy code

Answer 11

97140

Question 12

Group Therapy code

Answer 12

97150

Question 13

Therapeutic Activities code

Answer 13

97530

Question 14

Initial Eval: moderate complexity code

Answer 14

97162

Question 15

Initial Eval: high complexity code

Answer 15

97163

Question 16

Attended E-Stim code

Answer 16

97032

Question 17

Unattended E-Stim code

Answer 17

97014

Question 18

Unattended E-Stim for Medicare code

Answer 18

G0283

Question 19

Modifier code: PT provide services delivered under PT’s POC

Answer 19

GP

Question 20

Modifier code: distinct procedural service

Answer 20

59

Question 21

Modifier code: requirements specified in medical policy have been met

Answer 21

KX

Question 22

Modifier code: PT services performed in part/whole by PTA

Answer 22

CQ

Question 23

ICD-10 code purpose & example

Answer 23

code used to describe disease/condition
“S83.522A”

Question 24

Examples of non-billable services

Answer 24

documenting time, pt. rest periods, care plan meetings, supervision of unskilled activity, transporting pt to tx

Question 25

service delivery w/ constant attendance & cumulative time

Answer 25

individual

Question 26

service delivery: “team therapy” w/ 2 clinicians simultaneously treating pt

Answer 26

co-treatment

Question 27

service delivery with 1 therapist for 2 pts for different activities

Answer 27

concurrent

Question 28

service delivery: simultaneous tx to 2+ pts w/ same/different activities

Answer 28

group therapy

Question 29

example of untimed code/service-based code

Answer 29

group therapy
modalities (cold pack, wound care management)
PT eval/re-eval

Question 30

time-based codes based on service/procedure in __ min increments

Answer 30

15 min

Question 31

Medicare’s time-based coding system

Answer 31

8-minute rule (minimum 8 min. to be billable)

Question 32

examples of overbilling

Answer 32

upcoding
utilization abuse (over scheduling for unmedically necessary visits)
overcharging

Question 33

examples of underbilling

Answer 33

improper 8 minute rule
waiving fees/copays
providing services without billing

Question 34

ICD-10 Code purpose

Answer 34

describes diseases/conditions

Question 35

Level II HCPCS code examples

Answer 35

non-physician services
ex:AD, prothetics, unattended e-stim

Question 36

when a procedure/modality is not paid as distinct & separate

Answer 36

bundling

Question 37

group therapy billing

Answer 37

bill each pt 1 unit of group therapy (under Medicare)