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CCS-P Exam > CCS-P > Flashcards

CCS-P Flashcards

1
Q

Who issues the ICD-10 guidelines?

A

Centers for Medicare and Medicaid Services (CMS)
National Center for Health Statistics (NCHS)

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2
Q

Which cooperating parties above the ICD-10 guidelines

A

American Hospital Association (AHA)
CMS
NCHS

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3
Q

Which takes precedence over the ICD-10 guidelines?

A

Instructions and Conventions.

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4
Q

How is an Outpatient Surgery Coded?

A
  1. Reason for surgery. Applies even if surgery is not performed.
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5
Q

How is an Observation Stay Coded?

A
  1. Medical condition that caused observation.
  2. Complication that caused observation.
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6
Q

How is a therapeutic service coded?

A

Reason for service.

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7
Q

What does Excludes 1 Note mean?

A

Not coded here

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8
Q

What are the 6 sections of Procedural Coding?

A
  1. Surgery.
  2. Evaluation and Management.
  3. Anesthesia.
  4. Radiology.
  5. Pathology and Lab.
  6. Medicine.
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9
Q

What is Medical Necessity?

A

Payers will only cover services that are warranted by the patient’s condition.

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10
Q

What is Medicare’s definition of a Medical necessity?

A

Defined under Title XVIII of the social security act of 1862. No payment made not reasonable and necessary.

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11
Q

What is a National Coding Initiative (NCCI)?

A

Procedure to procedure edits. Based on CPT conventions. Edits updated quarterly.

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12
Q

Modifier 59?

A

Distinct Procedural Services that are not normally reported together but are appropriate under these circumstances. Different session or encounter. Different site or organ system. Separate incision/Excision. Separate Injury.

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13
Q

What are the modifier 59 alternatives for Medicare?

A

XE-separate procedure. XS-separate structure. XP-Separate practitioner. XU-unusual non overlapping service.

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14
Q

Modifier 58?

A

Staged or related procedure.

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15
Q

Modifier 78?

A

Return to the OR for a related procedure during a postop period.

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16
Q

Modifier 79?

A

Unrelated procedure of Service b the same physician during the postup period.

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17
Q

Hippa

A

Health Insurance Accountability and Portability Act. 1996. Privacy rule that requires compliance from all federal state and local laws.

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18
Q

OIG?

A

Office of Inspector General-Focuses on high dollar fraud and abuse. 25% of healthcare costs are associated with fraud and abuse. Estimated annual 100-170 billon dollars.

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19
Q

What is a OIG Work Plan?

A

Lists the current audits and reviews undertaken by the OIG . Reports viewable.

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20
Q

What are the 7 steps to Compliance OIG Work Plan?

A
  1. Conduct Internal Monitoring and Audits.
  2. Implement Compliance and Practice standards.
  3. Designating a compliance officer or contract.
  4. Conducting Appropriate training and education.
  5. Responding appropriately to detected offenses and developing corrective action.
  6. Developing Open lines of communication.
  7. Enforcing disciplinary standards trough well published guidelines.
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21
Q

Who are Government Auditors

A
  1. Medicare Administrative Contractors (MACs)
  2. Medicaid Integrity Contractors (MIC)
  3. Recovery Auditors (RAC)
  4. Zone Program Integrity Contractors.
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22
Q

What do Macs do?

A

Medicare Administrative Contractors are contracted to process Medicare Part A and B Medical claims or DME claims for Medicare fee for service beneficiaries.

23
Q

What is a MIC?

A

Medicaid Integrity Contractors-Review Provider activities and combat fraud and abuse.

24
Q

What is a Recovery Audit Contractor (RAC)

A

Mission to reduce proper Medicare improper payments through detection and collection of overpayments.

25
Q

What is a ZPIC

A

Zone Program Integrity contractor-7 zones-perform wide range of review, data analysis.

26
Q

The greatest % of claim denials are due to?

A

Registration Errors

27
Q

How do you handle unbundling errors?

A

Refunding overpayments to third party Payer.

28
Q

Where is the list of Modifiers located?

A

Appendix A

29
Q

What does Modifer AI mean?

A

Principal physician of record used for admit codes (not on list)

30
Q

Modifier 57?

A

Decision for Surgery.

31
Q

Modifier 66?

A

Surgical Team

32
Q

62

A

2 surgeons.

33
Q

53

A

discontinued procedures.

34
Q

74?

A

Discontinue outpatient procedure after anesthesia administration for outpatient hospital use.

35
Q

25

A

Significant separate E/M by same MD on day or procedure.

36
Q

24

A

Unrelated E/M by same MD during post op period.

37
Q

32

A

Mandated Services related to mandated consultation and or related services.

38
Q

99205

A

60 to 74 min

39
Q

99202

40
Q

99203

41
Q

99204

42
Q

99211

43
Q

99213

44
Q

99214

45
Q

99215

46
Q

What is performed at Nursing Facilities?
99304-99310

A

Nursing facilities
Skilled nursing facilities
Psychiatric residential treatment centers for immediate care facilities.

47
Q

Nursing care managed by

A

Admitting physician.

48
Q

MDM based on

A
  1. Number and complexity of problems
  2. Data reviewed/ordered
  3. Risk
49
Q

How do you code a pacemaker?

A

of leads, type of leads, insertion, new or replacement, permanent or ventricular electrode.

50
Q

What are the 3 major coronary arteries?

A
  1. LD left anterior descending.
  2. LC left circumflex.
  3. RD right coronary artery.
51
Q

how to do you code a central venous Access Device Procedure (CVAD)

A
  1. Port or pump?
  2. Age?
  3. Tunneled or not tunneled?
52
Q

Burns

A

Category T31
According to the extent of the body surface Rule of Nines is used.
Deep full thickness burn-3rd degree
Non healing burns are acute burns.

53
Q

MRSA

A

Code both infection and colonization.

CCS-P Exam (1 decks)

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