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Medical Office Procedures > Ch 5 > Flashcards

Ch 5 Flashcards

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USMLE® Step 1 flashcards
0
Q

Optional CPT codes the track performance measures to improve patient’s health.

A

Category II codes

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1
Q

Temporary codes for emerging technology, services, and procedures. May become another code set if used widely in the future.

A

Category III codes

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2
Q

Five digit procedure codes found in the main body of CPT. Each code has a descriptor.

A

Category I codes

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3
Q

What does CPT stand for?

A

Current procedural terminology he

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4
Q

How is the CPT organized?

A 
The CPT contains the main text which is six sections of category I codes:
-Evaluation and management
-Anesthesia
-Surgery
-Radiology
-Pathology and laboratory
-Medicine
•Category II and Category III codes have 14 appendixes and an index
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5
Q

What are usage notes at the beginnings of CPT sections?

A

Section guidelines

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6
Q

What is a service not listed in CPT?

A

Unlisted procedure

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7
Q

What is a note explaining the reasons for a new, variable, or unlisted procedure or service?

A

Special report

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8
Q

When does the CPT use a semicolon and indentions?

A
  • When some quotes and descriptors are followed by indented see or use entries in parentheses
  • Descriptors often contain clarifying examples in parentheses, sometimes with abbreviations e.g.
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9
Q

What are the symbols used in CPT and what do they stand for? (6)

A
  • A bullet indicates a new procedure code
  • A triangle indicates the codes descriptor has changed
  • facing triangles enclose new or revised text other than the codes descriptor
  • A bullet in a circle next to a code means conscious sedation is a part of the procedure the surgeon performs
  • A lightning bolt is used for codes for vaccines that are pending FDA approval
  • A number sign (#) indicates a resequenced code
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10
Q

CPT procedure codes reassigned to another sequence.

A

Resequenced

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11
Q

What is the CPT modifier?

A

A two digit-number that may be attached to most five-digit procedure codes. Modifiers communicate special circumstances involved with procedures.

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12
Q

What are the two parts of a procedure?

A
  1. Technical component (TC)- reflects the technicians work and the equipment and supplies used
  2. Professional component (PC)- represents a physician’s skill, time, and expertise used
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13
Q

What are the six general steps for selecting correct CPT procedure codes?

A
  1. Review complete medical documentation
  2. Abstract the medical procedures from the visit documentation
  3. Identify the main term for each procedure
  4. Locate the main terms in the CPT index
  5. Verify the code in the CPT main text 6. Determine the need for modifiers
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14
Q

Codes that’s cover physician services performed to determine the optimal course for patient care.

A

E/M codes

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15
Q

A factor documented for various levels of evaluation and management services.

A

Key component

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16
Q

What are the key components for selecting E/M codes? (3)

A
  • The extent of the history documented
  • The extent of the examination documented
  • The complexity of the medical decision-making
17
Q

What is a service in which a physician advises a requesting physician about a patient’s condition and care?

A

Consultation

18
Q

What is a patient who receives health care in a hospital setting without admission?

A

Outpatient

19
Q

What are the two types of modifiers used with anesthesia codes?

A
  1. Modifier that describes patient’s health status

2. Standard modifiers

20
Q

What is the code used with procedure codes to indicate a patient’s health status?

A

Physical status modifier

21
Q

What are the modifiers that describe a patient’s physical status?

A

P1: normal, healthy patient
P2: patient with mild systemic disease
P3: patient with severe systemic disease
P4: patient with severe systemic disease that is a constant threat to life
P5: moribund patient who is not expected to survive without the operation
P6: declared brain-dead patient whose organs are being removed for donation purposes

22
Q

What is the largest procedure code section?

A

The surgery section

23
Q

What is a combination of services included in the single procedure code?

A

Surgical package (or global surgery rule)

24
Q

What are the days surrounding a surgical procedure when all services relating to the procedure are considered part of the surgical package?

A

Global period

25
Q

What descriptor is used for a procedure that is usually part of the surgical package but may also be performed separately?

A

Separate procedure

26
Q

Using a single payment for two or more related procedure codes.

A

Bundling

27
Q

Incorrect billing practice of breaking a panel or package of services/procedures into component parts.

A

Unbundling

28
Q

Incorrect billing practice in which procedures are unbundled and separately reported.

A

Fragmented billing

29
Q

Radiology codes follow the same types of guidelines as? And?

A

The surgery section. Contains a professional component and a technical component.

30
Q

Single code grouping laboratory test frequently done together.

A

Panel

31
Q

How many codes do immunizations require?

A

Immunizations require two codes from the medicine section one for administering the immunization and the other for the particular vaccine or toxoid that is given.

32
Q

Services used to support a diagnosis.

A

Ancillary services

33
Q

What does HCPCS stand for?

A

Healthcare common procedure coding system

34
Q

How is the HCPCS organized?

A

It is organized in two sections:

  1. Level I, the CPT
  2. HCPCS Level II codes-national codes that identify supplies, products, and services not in Level I
35
Q

How are the Level II codes arranged?

A

Level II codes are five characters, beginning with a letter and followed by four numbers.

36
Q

What are reusable physical supplies ordered by the provider for home use?

A

Durable medical equipment (DME)

37
Q

What are the characteristics of DME?

A

They can withstand repeated use, primarily and customarily used for medical purposes, generally not useful to a person in the absence of an illness or injury, appropriate for use in the home,

38
Q

What government committee maintains the Level II HCPCS code set? What do the maintain?

A

The CMS HC PCS Workgroup.

They maintain the permanent national codes and temporary national codes of HCPCS Level II.

39
Q

When are the annual updates to the HCPCS made?

A

January 1st of each year. Interim updates for temporary codes are also found on the CMS HCPCS website.

40
Q

Correct HCPCS coding. (3 steps)

A
  • Begin by locating the item to be coded in the index (or the Table of Drugs)
  • Then verify the probable code in the main sections
  • Assign appropriate modifiers
41
Q

Coding steps (6)

A
  • look up the name of supply item in index
  • verify the code in the HCPCS Level II codebook
  • check symbols indicate change in code
  • review description of quantity
  • note method of distribution and dosage for prescription medication
  • use modifier for additional information
  • Attach modifier for “never event” if reporting a physician error such as procedure on wrong body part

Medical Office Procedures (4 decks)

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