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Medical Billing, Insurance, and Coding - Smith Fall 2020 > Chapter 8 > Flashcards

Chapter 8 Flashcards

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USMLE® Step 1 flashcards
1
Q

CPT codes are used by: (5)

A 
Physician's offices and clinics
Hospitals
Rehab units
Ambulance services
Long-term care facilities
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2
Q

CPT forms… (paragraph)

A

…the basis for a universal communication system that ensures accuracy and clarity when the procedures and services delivered within the health care system are described

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3
Q

Six main divisions in Category I of the CPT manual

A
  1. Evaluation and Management (E/M)
  2. Anesthesia
  3. Surgery
  4. Radiology
  5. Pathology and Laboratory
  6. Medicine
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4
Q

The universal paper form

A

CMS-1500

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5
Q

Services that are reported electronically by the CMS-1500

A

Outpatient services

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6
Q

Appendix A

A

Modifiers

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7
Q

Appendix B

A

Additions, Deletions, Revisions

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8
Q

Appendix C

A

Clinical Examples, E/M Codes

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9
Q

Appendix D

A

Add-on Codes

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10
Q

Appendix E

A

-51 Exempt Codes

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11
Q

Appendix F

A

-63 Exempt Codes

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12
Q

Appendix G

A

Include Moderate Conscious Sedation

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13
Q

Which appendix gives coders examples of how to apply E/M codes?

A

Appendix C

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14
Q

One subsection of E/M is…

A

…Office or Other Outpatient Services

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15
Q

What indicates that a portion of text has been changed?

A

right- and left- facing triangles surrounding the parenthetical note below the code description

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16
Q

An add-on code: (3)

A
  1. May only be used with another specific code
  2. Is never used alone
  3. Requires no reduction for multiple services
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17
Q

Where is the full list of add-on codes listed?

A

Appendix D

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18
Q

What is the purpose of an add-on code?

A

Additional code to show the furthest extent of the procedure

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19
Q

-51 Exempt Codes are services…

A

typically exempt from multiple procedure reductions

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20
Q

When is a modifier -51 used?

A

When multiple surgeries are performed on the same day during the same surgical session

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21
Q

Modifier -51 should not be used with…

A

…add-on codes

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22
Q

Symbol: plus (+) sign

A

add-on code

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23
Q

Symbol: circle with a line through it

A

“-51 may not be used with these codes”

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24
Q

Why is evaluation and management section listed first?

A

Procedures and services listed in the E/M section are frequently used

25
Q

How is the CPT categorized?

A

Sections
Subsections
Subheadings
Categories

26
Q

The surgery section is subdivided by…

A

…body systems

27
Q

Subdivisions may be categorized by:

A 
Anatomy: knee or shoulder
Procedure: incision or excision
Condition: fracture or dislocation
Description: cast or strap
Surgical approach: anterior cranial fossa or middle cranial fossa
28
Q

Where do guidelines appear in the CPT manual?

A

At the start of each section of the CPT

29
Q

Where do notes appear in the CPT?

A

Throughout and are listed before and after the codes that they reference

30
Q

What are notes?

A

Special instructions that must be followed for coding to be accurate

31
Q

Notes are a…

A

…must-reading for the coder

32
Q

Two types of codes used in the CPT manual

A

Stand-alone

Indented codes

33
Q

Codes which have a complete, full descriptions attached to them

A

Stand-alone

34
Q

Codes that are listed under related stand-alone codes.

A

Indented

35
Q

Descriptions for these codes depend on information in the code that precedes them

A

Indented

36
Q

Words before the semicolon applies to ___ indented codes that follow

A

all

37
Q

What divides the portion of the description that is related to all indented codes that follow it from the portion that pertains specifically and only to the current code

A

semicolon

38
Q

How does each surgeon bill the procedure?

A

modifier -62

39
Q

Medicare requires documentation of medical necessity when modifier ___ is used

A

-25

40
Q

Modifiers are placed…

A

…M1 and/or M2 of the EHR

41
Q

List modifiers in _______ order on the claim form

A

descending

42
Q

Unlisted procedures may be coded as…

A

“unlisted” of no specific Category I or III code describes the procedure

43
Q

Medicare requires unlisted codes to be accompanied by…

A

a special report

44
Q

Codes that are used to indicate an unlisted service

A

99

45
Q

Where are codes for unlisted services found?

A

At the end of each subsection and are categorized either by body area or type of procedure

46
Q

Codes that report the latest technology and temporary codes for up to five years

A

Category III

47
Q

Category III codes are listed…

A

immediately before Appendix A

48
Q

Format for the Category III codes

A

4 numbers and one letter

49
Q

Category III codes are published…

A

each January and July on the AMA website and then in the next edition of the CPT

50
Q

What must accompany claims for unlisted Category I and Category III codes to explain the need for the service provided

A

Written reports

51
Q

A special (written) report must state the following details about the procedure: (7)

A
  1. Nature
  2. Extent
  3. Need
  4. Time
  5. Effort
  6. Equipment used
  7. Photos and medical journal (if relevant)
52
Q

Used to locate the service/procedure terms and codes

A

The index

53
Q

What is the purpose of using the Index in the back of the CPT manual?

A

It speeds up the process of locating the term or code

54
Q

The index is organized…

A

Alphabetically

55
Q

How are entries coded?

A

May be single, multiple, or a range of codes. Depends on the entry noted in the Index

56
Q

Methods of locating codes in the CPT: (6)

A 
Service or Procedure: repair, excision
Anatomical Site: median nerve, elbow
Condition or Disease: cleft lip, clot
Synonym: toe and interphalangeal joint
Eponym: Jones procedure, Heller operation
Abbreviation: ECG, PEEP
57
Q

Used to cross-reference terms

A

“see”

58
Q

See means

A

Look here for the code

Medical Billing, Insurance, and Coding - Smith Fall 2020 (6 decks)

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