Final Exam Flashcards
(36 cards)
Established patient exam, expanded history, expanded exam, and straightforward clinical decision making.
-What is the correct CPT code?
99213
What is fraud and abuse?
Fraud = intentional misrepresentation or deception
Abuse = unintentional mismanagement
What is the correct order of coding for a subluxation for medicare?
1st code is subluxation, 2nd code is chief complaint (then follow hierachy)
Ex: M99.01, M54.2
Who is eligible for medicare?
1) 65 or older
2) On disability, at an age and received social security benefits for at least 2 years
3) People with end stage renal disease or ALS
T/F Abuse is worse than fraud and can include jail time.
FALSE.
-Fraud is intentional deception where abuse is unintentional, so fraud is worse
What medicare parts can cover chiropractic care?
Usually Medicare Part B and/or Part C (A = Hospital, D = Prescriptions)
What must a DC have to do to enroll in Medicare?
- Need National Provider Identifier (NPI)
- Use PECOS online system to enroll
(need revalidation every 5 years)
What X-ray modifers can be utilized?
- GX,GY = Medicare, service is definetly not covered
- 26 = Wrote report, but did not take films
- TC = took films but did not write report
- 25 = Duplicate code for services
T/F Medicard fraud is a state offense
FALSE
-Medicard fraud is a federal offense
You see a patient and adjust T5, T12, L5, Right SI joint, and Coccyx.
-Which codes and CPT do you use?
- M99.02, M99.03, M99.05, M99.04
- 98941
What should be included in a treatment plan?
-Frequency, number of visits, OATs, start/end dates, what procedures will be used, short term and long term goals, prognosis, and relative and absoulte contraindications.
What is the hierarchy of ICD-10 and why?
AAA.BBBC (Ex: S93.401A)
AAA = General location and general condition
BBB = Specific location and specific condition (including laterality)
C = Type of encounter (initial, subsequent, sequale)
What is the hierarchy code once we know all the ICD 10 codes?
- Neurological (Sciatica)
- Structural (Scoliosis)
- Functional (Subluxation)
- Soft tissue/other (Sprain)
What is the “nurses code”?
99211
How many key components have to be met for a new patient?
-Established patient?
New = 3/3
-Established = 2/3
What must you ask a patient who has been in an accident?
- Where the police called?
- Was a report filed?
- Do you have an attorney?
Etc.
What information is needed for a work comp case?
- Name of employer
- Name of work comp carrier
- Was a report filed?
- Did injury happen “on the job”
What information is needed for a bodily injury case?
- Name of patient insurance
- Name of person involved in injury (other than patient)
- Insurances involved or attorney contacted
When would you file a health care lien?
Personal injury or motor vehicle collision occurence
What is expected in a “cash practice”?
The same standard of care as if a patient had insurance
- Document the same
- DC gives a patient a “super bill” so that the patient can bill the insurance company on his own (NonPAR)
- Medicare = still have to bill on behalf on the patient (CAN NOT give super bill
What is the statue of limitations?
Amount of time from the date of the injury/accident in which the injured has to file a lawsuit
What 3 things have we learned about a cash practice?
1) Not possible to legally have a total cash practice if we take any Medicare patients
2) Still have to prepare insurance billing to give to patient per state law (you just might not have to submit claims) EXCEPTION: Medicare
3) Your documentation should be just as thorough if your patient is paying cash or if he is insurance or going to trial for bodily injury case
What is the worst type of audit and why?
External audit
-Someone outside your practice is going through and reviewing all your records for medical neccessity.
What does unbundling mean?
Utilizing multiple CPT codes in place of a single CPT code that would cover all the components provided to the patient
Ex: Adjusting 4 regions on a patient:
-Code 98942 and NOT 98940 4 times
