Final Part 1

Question 1

EOB

Answer 1

Explanation of benefits: Comes with all reponses. Will explain how to contest a denial

Question 2

ICD

Answer 2

International Classification of Diseases

No $

Question 3

CPT

Answer 3

Current Procedural Terminology (1/1/05)
E and M plus P and M
Evaluation/Management
Procedures (acu) and Modalities (other)
\$\$$
99 = office time

Question 4

Modifier

Answer 4

• 25 for E and M code

- 50 for CPT code

Question 5

6 min rule

Answer 5

E and M’s 6 min of evaluation of total 15 min

Question 6

Physical Medicine Codes

Answer 6

CPT codes used by other practitioners

require modifier

Question 7

HICF

Answer 7

Health Insurance Claim Form

Question 8

Carrier Block

Answer 8

HICF upper right margin where you put insurance company’s address

Question 9

Key for insurance taking practice

Answer 9

Verify patient’s coverage

Question 10

2 types of major medical

Answer 10

covered: normal; copay and reimbursement
discount: have to give in network discount

Question 11

4 Key ICD’s

Answer 11

Neck M54.2
Shoulder M25.519
LBP M54.5
Knee M25.569

Question 12

E and M code

Answer 12

99203 and 99213
Moderate severity
30 minutes
CPT

Question 13

Intitial E and M

Answer 13

99203
(Time spent)
History
Focused Eval
Decision Making

Question 14

Second E and M

Answer 14

99213
(Time spent)
Focused Eval
Decision Making

Question 15

4 CPT Procedure Codes

Answer 15

97810 and 97811

97813 and 97814

Question 16

CPT Modalities

Answer 16

97140 - tuina
97010 - heat lamp
97016 - cupping (vasopneumatic)

Question 17

4 Types of Insurance

Answer 17

Major Med
Workers Comp
No Fault
Medicare

Question 18

2 Top Audit Checks

Answer 18

License Visible

Locked patient Files

Question 19

Reasons for report writing

Answer 19

Legal/lawsuits
Insurance
Communication between providers

Question 20

4 Types of Reports

Answer 20

Initial
Follow Up
IME
Peer Review