Steps for CPT

Question 1

What organization handles CPT use?

Answer 1

The American Medical Association

Question 2

What are the steps for CPT use?

Answer 2

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

Question 3

How many categories are in the CPT codes?

Answer 3

Three

Question 4

What are category I codes?

Answer 4

Holds all procedures

Question 5

What are category II codes?

Answer 5

Track use track performance mesasure for medical goals; codes are optional not paid by carriers.

Question 6

Which category houses temporary codes?

Answer 6

Category III

Question 7

Who updates the CPT codes?

Answer 7

American Medical Association

Question 8

What sections are in category I?

Answer 8

1. Evaluation and Management
2. Anestheisa
3. Surgery
4. Radiology
5. Pathology and Laboratory
6. Medicine

Question 9

When will we use special reports?

Answer 9

When guidelines suggest an unlisted procedure or service code.

Question 10

What does a bullet mean near a CPT code?

Answer 10

The new procedure was added. Appears next to the code only in the year that was added.

Question 11

What does a triangle mean near a CPT code?

Answer 11

The code was changed. Appears only in the year the code was revised.

Question 12

Facing triangles mean?

Answer 12

Used when new or revised text other than the code’s descriptor.

Question 13

When are vaccine codes released?

Answer 13

Every 6 months on the AMA website.

Question 14

How are descriptors entered?

Answer 14

Semicolon and indention

Question 15

What does this mean (For bile pigments, urine, see 81000- 81005)

Answer 15

Cross Reference

Question 16

What does a bullet mean next to a CPT?

Answer 16

New procedure code.

Question 17

What does a plus sign mean next to the main text code?

Answer 17

Add-on code

Question 18

What does the triangle mean?

Answer 18

The code descriptor has changed.

Question 19

What are facing triangles?

Answer 19

They enclose the new or revised text other than the code’s descriptor.

Question 20

What do add-one codes describe?

Answer 20

Secondary procedures that are carried out in addition to a primary procedure

Question 21

What is a primary procedure?

Answer 21

CPT procedure during an encounter

Question 22

What does the lightning bolt mean?

Answer 22

Used with vaccine codes

Question 23

True or False: Anesthesia had its own CPT codes and section?

Answer 23

True

Question 24

How are anesthesia services reported?

Answer 24

Only report the services performed or supervised by a physician

Question 25

Additionally to standard modifiers what other codes are added to anesthesia codes?

Answer 25

a physical status modifier that indicates a patient’s health status

Question 26

How many add-on codes can be added for the administration of anesthesia?

Answer 26

4

Question 27

True or False: Anesthesia add-on codes can stand alone?

Answer 27

False; Add-on codes always appear in addition to the primary anesthesia procedure code.

Question 28

True or False: Do surgery codes include E/M, anesthetic, and postoperative care under one code?

Answer 28

False; A complete procedure includes the operation, the use of local anesthetic, and pose operative care.

Question 29

What is a single surgery code called?

Answer 29

Surgical package

Question 30

What two services are not included in a surgical package?

Answer 30

Complications or recurrences and diagnostic surgical procedures for a condition.

Question 31

True or False: Government and private payers do not reimburse all surgical package codes?

Answer 31

False; They are assigned a fee to a surgical package code that then reimburses all the services provided under it.

Question 32

What are the time frames for the global period?

Answer 32

0-90 days

Question 33

True or False: Should separate procedures be reported separately?

Answer 33

True

Question 34

What is a separate procedure?

Answer 34

The procedure is a necessary part of a surgical package

Question 35

What is the principal procedure code?

Answer 35

Inpatient medical code that is assigned to a related treatment of the principal diagnosis.

Question 36

What code is listed first under hospital coding?

Answer 36

Principal diagnosis (PDX)

Question 37

What is the admitting diagnosis?

Answer 37

This is the condition identified by the doctor at admission to the hospital

Question 38

What agency rules must be followed for the hospital to be reimbursed?

Answer 38

Uniform Hospital Discharge Data Set (UHDDS)

Question 39

What initials are next to the patient medical record for complications and/or comorbidities?

Answer 39

CC

Question 40

What are the three major steps in the patient’s hospital stay?

Answer 40

Admission, Treatment, and Discharge

Question 41

How many days does Medicare pay for a hospital stay?

Answer 41

90 days per benefit period and additional sixty days of coverage with a high coinsurance.

Question 42

How are observation services billed?

Answer 42

Outpatient service is charged by the hour rather than per a day charge.

Question 43

What would cause a Medical claim to deny?

Answer 43

Experimental treatments and medication are not covered by Medicare

Question 44

What is an exception to the HIPPA Privacy Rule?

Answer 44

Psychotherapy notes are treated differently from other mental health information both because they contain particularly sensitive info and they are the personal notes of the therapist. Therefore, the privacy rule requires a covered entity to obtain a patient’s authorization prior to a disclosure of psychotherapy notes.