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Summer 2023- Practice Management > Unit 2-WK6- Diagnosis and Procedural Coding I and II > Flashcards

Unit 2-WK6- Diagnosis and Procedural Coding I and II Flashcards

1
Q

Why is it important for physical therapists to understand how to select the correct codes ?

A

To demonstrate medical necessity for PT

PTs are also held accountable for their coding; they can be held liable for incorrect billing.

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2
Q

ICD-10 ccodes are used to describe Medical and Physical Therapy Treatment diagnoses what is the difference ?

A

Medical Diagnosis: femur fracture, CVA
medical reason they’re seeing a PT

Physical Therapy/Treatment diagnosis: labeling of PT diagnosis for which the patient will be treated. knee pain muscle stiffness etc.

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3
Q

List the benefits of ICD-10 codes.

A

laterality ( RT v LT)
traumatic or non-traumatic injury
dominant side or non-dominant side
unilateral or b/l
cause of traumatic injury
place of occurrence
activity being performed when illness/injury occurred

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4
Q

Describe the anatomy of an ICD-10 code.

A

Category: the first 3 characters of a code, signifies diagnosis that relates to a chapter, normally used in conjunction with number to specify injury

Etiology, Anatomic site, severity: spaces 3-6, the cause anatomic site, severity, or other vital clinical details

Extension: the 7th character: episode of care

S86.011D

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5
Q

How do you determine the first ICD-10 CM code on your eval ?

A

The first code is the main reason that the patient is receiving therapy, other codes are then detailed for other conditions the patient may have

code can describe symptoms if MD has not diagnosed.

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6
Q

Explain the different 7th characters.

A

A(initial): used for the entire period in which a patient receiving active treatment for the condition

D( subsequent): after the active phase of treatment when the patient is receiving routine care for the condition during ht period of healing or recovery phase of treatment.

S( sequela): complications or conditions that arises as a direct result of the condition

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7
Q

What chapter is the 7th character REQUIRED for ?

A

CH19+15

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8
Q

Do all codes have 7th characters ?

A

no

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9
Q

What is the purpose of external clause codes ?

A

they capture how conditions occured, provide context, function as secondary codes

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10
Q

What are the different kinds of external cause codes ?

A

external cause code, place of occurence, activity, intent, individuals status

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11
Q

Is it mandatory to report external cause codes ?

A

no

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12
Q

Do external cause codes apply to all categories of diagnosis codes ?

A

no

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13
Q

Where do you document external cause codes ?

A

on initial evaluation; not principle diagnosis

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14
Q

When should “ aftercare codes” be used ?

A

first try to find the 7th character code

if there is no other way to express that patient is on the after side of an aforementioned before and after event.

code for underlying conditions

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15
Q

For conditions involving multiple sites such as OA, there often is a “ multiple sites” code available. If none is available you should:

A

list multiple codes to indicate all different sites involved.

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16
Q

Acute vs Chronic or reccurent codes are found in what chapters ?

A

19 includes: acute, traumatic problems

13: includes chronic or recurrent problems.

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17
Q

What is the difference between ICD-10 codes and CPT codes ?

A

CPT= procedure codes, interventions
ICD-10= diagnosis codes

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18
Q

When are CPT codes updated by the AMA ?

A

every jan 1st

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19
Q

In outpatient settings CPT codes are used for __________ while in inpatient settings they are used for ____________

A

billing

productivity, staffing, tracking

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20
Q

CPT codes have different values based on:

A

work expenses
practice expenses
geographical location

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21
Q

Compare and contrast service based and time based CPT codes

A

service based: untimed
bill on unit of code per discipline, per practice, per insurance
does not matter how many different body parts you treat or how long you treat.

Time based: 1 on 1 patient contact
timed in 15 minute increments= 1 unit
can bill multiple units of the same time based CPT code on same day per discipline per patient.

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22
Q

What series are the majority of CPT codes forr PT procedures found ?

A

97000 series

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23
Q

Describe what can happen if a PT bills for procedures they did not provide.

A

audits, fines, litigation, loss of license

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24
Q

Compare and contrast supervised modalities vs constant attendance modalities.

A

supervised- modality that does not require 1 on 1 patient contact ( untimed and service based )

constant attendance- modality that requiress direct 1 on1 patient contact ( time based, minute units)

25
Q

Explain what therapeutic procedures are and how the interventions for it are used.

A
  • direct patient contact; 1 on 1
  • requires the PT to maintain direct patient contact during the provision of services
26
Q

What does Therapeutic exercise include ?

A

strength
ROM
flexibility
endurance
functional limitations

27
Q

List examples of documenting skill forr therapeutic exercise.

A

” PROM flexion and extension to LT knee to prevent joint contracture, 10x10 reps in each direction, monitoring for pain w/ each repetition’

28
Q

Neuromuscular reducation is used when you are providing services to improve:

A

balance, coordination, kinesthesia, proprioception

29
Q

Gait training is defined as:

A

direct 1 on 1 contact in performance of directive exercises or activities designed to improve a patient’s ability to ambulate safely and efficiently

ambulation on level and unlevel surfaces
stair training
education of use of an assistive device
ambulating w/ prosthesis or orthosis
ambulation to decrease gait deviations
educating a caregiver on how to guard a patient during ambulation

30
Q

Therapeutic activities is defined as:

A

use of functional/dynamic activities to improve/restore functional performance in a progressive manner.

such as:

bed mobility
transfer training
car transfer
lifting and carrying
pushing and pulling
pinching and grasping
crawling and climbing
throwing and jumping
any functional activities

31
Q

Manual therapy techniques is used to:

A

decrease pain, swelling, and increase joint mobility and ROM

such as:
joint mobs
manipulation
manual lymphatic drainage
manual traction
myofascial release

32
Q

Self/care home management training is used for anything that involves:

A

anything that involves training the patient how to function in their home

such as:

ADLs
meal prep
safety procedures
personal hygiene
chores and cleaning

33
Q

When instructing a patient in an HEP should you bill the home management code ?

A

No, it would go under TherEx or NMR

34
Q

Aquatic therapy can be billed:

A

any activity performed in the water

35
Q

What must be included in the documentation when billing for aquatic therapy ?

A

why it is reasonable and necessary

i.e. why patient cannot tolerate land therapy

36
Q

Community worrk integration training is the codes used anytime you work toward:

A

re-integrating patient into community

such as:
shopping
transportation
money management
assistive tech

37
Q

Wheelchair management is used for

A

assessment, fitting, or training for a wheel chair

would include any therapy regarding a wheel chair

38
Q

Work hardening/conditioning is used to address:

A

specific, work related lifting, pulling, carrying, anything specific to occupational requirement

39
Q

Group therapy involves constant attendance but does not require one on one patient contact. The therapist is working with ____________ while providing skilled therapy.

A

2 or more patients

40
Q

Is group therapy timed or untimed code ?

A

untimed

41
Q

LT shoulder PROM into flexion, extension, adduction, and abduction, 3x10 in each direction would be coded as :

A

Therapeutic Exercise

42
Q

Standing on a wobble board without UE support, focus on ankle reactions and maintaining balance would be coded as:

A

NME

43
Q

TENS to low back, x15 minutes while therapist documents at desk would be coded as

A

unattended e-stim

44
Q

transferring in< > out of a car using a walker with CGA and cues for correct sequencing would be coded as

A

therapeutic activites

45
Q

ambulating in the hallway with a quad can x8 minutes to improve activity tolerance would be coded as

A

therapeutic exercise

46
Q

sidesteping right and left over small hurdles with 3 lbs ankle weights with focus on increasing hip flexion to clear the hurdle would be coded as

A

TherEx

47
Q

Sidestepping to right and left over small hurdles with 3 lbs ankle weights with focus on ankle reactions and increasing single leg stance would be coded as

A

NME

48
Q

PT eval codes reflect the _____, ______ and __________ of PTs in caring their patients/clients.

A

expertise, skill, and responsibility

49
Q

Are PT evals and re-evals codes timed or untimed ?

A

untimed

50
Q

The PT eval codes reflect 3 levels of patient presentation:

A

low
moderate
complex

51
Q

The components used to determine which eval code to use:

A

patient Hx
examination
clinical presentation

52
Q

Explain the low moderate and high categories for patient Hx

A

low: no personal factors or comorbidities
moderate: 1-2 personal factors or comorbidities
high: 3+ personal factors or comorbidities

53
Q

Explain the low moderate and high categories for the examination of eval codes.

A

low: 1-2 areas assessed
moderate: 3+ areas assessed
high: 4+ areas assessed

54
Q

Explain the clinical presentation low moderate and high categories:

A

low: no complicating factors
moderate: evolving condition
high: unstable condition

55
Q

Should time be used when determining eval codes ?

A

no

56
Q

Describe how you determine which eval code to bill for after completing a patient evalutation.

A

low to high in each category then choose the lowest one

57
Q

Describe the re-evaluation of an established POC CPT code.

A

an exam that includes a Hx review and use of standardized test and measures

a revised POC using a standardized patient assessment instrument.

58
Q

When is it appropriate to bill for a re-evaluation ?

A

a. improvement or decline, or change in pts condition not anticipated
b. new clinical findings during Tx
c. the patient fails to respond to Tx in POC
d. if state practice act requires it
e. treating a chronic condition

Summer 2023- Practice Management (6 decks)

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