20 Questions
What is the purpose of 'Global Period or Package' codes in medical billing?
To combine services that occur over a period of time into one 'package'
What types of codes are used for diagnostic purposes, and goes with the diagnosis in the assessment section of the note?
ICD-10
What is the common procedural coding system?
HCPCS
What codes includes evaluation and management (E&M), surgical procedures, and other services? This code describes what you did for the patient!
CPT
What is the benefit of ICD-10 over ICD-9?
ALL of the above
You need to use ICD-10 codes for each differential diagnosis.
False
HCPCS codes are 5 digit codes that are specific to supplies.
True
What are CPT codes billing dependent on?
A OR B
E&M Codes for Annual exams are based on:
A and B
How is the level of service provided determined?
Medical decision making or total time
What is NOT a major reason that the 2011 change from ROS based service coding to medical decision making and time service coding has been a good change?
More focus on documentation and using specific words in notes to allow for increased billing
Billing based on TOTAL TIME. Total time the healthcare provider spent on that patient on the day of the encounter. What counts?
Reviewing the pt’s chart before visit = Included Discussing pt’s care with other healthcare professionals or family = Included Ordering meds, diagnostics, procedures or referrals = Included Time spent performing a procedure during the same visit = NOT included
Billing based on TOTAL TIME. Total time the healthcare provider spent on that patient on the day of the encounter. What counts?
Face-to-face time during visit (not including time with MA or nurse) = Included Charting = Included Ordering meds, diagnostics, procedures or referrals = Included Time spent on anything not occurring on the day of the encounter = NOT included
When it comes to medical billing based on medical decision making, level of service is based on the highest level met by at least two of the three elements. What is NOT one of the three elements?
Amount of time spent face to face with the patient
A patient suffered from a fracture of his leg and needs casting. It will require lots of supplies to do this. What can be used to code multiple CPT codes to include the subordinate procedures and the supplies necessary to complete a procedure/visit?
Bundling
A patient presents for a possible bacterial vaginosis. At the visit the patient decided they also want a Nexplanon. These are two separate visit reasons that are completed in one visit. What should you use to justify “bundling” of these two unrelated items?
Modifiers
Under CMS rules, PA get ___% of the fully reimbursable amount. (answer with number only)
85
There are a number of conditions that must be met to be able to bill in "incident to" in order to get complete reimbursement. What is NOT one of those conditions?
PA must be the primary care provider for the patient and evaluate the patient on the primary visit
HCPCS codes are used to report supplies, equipment, and services not covered by CPT codes, including durable medical equipment (DME), prosthetics, orthotics, and certain outpatient services.
True
ICD-10 codes are patient centered and CPT codes are provider centered
True
Study Notes
Accreditation Standards for Physician Assistants
- The Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) sets accreditation standards for physician assistant programs
- Section B: Curriculum and Instruction, Subsection B2: Didactic Instruction, states that the curriculum must include instruction on the business of healthcare, including coding and billing, documentation of care, healthcare delivery systems, and health policy
Objectives for Medical Coding and Billing
- Discuss reimbursement by Medicare for services rendered by a physician assistant (PA)
- Compare and contrast ICD-10, CPT, and HCPCS in terms of documentation for coding and billing
- Understand the key components of E/M coding, including Medical Decision Making (MDM) and complexity of the visit
- Identify the two ways a medical provider may bill for services: by complexity and by time
- Describe "Incident To" billing and when it may be utilized
Types of Codes
- ICD-10 codes: diagnosis codes, used for international classification of diseases
- HCPCS codes: service codes, used for healthcare financing agency's common procedural coding system
- CPT codes: service codes, published and owned by the American Medical Association (AMA)
ICD-10 Codes
- International Classification of Diseases, 10th Revision (ICD-10)
- Created in 1893 as a way to collect epidemiologic data
- Adopted in the US in 1898, owned by the World Health Organization (WHO) as of 1948
- 10th revision endorsed by the World Health Assembly in 1990, implemented in the US in October 2015
- Benefits of ICD-10 over ICD-9 include:
- More specific and detailed codes
- Classified by body part/system instead of condition
- More specific and detailed codes for related medical conditions, causes, and location of condition/injury
- ICD-10 code structure:
- 3-7 characters, with the first character being alpha, and characters 2-7 being alpha or numeric
- Specifies R vs. L, initial vs. subsequent encounter, and complexities
HCPCS Codes
- Health Care Financing Agency's Common Procedural Coding System (HCPCS) codes
- Used for supplies and other services
- Examples: Nexplanon (J7307), Depo Provera (J1050), Crutches (E0114), Compression stockings (A6501-A6550)
CPT Codes
- Current Procedural Terminology (CPT) codes
- Published and owned by the American Medical Association (AMA)
- Used for evaluation and management (E&M) codes, surgical procedures, and other services
- Examples:
- New patient 99202, established patient 99212
- Annual preventive exam: 99381
- ICD-10 code selection affects billing code selection
Evaluation and Management (E&M) Codes
- Describe what the provider did for the patient
- Codes range from 00100 to 99607
- Type of code depends on setting (outpatient office, inpatient hospital, nursing home, emergency department, etc.)
- Billable visit level of service decided by total time or complexity
Modifiers and Bundling
- Modifiers:
- 24: unrelated E&M service during a postoperative period
- 25: significant, separately identifiable service by the same provider on the same day of the procedure or other service
- Bundling: billing of multiple CPT codes to include subordinate procedures and supplies necessary to complete a procedure or "visit"
- Examples:
- I&D procedure with casting (bill for materials used)
- Fracture patient that needs casting (supplies for casting)
Global Period/Package
- Billing of services that occur over a period of time as one “package” instead of billing visits/services individually
- Examples:
- Prenatal care with multiple visits
- Post-operative visits for I&D or pregnancy
This quiz covers instruction on the business of healthcare, including coding and billing, documentation of care, health care delivery systems, as per ARC-PA accreditation standards. It is relevant for students in Ashley Nordan's PA Program Spring 2024.
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