Podcast
Questions and Answers
What does the fifth digit of the ICD-10 code H35.3131 specify?
What does the fifth digit of the ICD-10 code H35.3131 specify?
What defines a patient as an established patient in the context of ophthalmological services?
What defines a patient as an established patient in the context of ophthalmological services?
What is the primary purpose of coding using ICD-10 codes?
What is the primary purpose of coding using ICD-10 codes?
Which of the following is the correct code for an intermediate examination of a new patient?
Which of the following is the correct code for an intermediate examination of a new patient?
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Which of the following correctly describes bilateral laterality in ICD-10?
Which of the following correctly describes bilateral laterality in ICD-10?
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What happens if a patient was seen for a minor complaint less than three years ago?
What happens if a patient was seen for a minor complaint less than three years ago?
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What is crucial for providing medical services and securing payment?
What is crucial for providing medical services and securing payment?
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For billing purposes, if a patient was seen by a different doctor within the same practice two years ago, how are they classified?
For billing purposes, if a patient was seen by a different doctor within the same practice two years ago, how are they classified?
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If a patient returns after four years for a comprehensive exam, how are they classified?
If a patient returns after four years for a comprehensive exam, how are they classified?
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Which code would appropriately support the need for retinal photos?
Which code would appropriately support the need for retinal photos?
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What do S codes provide in the context of eye exams?
What do S codes provide in the context of eye exams?
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Which code is used for comprehensive examination and evaluation of an established patient?
Which code is used for comprehensive examination and evaluation of an established patient?
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Which of the following statements about S codes is NOT true?
Which of the following statements about S codes is NOT true?
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How does the Medical Decision Making (MDM) for a 63-year-old patient with cataracts differ from that of a 21-year-old myope?
How does the Medical Decision Making (MDM) for a 63-year-old patient with cataracts differ from that of a 21-year-old myope?
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What do S codes allow doctors to do with regard to billing for routine eye exams?
What do S codes allow doctors to do with regard to billing for routine eye exams?
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Which condition would support the code for dilation of lacrimal punctum (68801)?
Which condition would support the code for dilation of lacrimal punctum (68801)?
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What should be done when entering new or changed information after the original date of service?
What should be done when entering new or changed information after the original date of service?
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What is the correct method for amending a paper medical record?
What is the correct method for amending a paper medical record?
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How should original content in a record be treated when an amendment is made?
How should original content in a record be treated when an amendment is made?
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What is necessary to do when co-directing a paper medical record?
What is necessary to do when co-directing a paper medical record?
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What does CMS encourage regarding the documentation of entries during a service?
What does CMS encourage regarding the documentation of entries during a service?
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What should electronic records provide when modifications are made?
What should electronic records provide when modifications are made?
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What action is discouraged when making corrections or addenda to a medical record?
What action is discouraged when making corrections or addenda to a medical record?
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What should a provider primarily focus on during a patient examination?
What should a provider primarily focus on during a patient examination?
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What is the purpose of the Narrative of Present Illness (NPI)?
What is the purpose of the Narrative of Present Illness (NPI)?
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Which of the following is NOT a component of the NPI checklist?
Which of the following is NOT a component of the NPI checklist?
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What should be documented about the duration of the problem according to the NPI checklist?
What should be documented about the duration of the problem according to the NPI checklist?
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Why might a patient express a need for new glasses?
Why might a patient express a need for new glasses?
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Which factor can influence the symptoms experienced by the patient?
Which factor can influence the symptoms experienced by the patient?
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In the context of patient evaluations, what does 'context' refer to?
In the context of patient evaluations, what does 'context' refer to?
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Which statement best describes the chief complaint in a patient assessment?
Which statement best describes the chief complaint in a patient assessment?
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What is a primary benefit of submitting claims through a clearinghouse?
What is a primary benefit of submitting claims through a clearinghouse?
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Which method of claim submission is typically the least efficient?
Which method of claim submission is typically the least efficient?
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Why might an office choose to submit claims through a clearinghouse?
Why might an office choose to submit claims through a clearinghouse?
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What type of information is NOT typically required when submitting a claim?
What type of information is NOT typically required when submitting a claim?
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In what situation would a provider likely submit claims manually?
In what situation would a provider likely submit claims manually?
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Which statement accurately describes Availity?
Which statement accurately describes Availity?
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What is essential to have before submitting a claim?
What is essential to have before submitting a claim?
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What is one of the key benefits of submitting claims through a clearinghouse?
What is one of the key benefits of submitting claims through a clearinghouse?
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Which scenario typically necessitates manual claim submission?
Which scenario typically necessitates manual claim submission?
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What demographic data is necessary to submit a claim?
What demographic data is necessary to submit a claim?
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How does using a direct provider portal for claims submission benefit healthcare providers?
How does using a direct provider portal for claims submission benefit healthcare providers?
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What information is typically NOT needed during claim submission?
What information is typically NOT needed during claim submission?
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Why is scanning or copying the patient's insurance card important before submitting a claim?
Why is scanning or copying the patient's insurance card important before submitting a claim?
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Study Notes
Patient Perception and Complaints
- Chief complaints like "trouble walking" or "leg pain" need thorough evaluation beyond patient perception.
- Patient's belief that new glasses will solve vision issues indicates underlying conditions like myopia or AMD.
- Focus on the actual symptoms (e.g., blurred vision or headaches) rather than patient assumptions.
Narrative of Present Illness (NPI)
- NPI is a chronological account of the patient's illness from initial symptoms to current status, guiding treatment decisions.
- Documentation can be done by both doctors and technicians.
- Important NPI Checklist components:
- Location of the problem (unilateral or bilateral eyes).
- Duration of the issue.
- Contextual factors (associated activities).
- Modifying factors (conditions that alleviate or worsen symptoms).
- Quality of the problem nature.
Amending Medical Records
- CMS recommends documenting all relevant entries at the time of service; amendments should clearly indicate changes made post-visit.
- Original entries must remain intact, marked with a single strike through in paper records and tracked in electronic records.
- Correctly document the date and author of amendments.
ICD-10 Coding and Diagnosis
- Use specific ICD-10 codes for accurate billing purposes; organized by body system, laterality, and severity.
- Example ICD-10 Codes:
- H52.223 for bilateral regular astigmatism.
- H35.3131 for early dry stage, nonexudative age-related macular degeneration.
- Importance of avoiding unspecified laterality codes for clarity.
Types of Patients in Billing
- New Patients: Never seen in the practice or not seen for over three years.
- Established Patients: Seen by any practitioner in the practice within the last three years.
Ophthalmological Exam Codes
- Primary codes for ophthalmological exams include:
- 92002: Intermediate medical examination for new patients.
- 92004: Comprehensive examination for new patients.
- 92012: Intermediate examination for established patients.
- 92014: Comprehensive examination for established patients.
Medical Necessity in Documentation
- Document services with clear medical necessity for payment approval.
- Ensure test justifications align with documented diagnoses to avoid billing issues.
S-Codes for Routine Exams
- S-Codes enable billing for routine eye exams with lower complexity, used when medical necessity is not established.
- Provide a structured alternative for routine wellness care, differing from more complex codes.
- Ensure compliance with state standard care guidelines despite confusions with similar procedures for varying patient needs.
Claims Submission Process
- Collect patient's demographic data and insurance details from intake paperwork.
- Copy or scan the front and back of the insurance card for policy and contact information.
- Consider scanning or copying IDs of patients or their legal guardians for verification.
Submission Methods
-
Directly through Insurer Portals:
- Utilize online provider portals for submitting claims, which is the fastest method.
- Access eligibility information before submission to ensure accurate claims.
- Example: Availity.com serves as a third-party portal for many insurers.
-
Indirectly through Clearinghouses:
- Use if insurers lack a straightforward portal or if their portal is complex.
- Clearinghouses act as intermediaries between the office and insurance companies.
- Benefits include:
- Claim scrubbing to check for coding errors.
- Batched submission of prepared claims.
- Electronic information exchange with insurers.
- Management of claim rejections or denials.
-
Manual Submission:
- Offered as an option only when no direct portal or clearinghouse is available.
- Requires filling out a claim form and submitting it via fax or postal mail.
- This method is less efficient, likened to outdated practices.
Claims Submission Process
- Collect patient's demographic data and insurance details from intake paperwork.
- Copy or scan the front and back of the insurance card for policy and contact information.
- Consider scanning or copying IDs of patients or their legal guardians for verification.
Submission Methods
-
Directly through Insurer Portals:
- Utilize online provider portals for submitting claims, which is the fastest method.
- Access eligibility information before submission to ensure accurate claims.
- Example: Availity.com serves as a third-party portal for many insurers.
-
Indirectly through Clearinghouses:
- Use if insurers lack a straightforward portal or if their portal is complex.
- Clearinghouses act as intermediaries between the office and insurance companies.
- Benefits include:
- Claim scrubbing to check for coding errors.
- Batched submission of prepared claims.
- Electronic information exchange with insurers.
- Management of claim rejections or denials.
-
Manual Submission:
- Offered as an option only when no direct portal or clearinghouse is available.
- Requires filling out a claim form and submitting it via fax or postal mail.
- This method is less efficient, likened to outdated practices.
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Description
This quiz focuses on analyzing patient complaints, specifically their perceived solutions to chief complaints such as trouble walking or visual issues. Understanding the actual experiences behind these complaints is crucial for effective evaluation and diagnosis. Explore how to accurately interpret patient statements in a clinical context.