Questions and Answers
In procedural coding, that portion of a test or procedure that the physician performs is known as the?
professional component
In procedural coding, that portion of a test or procedure pertaining to the use of the equipment is known as the?
technical component
A single procedural code that describes or covers two or more CPT component codes that are bundled together as one unit is known as a?
comprehensive code
When coding surgical procedures, a term that refers to both sides of the body is?
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In procedural coding, one fee applied to a procedure code that includes other services is referred to as a?
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A reference book established by the American Medical Association for identifying procedures/services using a coding system is called?
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When using relative value studies, the established dollar amount for one unit applied to a procedure is referred to as a?
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A list of procedure codes for professional services that indicate the value of one procedure over another is called?
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A Medicare policy relating to surgical procedures that includes services in one fee is termed the?
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In procedural coding, a two-digit add-on number after the usual procedure code to indicate alteration is called a?
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In CPT, a new code shown in a current edition is indicated by a?
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A national uniform coding structure for reporting physician/supplier services under Medicare is known as?
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CPT codes created for billing new and emerging technology procedures are called?
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An organized facility that provides unscheduled medical services to patients needing immediate attention is called a/an?
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When billing a medical service, the counseling or coordination of care must be more than?
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The proper documentation in the patient's health record when medication is given is to list the?
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Treatment by administering an agent that interferes with the body's immune system is known as?
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Charge considered fair and equitable after peer review is known as a?
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Method used by insurance companies to establish their fee schedules is?
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List of charges or established allowances for specific medical services is called a?
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Amount that a physician usually charges most of his or her patients is known as?
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Using numerous procedure codes to identify procedures normally covered by a single code is called?
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Occurs when the coding system used by the physician's office does not match the coding system used by the insurance company is known as?
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To group more than one component into one CPT code is to use?
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Deliberate manipulation of procedure codes for increased payment is called?
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If a patient is seen in the emergency department and is subsequently admitted to the hospital, it is billed as an emergency visit when done on the same date as the admission.
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If a complex surgical procedure is billed, it is unnecessary to include a copy of the operative report.
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CPT code 99024 may be listed on an itemized billing statement to let the patient know that after-surgery office visits have been provided at no charge.
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When billing for prolonged service, time must be documented in the health record.
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When there is a choice between two or three somewhat similar codes, the third-party payer's claims examiner will choose the highest paying code.
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You cannot bill two E/M codes in a day.
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What is the wait time for minor and major Medicare procedures?
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When a code isn't listed in CPT, what code do you use?
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What are code levels 1-5?
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The term 'global' in procedural coding refers to?
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What type of procedure pays better?
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CPT code 99024 indicates what charge?
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Level 2 HCPCS codes pertain to which professionals?
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Modifier -22 refers to?
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Modifier -25 indicates?
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Modifier -26 refers to?
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Modifier -50 indicates?
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Modifier -51 refers to?
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Modifier -52 indicates?
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Modifier -57 refers to?
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Modifier -58 refers to?
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TC stands for?
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Add-on codes need to have parent codes.
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You cannot bill if you do not document.
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A 'never event' refers to what type of surgical procedure?
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Study Notes
Procedural Coding Key Concepts
- Professional Component: Refers to the physician's interpretation or performance of a test, such as interpreting an ECG or X-ray.
- Technical Component: Relates to the equipment used and the operator performing procedures, like a radiography machine or technician's work.
- Comprehensive Code: A single procedural code that encompasses multiple bundled CPT component codes.
- Bilateral Procedures: Coding term indicating procedures that involve both sides of the body in surgical contexts.
- Surgical Package: A singular fee applied to a procedure including the operation, anesthesia, and uncomplicated postoperative care.
Coding Systems and Terminology
- CPT (Current Procedural Terminology): A five-digit coding system developed by the American Medical Association for procedures/services identification.
- Conversion Factor: Monetary value for one unit of service that helps transform procedures into fee structures.
- RVS (Relative Value Studies): A system that assigns unit values to procedure codes for comparison of value between services.
- Global Surgery Policy: Medicare's policy that includes preoperative, intraoperative, and postoperative services in one fee for surgical procedures.
- Modifier: A two-digit code appended to a primary procedure code indicating any modifications due to specific circumstances.
CPT Code Indicators and Categories
- Bullet Symbol: Used in CPT to indicate new codes in the current edition.
- HCPCS (Healthcare Common Procedure Coding System): A national coding system developed for reporting physician/supplier services under Medicare.
- Category III Codes: CPT codes specifically for billing new and emerging technology procedures.
Billing and Documentation Practices
- Emergency Department: A dedicated hospital facility for providing immediate medical attention to patients.
- Time Billing Rule: To bill a medical service based on time, at least 50% of the visit must involve counseling or care coordination.
- Medication Documentation: Required to include name, amount, strength, and route of administration for accuracy in patient records.
Fees and Payment Structures
- Reasonable Fee: A charge considered fair upon peer review, even if it does not meet usual or customary criteria.
- Usual, Customary, and Reasonable: A method insurances use to establish fee schedules for medical services.
- Fee Schedule: Pre-established allowances for specific medical services and procedures.
- Customary Fee: The standard charge a physician usually bills most patients.
Coding Practices and Ethics
- Unbundling: Using multiple procedure codes for services that could typically be covered by a single comprehensive code.
- Downcoding: Occurs when the coding system used by a physician does not match the payer's system leading to reduced payment.
- Bundled Codes: Grouping multiple components into a single CPT code.
- Upcoding: Deliberate manipulation of codes to increase payment amount.
Additional Insights
- Emergency Visit Billing: If a patient is admitted to a hospital on the same day as an emergency department visit, the visit is billed as an emergency.
- Operative Report Requirement: Complex surgical procedures require accompanying operative reports for billing.
- Prolonged Service Documentation: Must be documented in the health record when billing for extended services.
- Modifiers: Various modifiers indicate specific circumstances related to procedures, e.g. modifier -22 for increased services or -50 for bilateral procedures.
- Never Event: A surgical error where a procedure is performed on the wrong side or body part, deemed unacceptable in medical practice.
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Description
Test your understanding of procedural coding key concepts, emphasizing the distinctions between professional and technical components, as well as comprehensive coding and surgical packages. This quiz also covers essential coding terminology such as CPT and conversion factors.
