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CPT Coding: Beyond the Basics AANP NATIONAL CONFERENCE 2010 Barb Pierce, CCS-P, ACS-EM Barb Pierce Coding and Consulting, LLC

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Presentation on theme: "CPT Coding: Beyond the Basics AANP NATIONAL CONFERENCE 2010 Barb Pierce, CCS-P, ACS-EM Barb Pierce Coding and Consulting, LLC"— Presentation transcript:

1 CPT Coding: Beyond the Basics AANP NATIONAL CONFERENCE 2010 Barb Pierce, CCS-P, ACS-EM Barb Pierce Coding and Consulting, LLC

2 Barb Pierce, CCS-P, ACS-EM2 Objectives Review the overall billing process, including CPT, HCPCS, and ICD-9 coding systems 30 minutes Review the codes used on a daily basis 90 minutes Review surgical coding, proper use of modifiers and other coding concepts 60 minutes

3 Barb Pierce, CCS-P, ACS-EM3 Outline E/M codes Office, hospital, consultations, preventive medicine Injections and immunizations Lacerations, lesions and other minor surgical procedures Modifiers ICD-9 coding and linking Coding for compliance

4 Barb Pierce, CCS-P, ACS-EM4 The codes CPT Main coding system that describes what was done HCPCS Further specification of some CPT codes, including supplies ICD-9 Describe why the service was performed, diagnostic statement

5 Barb Pierce, CCS-P, ACS-EM5 Billing the codes The “what” and the “why” need to be linked and must meet medical necessity The encounter form (superbill) needs match the information in the medical record

6 Barb Pierce, CCS-P, ACS-EM6 Billing for the Provider Billing rules for the Nurse Practitioner Own number Incident to Medicare versus everybody else Split/shared visits Consultations

7 Barb Pierce, CCS-P, ACS-EM7 E/M Coding New vs. established and initial vs. subsequent What is a new patient? Determined by site of service Follow the HCFA/AMA Documentation Guidelines to choose the level

8 Barb Pierce, CCS-P, ACS-EM8 New vs. Est Patients Per CPT: Solely for purposes of distinguishing between new and established patients, professional services are those face-to-face services rendered by a physician and reported by a specific CPT code(s). Cardiologist read an EKG on a patient a year ago without a face-to-face visit. NP in same group sees the patient on 1/15/10. New patient

9 Barb Pierce, CCS-P, ACS-EM9 New vs. Est Patient Per CPT: A new patient is one who has not received any professional services from the physician or another physician of the same specialty who belongs to the same group practice, within the past three years. Dr. FP1 saw the patient for bronchitis six months ago. NP is now seeing the patient for abdominal pain. Established patient to Dr. FP2 Dr. Heart (general cardiology) saw the patient for HTN six months ago. Now the patient is seeing Dr. Vessel (interventional cardiology) for coronary artery blockage six months later. Established patient to Dr. Vessel

10 Barb Pierce, CCS-P, ACS-EM10 New vs. Est Patient Watch for specialty designations, as recognized by Medicare Example on previous slide, no different specialty designation for Dr. Heart and Dr. Vessel Dr. Podiatry and Dr. Back in the same Ortho group. These are recognized as different specialties according to Medicare. So, if Dr. Podiatry saw the patient within the past 3 years and now Dr. Back is seeing the patient, Dr. Back could bill a new patient visit.

11 Barb Pierce, CCS-P, ACS-EM11 E/M Section Key components History Examination Medical Decision Making Some require 3/3 Some require 2/3 Coding by time instead

12 Barb Pierce, CCS-P, ACS-EM12 Office/Other outpatient services 99201-99215 Codes don’t crosswalk, i.e... 99213 compared to 99203 Office and where else? 99211 … be careful Hints for construction of encounter form

13 Barb Pierce, CCS-P, ACS-EM13 Consultations 2010 … CPT A consultation is a type of evaluation and management service provided by a physician at the request of another physician or appropriate source to either recommend care for a specific condition or problem or to determine whether to accept responsibility for ongoing management of the patient’s entire care or for the care of a specific condition or problem The written or verbal request for consult may be made by a physician or other appropriate source and documented in the patient’s medical record by either the consulting or requesting physician or appropriate source. The consultant’s opinion and any services that were ordered or performed must be documented in the patient’s medical record and communicated by written report to the requesting physician or other appropriate source. Still cautioned about transfer of care Billing for consultations based on new wording “on the unit”

14 Barb Pierce Coding and Consulting, LLC14 Consultations 2010 … Medicare Medicare has decided not to pay for consultations starting in 2010. Instead the RVU’s have been reallocated and increased for the other visit codes. Office, use new or established patient visit codes (3 yr rule will apply) Hospital and Nursing Facility, use admission codes Office: Codes formerly used for consultation services 99241 – 99245 crosswalk exactly with documentation requirements of 99201 – 99205. If patient seen in last 3 years by physician of same group of same specialty, then use 99212 – 99215. Hospital and Nursing Facility: Codes formerly used for consultation services 99251 – 99255 do not crosswalk with admission codes (5 levels of consults versus 3 levels of admissions)

15 Barb Pierce, CCS-P, ACS-EM15 Observation codes Based on patient status Admit to OBS 99218-99220 Discharge from OBS 99217 What if patient is held in OBS for 3 calendar days? Admit and discharge from OBS same date 99234-99236

16 Barb Pierce, CCS-P, ACS-EM16 Medicare Coding for OBS patients Consultations for patients in OBS status The ordering physician for the OBS status will use the OBS admission codes 99218 – 99220 The “specialist” will use the outpatient visit codes 99201 – 99215 Three year rule will apply

17 Barb Pierce, CCS-P, ACS-EM17 Inpatient Services Admission 99221 - 99223 H/E/MDM similar to 3,4,5 new patient/consult codes admission from the office…bill the office visit or the initial hospital care? daily visits without an initial hospital code first Admit/discharge same date: 99234-99236

18 Barb Pierce, CCS-P, ACS-EM18 Inpatient Admissions 99221 requires Detailed history and Detailed exam and Straightforward medical decision making 99222 requires Comprehensive history and Comprehensive exam and Moderate medical decision making 99223 requires Comprehensive history and Comprehensive exam and High medical decision making

19 Barb Pierce, CCS-P, ACS-EM19 Hospital Admissions No three-year rule For Medicare, the admission code will be billed by the “physician-formerly-known-as-a-consultant” per hospital admission. Multiple physicians may be billing the 99221 – 99223 on the same patient. Admitting physician of record will use modifier -AI. Oncologist saw the Medicare patient during an admission six weeks ago. The patient is admitted again, the oncologist is “consulted” again (for the same or a different problem). Oncologist bills 99221-99223.

20 Barb Pierce, CCS-P, ACS-EM20 Inpatient Admissions CPT’s intent of 99221 – 99223: Report the first hospital inpatient encounter Not necessarily the date of admission Not used if patient seen subsequently that date and discharged New for 2010, these are the codes recognized by Medicare for all physicians seeing the patient for the first time during a hospital stay Used in place of consultation codes If documentation is less than documentation requirements for 99221, use the unlisted code 99499 or subsequent hospital visit code 99231 – 99233. Admitting physician of record will use modifier -AI Diagnosis coding issues … medical necessity will prevail

21 Barb Pierce, CCS-P, ACS-EM21 Modifier for Admitting Physician of Record What modifier should the admitting physician of record use? AI is a new HCPCS modifier for “principal physician of record” Informational modifier Specialist claims should not be held up if admitting physician of record forgets to use the AI If AI is used unnecessarily, claims should not deny … no edit in place currently

22 Barb Pierce, CCS-P, ACS-EM22 Inpatient Services Subsequent hospital care 99231 - 99233 Only need 2/3 key components Can’t bill for more than one/day Code by time when appropriate Discharge: 99238 or 99239 based on time…and what is included in that time

23 Barb Pierce, CCS-P, ACS-EM23 Inpatient Discharge 99238 Discharge day management, 30 minutes or less 99239 Discharge day management, more than 30 minutes Documentation must indicate that >30 minutes spent and why Includes: Final evaluation of the patient Discussion of hospital stay Instructions (may include caregivers) Preparing discharge records, prescriptions and referral forms

24 Barb Pierce, CCS-P, ACS-EM24 OBS or Inpatient Care - Admit and Discharge Same Date Same calendar date Can be used for OBS or inpatients Medicare guidelines require that the patient be there at least 8 hours if using these codes and provider must document that fact Patient could be inpatient status or OBS status … codes are the same, place of service would be different 99234, 99235, or 99236 (same criteria for history, examination, and MDM as other admission codes) Require two face-to-face visits Why? The RVU for these codes = admit + discharge Face-to-face for one and phone call for other won’t work If only seen once, then bill for the service rendered, which might be the admit (inpatient or OBS) or it might be the discharge

25 Barb Pierce, CCS-P, ACS-EM25 Nursing Facility services Nursing Facility Codes Include SNF, even if bed located in hospital setting Don’t forget the discharge codes 99315-99316 based on time Hospital discharge and nursing facility admission on same date IF both services meet criteria For Medicare, the service formerly reported as a consultation will now be reported as an admission to the facility.

26 Barb Pierce, CCS-P, ACS-EM26 Domiciliary Services Facilities without a medical component Can be used for Assisted Living facilities

27 Barb Pierce, CCS-P, ACS-EM27 Emergency Department codes “organized hospital-based facility”…must be available 24 hours a day Five levels 99281 - 99285 with different criteria than office visits Can’t code by time Specialists should used consultation codes instead, if criteria met (except for Medicare)

28 Barb Pierce, CCS-P, ACS-EM28 ER Visits 99281 – 99285 Codes usually used by the provider assigned to the ER Could be possible for more than one provider to use this code on same patient But … probably a consultation or office/out-patient service instead However, for Medicare, multiple physicians are to use the ER codes (in place of consultation codes)

29 Barb Pierce, CCS-P, ACS-EM29 Medicare Resources Prolonged Services MLN Matters MM5972 7/1/08 es/downloads/MM5972.pdf es/downloads/MM5972.pdf Critical Care MLN Matters MM5993 7/7/08 es/downloads/MM5993.pdf

30 Barb Pierce, CCS-P, ACS-EM30 Preventive Medicine When considering the billing options for preventive medicine, we must keep in mind: We intend to submit accurate information to health insurers. We will not misrepresent the nature or purpose of encounters in order to receive insurance reimbursement.

31 Barb Pierce, CCS-P, ACS-EM31 Preventive Medicine When an appointment is scheduled, attempt to determine the nature of the visit so as to allow adequate time for the service. Patient education could occur at that time. Are you going to take care of everything today and split bill?

32 Barb Pierce, CCS-P, ACS-EM32 PM with E/M Define “additional work” E/M codes require a chief complaint and history of present illness From an auditing standpoint, expect additional history and medical decision making

33 Barb Pierce, CCS-P, ACS-EM33 CPT Codes 99381-99397 are for preventive medicine services are defined by the patient’s age in two categories: new or established require comprehensive history and comprehensive examination (but not same definition as comprehensive in E/M Documentation Guidelines)

34 Barb Pierce, CCS-P, ACS-EM34 MEDICARE P/P/B Medicare will pay every two years for a screening pap, pelvic and breast exam for females at low risk G0101 is for the pelvic and breast exam, requires 7/11 elements on exam Q0091 is for collection of Pap smear Paid yearly for patients at high risk Can bill E/M-25, G and Q on same date

35 Barb Pierce, CCS-P, ACS-EM35 G and Q Use ICD-9 codes V76.2, V76.47, or V76.49 for patients at low risk Each ones pays $30.00 + Paid every two years for low risk If unsure when patient last had these services, get an ABN signed and use - GA modifier

36 Barb Pierce, CCS-P, ACS-EM36 E/M, G, and Q Document and code the E/M service at the appropriate level based on history, exam and decision making. Modifier - 25 and diagnosis(es) for problems addressed Bill the G0101 and Q0091 additionally with V code as diagnosis

37 Barb Pierce, CCS-P, ACS-EM37 Medicare Carve Out 99397 9921X-25 G0101 Q0091 (?) Any combination of above, based on documentation Patient pays 99397 minus Medicare allowed services

38 Barb Pierce, CCS-P, ACS-EM38 What about the guys?? Medicare digital rectal exam G0102 Medicare PSA G0103 Here’s the good news: both are paid yearly Here’s the bad news: both are bundled with E/M code if done on same day

39 Barb Pierce, CCS-P, ACS-EM39 Other preventive medicine services Other than these E/M services, Medicare also pays for other screening, preventive services. Research your Medicare bulletins Welcome to Medicare Physical Much better with 2009 changes Some screening labs for diabetes and cardiovascular disease

40 Barb Pierce, CCS-P40 E/M Documentation Guidelines E/M Documentation Guidelines: Education/Medicare-Learning-Network- MLN/MLNEdWebGuide/EMDOC.html Education/Medicare-Learning-Network- MLN/MLNEdWebGuide/EMDOC.html

41 Barb Pierce, CCS-P41 E/M Coding and Auditing Documentation must support the level of service billed Service performed vs. level billed vs. level documented 95 vs. 97 Documentation Guidelines

42 Barb Pierce, CCS-P42 General Principles Record must be complete and legible Even the signature or identification Record stands on its own…but can incorporate by reference Signature log

43 Barb Pierce, CCS-P43 3/3 or 2/3 ?? Key components = history, examination, and medical decision making New patient visits, consultations, hospital admits require 3/3 Established patient visits, daily hospital care require 2/3

44 Barb Pierce, CCS-P44 History ROS and PFSH can be incorporated by reference by reviewing and updating prior information, noting the date and location of earlier information…but not HPI Can also incorporate by reference information recorded by ancillary staff or patient If unable to get history, say why “all others negative” “noncontributory”

45 Barb Pierce, CCS-P45 Examination 1995 guidelines are more generic by body system How do you apply the ’95 exam criteria? 1997 guidelines are very specific..the “bullets” numeric requirements must be met parenthetical examples are for clarification and guidance only “and” really means “or”

46 Barb Pierce, CCS-P46 Medical Decision Making Based on the average of : number of diagnoses/management options data to be ordered/reviewed risk (nature of presenting problem, diagnostic procedures, management options)

47 Barb Pierce, CCS-P, ACS-EM47 Medicine Section Immunizations and injections require 2 codes: the administration and the supply 96372 with J code (watch for units) 90471 for one vaccine 90472 for each additional vaccine code the actual vaccine additionally

48 Barb Pierce, CCS-P, ACS-EM48 Surgery Section Global surgery package includes pre-op day(s) and post-op days Medicare Fee Schedule is good resource…some minor procedures have a post-op period

49 Barb Pierce, CCS-P, ACS-EM49 Surgery Section Separate procedure designation … code only if it is the only procedure done. Example: exploratory laparotomy Bundled with more extensive procedure May be the approach Watch for CCI edits (Correct Coding Initiative) which bundle certain services

50 Barb Pierce, CCS-P, ACS-EM50 CCI Edits Published by NTIS and updated quarterly Other resources may include other coding standards Misuse of Column 2 with Column 1 20550 Injection tendon sheath is a therapeutic injection. If 20520 (removal of foreign body) is done, it would be a misuse if code 20550 is billed to represent injection of local anesthesia to do the 20520

51 Barb Pierce, CCS-P, ACS-EM51 Coding Edits Surgical package and separate procedure concepts Designation of sex Family of codes Most extensive procedure: simple/complex, superficial/deep, incomplete/complete Sequential procedures With/without Mutually exclusive

52 Barb Pierce, CCS-P, ACS-EM52 Surgery Section Lacerations Need location, size, type of repair (simple, intermediate, complex) Add laceration lengths if same type of repair and same anatomical site Have the provider be specific on the encounter form Additional E/M only if significant, separately identifiable services done, then add -25

53 Barb Pierce, CCS-P, ACS-EM53 Surgery Section Lesions Need location, size, type of removal or destruction Lesion size vs. excised size Destruction codes changed for 2007 May need a special lesion removal charge ticket For removals, hold for path report to determine if benign or malignant Don’t rely on path report for size or number of lesions

54 Barb Pierce, CCS-P, ACS-EM54 Surgery Section Fracture care codes Global periods Bill casting materials additionally Re-casting can be billed additionally Casting or splinting can be billed if done to stabilize Medicare has special Q codes (HCPCS) for splint and cast supplies

55 Barb Pierce, CCS-P, ACS-EM55 OB Maternity care and delivery should be billed as a global OB package unless you only did part of the OB care Antepartum care (code based on number of visits) Delivery (different codes vaginal delivery vs. cesarean delivery) Postpartum care No special codes for high risk. Bill additional E/M codes separately “package” may vary by insurance company

56 Barb Pierce, CCS-P, ACS-EM56 Medicare Physician Fee Schedule Data Base - MPFSDB Indicator list Gives information about specific codes Updates quarterly by CMS

57 Barb Pierce, CCS-P, ACS-EM57 Modifier –24 Unrelated E&M service E&M service by the same physician during a postoperative period for condition not related to surgery Global periods of 0-10 and 90 days Individual payers define postoperative period Diagnosis code identifies the reason for the E&M as unrelated to the procedure Informational modifier - claim gets paid Examples

58 Barb Pierce, CCS-P, ACS-EM58 Modifier -25 Indicates a significant, separately identifiable E/M service by the same physician on the same day as another procedure or service Use on E/M code Examples

59 Barb Pierce, CCS-P, ACS-EM59 Modifier –26 Professional Component Professional portion for procedures that are a combination of professional and technical components Provider must prepare a written report Medicare fee schedule P/T column Appropriate to use -26 modifier Global code - payment for both components -26 Payment for professional component -TC Payment for technical component Check indicator number for P/T

60 Barb Pierce, CCS-P, ACS-EM60 Modifier -50 50- Bilateral procedure Indicates bilateral procedures performed during same operative session Verify if code description states procedure is bilateral Payment based on 150% of fee schedule Use one line item with # of services “1”

61 Barb Pierce, CCS-P, ACS-EM61 Modifier -51 51- Multiple procedures Indicator 0- does not apply- do not use 51 Indicator 2- does apply( 100%, 50%, 50% etc.) Indicator 3- special endoscopy rules apply if billed with another endoscopy code. Indicator 9- does not apply- do not use 51

62 Barb Pierce, CCS-P, ACS-EM62 Modifier -57 Decision for surgery with supporting documentation Use on E/M code to keep it out of the global package Applies to major procedures for scopes and procedures with 10 day global, use -25 modifier instead (especially Medicare)

63 Barb Pierce, CCS-P, ACS-EM63 Modifier -59 Used to identify procedures or services that are normally reported together, but need to indicate a particular circumstance such as different encounter, different procedure, different site Modifier of last resort Will bypass CCI edit…should not be used routinely to bypass the edit

64 Barb Pierce, CCS-P, ACS-EM64 CCI cont. 59- Distinct procedural service Separate encounter, different site/organ system, separate injury, procedures performed on same day by same physician Appropriate under certain circumstances Example 02/15/0917000 destruction of lesion hand 02/15/0911000-59 biopsy of arm

65 Barb Pierce, CCS-P, ACS-EM65 ICD-9 Coding ICD-9-CM codes describe “why” the service was performed Be specific !!! Always confirm the code Code what you know at the time the service is performed…signs and symptoms are okay

66 Barb Pierce, CCS-P, ACS-EM66 ICD-9 Coding There are two volumes…use both !! Note the main terms Use the alpha index to locate main term Look for modifiers, subterms, notes and cross-references Select a tentative code Confirm in the tabular Code to the highest level of specificity

67 Barb Pierce, CCS-P, ACS-EM67 ICD-9 Abbreviations NEC: Not elsewhere classifiable means the coding system limits the code selection, such as “other” NOS: Not otherwise specified means the documentation was unspecified Is there more specific information available? Develop a “hit list” of unspecified codes

68 Barb Pierce, CCS-P, ACS-EM68 ICD-9 Unspecified codes Diabetes Musculoskeletal diagnoses or symptoms without a specific location Hypertension Illnesses that are acute or chronic Others???

69 Barb Pierce, CCS-P, ACS-EM69 Coding Signs & Symptoms Definitive diagnosis not available Possible, probable, rule out Used widely in primary care Check out Chapter 16 which includes many signs, symptoms, and ill-defined conditions. Also the location for abnormal test result codes

70 Barb Pierce, CCS-P, ACS-EM70 V Codes Describe a reason for the encounter without active illness Personal history and family history of malignant neoplasms V codes are our friends and can be used as the primary code Codes for preventive medicine services

71 Barb Pierce, CCS-P, ACS-EM71 V Codes Look for terms such as: admission, examination, problem with, aftercare, history of, screening for, supervision of, attention to, observation for, status (or status post) Pre-op evaluations: V72.8_ Personal and family history of malignant neoplasms: V10 and V16 codes

72 Barb Pierce, CCS-P, ACS-EM72 Diagnosis Code Linking Helps identify medical necessity Helps justify the reason for the CPT code Multiple codes present challenges…who links? Does your encounter form allow for linking? LCD’s, NCD’s, and ABN’s ICD-10

73 Barb Pierce, CCS-P, ACS-EM73 Waiver or not? Screening tests - no waiver if due to statutory exclusion Screening tests - waiver if sometimes payable (frequency) Tests not meeting medical necessity criteria require the waiver

74 Barb Pierce, CCS-P, ACS-EM74 Modifiers for ABN situations GY: item or service statutorily excluded or does not meet definition of any Medicare benefit (will result in denial) GZ: item or service expected to be denied as not reasonable and necessary…without ABN signed GA: ABN signed and on file

75 Barb Pierce, CCS-P, ACS-EM75 Compliance Work your compliance plan Education Monitoring Correction Internal reviews External reviews

76 Barb Pierce, CCS-P, ACS-EM76 Patient, Physician and Staff Education Patients need to understand the rules Use information provided by the carrier Make sure staff know the rules Let physicians know how they can help Create policies and procedures Use carrier provided patient education

77 Barb Pierce, CCS-P, ACS-EM77 Areas to Monitor/Look for Improvement Compare the medical record, encounter form, and CMS-1500 (or computer entry) Do all three tell the same story? Level of service for E/M Type of E/M service Provider of service Date and location of service

78 Barb Pierce, CCS-P, ACS-EM78 Templates and other tools History forms completed by patient or staff with past history, family history, social history, and system review Progress notes that prompt the provider of documentation requirements (and may reduce transcription costs) Build a helpful encounter form Common procedures ICD-9 codes ?

79 Barb Pierce, CCS-P, ACS-EM79 Coding Compliance Medical necessity above all else, regardless of documented history or examination Follow incident-to rules Follow teaching rules

80 Barb Pierce, CCS-P, ACS-EM80 Incident to Services Office only Incident to provider on site Incident to provider’s already established care plan, so no new patients or new problems PA’s and NP’s can bill this way or under their own provider numbers

81 Barb Pierce, CCS-P, ACS-EM81 Teaching Rules Residents are individuals in an approved GME (graduate medical education) program…includes interns and fellows Carriers Manual Section 15016 … revisions Teaching physician has to document presence and participation in service Clarifications of what medical students can and cannot document

82 Barb Pierce, CCS-P, ACS-EM82 Teaching Rules Can’t code by time Special rules for procedures…key portions Medical Students are not residents For tying into resident note, the following are NOT adequate: signature only seen and agree with signature reviewed resident’s note and agree

83 Barb Pierce, CCS-P, ACS-EM83 Policies and Procedures/Education 99211 Procedures with E/M Use of modifiers New vs. established patients Incident-to rules Teaching rules Importance of ICD-9 coding and linking NCDs and LCDs … need for ABNs

84 Barb Pierce, CCS-P, ACS-EM84 Keep going …. Preventive medicine and split billing Consultation codes Proper documentation of time Look at some EOB’s

85 Barb Pierce, CCS-P, ACS-EM 85 Post-test Questions Preview To receive CE credit, the post-test and evaluation must be completed online at If you successfully answer at least 70% of the test items, you will be able to print a certificate. For questions or more information concerning this online CE opportunity, please contact Stormy Causey, CE Coordinator at This program provides the following Post-Test Preview as a convenience, ONLY to help in preparation for the online Post-Test. Credit is awarded for tests completed online. 1.CPT codes represent: a.Diagnosis b.Procedures c.Patient demographics d.Fees 2.CPT classifies a new patient as one who: a.Has never been seen by the provider b.Has not been seen by a member of the same group of the same specialty in three years c.Needs a new medical record and account established d.Is referred by another provider 3.The global surgery package: a.Applies to all CPT codes b.Allows you to bill for post-op office visits c.Includes some pre-op and post-op services d.Does not apply to procedures performed in the office

86 Barb Pierce, CCS-P, ACS-EM86 Post-test Questions Preview (cont.) 4.An Advanced Beneficiary Notice (ABN) is required: a.In situations where you believe Medicare may deny the service based on the limitations of a local or national policy b.On every service provided to a Medicare patient c.So that Medicare can bypass their edits and pay you for everything d.On all screening tests 5.The difference between 99212 and 99215 is: a.The amount of time spent taking the history b.Whether a PCP or specialist provided the service c.The fact that 99215 is reserved for new patients d.The amount of history, examination, and medical decision making that must be performed and documented 6.An office visit and minor procedure on the same day: a.Will always be paid and you won’t need a modifier b.Require documentation of significant and separately identifiable history, exam and/or medical decision making over and above the procedure c.Must be performed at two visits at separate times d.Cannot both be billed

87 Barb Pierce, CCS-P, ACS-EM87 Post-test Questions Preview (cont.) 7.Time overrides history, examination, and medical decision making for those patient encounters where the majority of the visit is spent counseling the patient. a.True b.False 8.Since Medicare no longer pays for consultations, patients who present to the office for a pre- operative clearance would always be coded as new patients. a.True b.False 9.Code G0101 is: a.Paid by Medicare every year b.The code accepted by Medicare for a screening breast exam, pelvic exam and collection of a Pap smear c.Never to be billed in addition to 99213 d.The code used to describe a digital rectal exam for males 10.If the patient presents with abdominal pain and is sent to the hospital for further testing to rule out appendicitis, the diagnosis for the office visit would be : a.Abdominal pain b. Appendicitis

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