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37 Cards in this Set
- Front
- Back
Modifiers can indicate |
only part of a service, a bilateral procedure, unusual service |
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modifier 22 |
unusual services (increased procedural services) |
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modifier 25 |
significant, separately identifiable |
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modifier 50 |
bilateral procedure |
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modifier 51 |
multiple procedures at the same visit |
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Name of the book that contains a coded list of procedures with unit values that indicate the relative value of various services |
healthcare common procedure coding system (HCPCS) |
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What should be done when a service rendered is not listed in the coding book |
use a code with a description stating unlisted and attach appropriate documentation to the claim |
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bundling |
to group codes together that are related to a procedure |
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unbundling |
coding and billing numerous CPT codes to identify procedures usually described by a single code |
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downcoding |
refers to a code that is changed by and insurance carrier because it is not recognized by the system |
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upcoding |
the deliberate manipulation of CPT codes for increased payment |
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CPT is divided into 6 code sections |
evaluation and management, anesthesia, surgery, radiology nuclear medicine diagnostic ultrasound, pathology and laboratory, medicine |
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when coding for a claim that involves a surgery, the coder should have |
a copy of the operative report |
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coding procedure that involve repairs need to use the main term that specifies the |
length and depth of the repair performed |
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when coding a claim for a procedure that involved a biopsy, the coder needs to have |
a pathology report to code the diagnosis properly |
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elements of evaluation and management codes |
history, examination, medical decision making, nature of presenting problem, counseling, coordination of care, time |
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when coding for procedures it is vital that the billing specialist ensure |
that the medical record contains the appropriate documentation of the procedure that was performed |
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fee schedule |
method of payment that is similar to a price list |
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relative value scales or schedules |
service performed+time+skill+overhead=payment formula |
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neoplasms |
benign or malignant new growth |
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before coding a claim for HIV/AIDS, it is necessary to have |
an authorization for release of HIV status form signed by the patinet |
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when coding a diagnosis, you need to first use |
volume 2 and then read about the code in volume 1 |
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it is necessary to have an understanding of anatomy and physiology to be a good medical coder |
true |
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sequencing of diagnostic codes |
primary diagnosis (first listed), main reason for the encounter |
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V codes are |
a supplementary classification of coding and may be used in four primary circumstances |
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classification of factors influencing health status and contact with health service |
v01 -v89 |
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E codes are |
supplenentary diagnosis in which you look for external causes of injury rather than disease |
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For what situation would an E code be used for |
an allergic reaction due to a medication |
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Codes E800-E999 are |
classification of external causes of injury and poisioning |
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the 4th or 5th digit added to an ICD-9 code provides more information regarding, etiology, site or manifestations |
true |
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which of the following describes a primary diagnosis |
the main reason for an encounter |
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which of the following type of codes is not listed in the ICD-9 CM coding book |
medications |
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which of the following is not part of the relative value studies formula |
diagnosis |
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e codes may be used as a primary diagnosis or as a supplementary diagnosis |
false |
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whic of the following is a method of payment that is similar to a price list |
FEE SCHEDULE |
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THE KEY COMPONENTS OF EVALUATION AND MANAGEMENT ODES ARE WHICH OF THE FOLLOWING |
history, examination, and medical decision making |
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which of the followuing is not part of the relative studies formula |
time, skill, overhead cost |