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Clinical Aspects of Billing and Coding > chapter 19 > Flashcards

chapter 19 Flashcards

1
Q

done to show which type of procedures were done in the clinic

A

procedural coding

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2
Q

produces procedural codes that report medical procedures

A

CPT manual

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3
Q

what is the format for a CPT code?

A

5-digit numeric code followed by a description

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4
Q

what are add on codes used for?

A

to describe procedures done in addition to the main procedure

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5
Q

one or more 2 digit codes assigned to the main code to show that some special circumstance applied to the procedure

A

CPT modifiers

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6
Q

any codes that includes more than one procedure in their description

A

bundled codes

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7
Q

when the insurance carrier bases reimbursement on a code level lower than the one submitted by the provider

A

downcoding

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8
Q

breaking bundled codes into its component parts for higher reimbursement

A

unbundling

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9
Q

coding a procedure or service at a higher level than provided to receive higher compensation

A

upcoding

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10
Q

how are E/M codes divided?

A

based on PT status (new or established)

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11
Q

what are the 3 key factors of E/M level of service?

A
  1. extent of PT history taken
  2. extent of exam conducted
  3. complexity of the medical decision making
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12
Q

what is taken in a problem focused history?

A
  • CC
  • HPI
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13
Q

what is taken in a expanded problem focused history?

A
  • CC
  • HPI
  • brief ROS
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14
Q

what is taken in a detailed history?

A
  • CC
  • extensive hx of CC and ROS
  • brief PFSH
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15
Q

what is taken in a comprehensive history?

A
  • CC
  • HPI
  • ROS
  • PFSH
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16
Q

what does HCPCS stand for?

A

healthcare common procedure coding system

17
Q

what is the difference between HCPCS level 1 and HCPCS level 2 ?

A

level 1 - CPT codes
level 2 - supplies

18
Q

done by insurance company to verify coverage connection between diagnostic and procedural codes

A

code linkage

Clinical Aspects of Billing and Coding (5 decks)

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