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medicial billing and coding > chapter 7 cpt coding > Flashcards

chapter 7 cpt coding Flashcards

1
Q

care plan oversight services

A

cover the providers time supervising a complex and multidisciplinary care treatment program for a specific patient who is under the care of a home health agency hospice or nursing facility

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2
Q

case managemnt services

A

process by which an attending physician coordinates and supervise care provided to a patient by other providers

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3
Q

category 1 codes

A

procedurze service identified by a five digit cpt code and descriptor nomenclature these code are traditionally associated with cpt and organized within six sections

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4
Q

category II codes

A

optional evidence based performance measurement tracking codes that are assigned an alphanumeric identifier with a letter in the last field

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5
Q

category III codes

A

temporary codes for data collection purposes that are assigned an alphanumeric identifier with a letter in t he last field

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6
Q

comprehensive assessment

A

must include an assessment ofthe patients functional capacity identification of potential problems and a nursing plan to enhance or at least maintain the patients physical and psychosocial functions

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7
Q

concurrent care

A

provision of similar services such as hosptial inpatient visits to the same patient by more than one provider on the same day

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8
Q

consultation

A

examination of a patient by a health care provider usually a specialist for purpose of advising the referring or attending physician in the evaluation and or management of a specific problem with a know diagnosis

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9
Q

contributory components

A

include conseling coordination of care nature of presenting problem and time

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10
Q

coordination of care

A

provider makes arrangements with other providers or agencies for services to be provided to apatient

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11
Q

counseling

A

discussion with a patient and or family concerning one or more of the following areas diagnostic results impression and or recommended diagnostic studies prognosis risk and benefits of management options instructions for management and or follow up importance of compliance with chosen management options risk factor reduction and patient and family education

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12
Q

boldface type

A

highlights main terms in the cpt index and categories subcategories headings and code numbers in the cpt manual

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13
Q

cross reference terms see, see also

A

direct coders to a different cpt index entry because no code are found under the original entry

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14
Q

descriptive qualifier

A

terms that clarify assignment of a cpt code

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15
Q

guidelines

A

define terms and explain the assignment of codes for procedures and services located in a particular section

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16
Q

inferred words

A

used to save space in the cpt index when referencing subterms

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17
Q

instructional notes

A

appear throughout cpt sections to clarify the assignment of codes

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18
Q

italicized type

A

used for teh cross reference term

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19
Q

bullet symbol

A

bullet located to the left of a code number identifies new cpt procedures and services

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20
Q

triangle symbol

A

triangle located to teh left of a code number identifies a revised code description

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21
Q

horizontal triangles symbol

A

surround revised guidelines and notes this symbol is not used for revied code description

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22
Q

semicolon

A

saves space in cpt so that some code descriptions are not printed in their entirety next to a code number the entry is indented and the coder refers back to the common portion of the code description located before the semicolon

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23
Q

plus symbol

A

identifies add on codes for procedures that are commonly but not always performed at the same time and buy the same surgeon as the primary procedure

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24
Q

forbidden symbol

A

identifies codes that are not to be appended with modifier -51

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25
Q

flash symbol

A

indicates that a code is pending d=fda approval but that it has been assigned a cpt code

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26
Q

number symbol

A

precedes cpt codes that appear out of numerical order

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27
Q

star symbol

A

cpt codes that rae reported for synchronous telemedicine services and require addition of modifier -95

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28
Q

green reference symbol

A

that the coder should refer to the cpt assistance monthly newsletter

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29
Q

blue reference symbol

A

that the coder should refer to the cpt changes

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30
Q

red reference symbol

A

that the coder should refer to the clinical examples in radiology quarterly newsletter

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31
Q

duplicate pla symbol

A

identifies duplicate proprietary laboratiry analyses PLA test

32
Q

double arrow symbol

A

double arrow symbol identifies cpt catory 1 PLA codes

33
Q

critical care services

A

reparted when a provider directly delivers medical care for critically ill injured patient

34
Q

direct patient contact

A

face to face patient contract outpatient or inpatient

35
Q

emergency department services

A

services provided in an organixed hispital based facility which is open on a 24 hour basis for the purpose of providing unscheduled episodic services to patients requiring immediate medical attention

36
Q

established patient

A

one who has recived professional services from the provider or from another provider of the same specialty who belongs to the same group practice within the past three years

37
Q

evaluation and management documetation guidelines

A

federal cms guidelines that explain how e/m codes are assigned according to elements associated with comprehensive multisystem and single system examination

38
Q

evaluation and management e/m section

A

located at eh beginning of cpt because there codes describe services that are most frequently provided by physicians and other health care practitioners

39
Q

extent of examination cpt

A

includes comprehensive detailed expanded problem focused and problem focused levels based on physician documentation

40
Q

comprehensive examination

A

general multisystem examination or a complet examination of a single organ system

41
Q

detailed examination

A

affected body areas and other symptomatic or related organ systems

42
Q

expanded problem focused examination

A

limited examination of the affected body area or organ system and other symptomic or related organ systems

43
Q

problem focused examination

A

limited examination of the affected body area or organ system

44
Q

extent of history cpt

A

includes comprehensive detalied expanded problem focused and problem focused levels based on physician documentation

45
Q

comprehensive history

A

cheif complaint extended history of present illness review of systems directly related to the problems identified in the history of the present illness plus a review of a;; additional body systems and complete past family social history

46
Q

detailed history

A

chief complaint extended history of present illness problem pertinent system review extended to include a limited number of additional systems pertinent past family social history directly related to patients problem

47
Q

expanded problem focused history

A

chief complaint brief history of present illness problem pertinent system review

48
Q

problem focused history

A

chief complaint brief history of present illness or problem

49
Q

face to face time

A

amount of time the office or outpatient care provider spends with the patient and or family

50
Q

global period

A

includes all services related to a procedure during a period of time

51
Q

global surgery

A

package concept or surgical package includes the procedure local infiltration metacarpal digital block or topical anesthesia when used and normal uncomplicated follow up care

52
Q

history

A

interview of the patient that includes the following components history of present illness a review of systems and past family social history

52
Q

hospital discharge services

A

includes the final examination of the patient discussion of the hospital stay with the patient and or caregiver instructions for continuing care provided to the patient and or caregiver and preparation of discharge records prescription and referral forms

52
Q

home services

A

health care sevices provided in a private residence

53
Q

indented code

A

cpt code that is indented below a stand alone code requiring the coder to refer back to the common portion of the code description that is located before the semicolon

54
Q

initial hospital care

A

covers the first inpatient encounter ther admitting attending physician has with the patient for each admission

55
Q

key components

A

extent of history exten of examination and complexity of medical decision making

56
Q

level of E/M service

A

use of last number of each cpt evaluation and management services code to represent level of service provided

57
Q

medical decision making

A

refers to the complexiity of establishng a diagnosis and or selecting a management option as measured by the nume=ber of diagnoses of=r management options amount and or complexity of data to be reviewed and risk of complications and or morbidity or mortality

58
Q

moderate sedation

A

administration of moderate sedation or analgesia which results in a drug induced depression of consciousness

59
Q

modifier

A

provide additional information about a procedure or service

60
Q

monitored anesthesia care MAC

A

provision of local or regional anesthetic services with certain conscious a;tering drugs when provided by a physician anesthesiologist or medically directed crna monitored anesthesia care incolces sufficiently monitoring the patient to anticipate the potential need for administration of general anesthesia and it requires continuous evaluation of vital physiologic functions as well as recognition and treatment of adverse changes

61
Q

multiple surgical procedures

A

two or more surgeries performed during the same operative session

62
Q

nature of the presenting problem

A

defined by cpt as a disease condition illness injury symptom sign finding complaint or other reason or other reason for the encounter with or without a diagnosis being established at the time of the encounter

63
Q

new patient

A

one who has not recived any professional services from the provider or form another provider of the same specialty who belongs to the same group practice within the past three years

64
Q

newborn care

A

covers examinations of normal or high riskk neonates in the hospital or other locations subsequent newborn care in a hospital and resuscitation of high risk babies

65
Q

nursing facility services

A

performed at the following sites

66
Q

observation or inpatient care services

A

cpt codes used to report observation or inpatient hospital care services provided to patients admitted and discharged on the same data of service

67
Q

observation services

A

furnished in a hospital out patient setting to determine whether further treatment or inpatient admission is needed when a patient is placed under observation the patient os categorized as an outpatient if the duration of observation care is expected to be 24 hours or more the physician must order an inpatient admission

68
Q

organ or disese oriented panel

A

series of blood chemisty studies routineluy ordered by providers at the same time to investigate a specific organ

69
Q

partial hospitalization

A

short term intensive treatment program where individuals who are experiencing an acute episode of an illness

70
Q

physical examination

A

assessmetn of the patients bofy areas

71
Q

physical status modifier

A

indicates the patients condition at eh time anesthesia was adminustered

72
Q

place of service pos

A

physical location where health care is provied to patients

73
Q

preoperative clearance

A

occurs when a surgeon request that a specialist or other physician examine patient and give an option as to weather that patient can with stand the expected risks of a specific surgery

74
Q

preventive medicine services

A

routtoms of a disorder while presemtomg pine examinations or risk managemtn counseling for children and adults exhibiting no over signs orsymp

medicial billing and coding (8 decks)

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