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HIM 215 Test 1 part 1

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rad2329's version from 2017-02-02 19:33

Section 1

Question Answer
What does CPT stand for?Current Procedural Terminology
* Level I codes are ?CPT codes used to identify services and procedures delivered by a physician to describe health care services.
* Level II codes are ?National codes (HCPCS) used by providers to report services, supplies, and equipment not covered in the CPT codes. (Temporairy codes for Medicare) Also known as National Codes.
Level II codes are used for what types of services?Specific Drugs, Durable Medical Equipment (DME), Ambulance Services, Prosthetics, Orthotics, Facilities (therapies like renal dialysis)
Are Level I codes alpha, numeric, or alphanumeric ?Numeric
Are Level II codes alpha, numeric, or alphanumeric ?Alphamumeric
Are Level III codes alpha, numeric, or alphanumeric ?Alphamumeric
Who developed CPT and when?AMA in 1966
How many digits are codes in CPT Level IFive
Six CPT sections (like chapters)Evaluation & Management (E/M), Procedures & Services, Anesthesia, Surgery, Radiology, Pathology & Laboratory, Medicine
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Section 2

Question Answer
Codes are used to tell third party payers about ?Services / procedures provided
Codes become the basis for ?payment of claims submitted.
Failure to code correctly may result in ?overpayment, underpayment, or denial of a claim, may be liability Issue, incorrect coding may result in fines, imprisonment, or both when it is the result of fraud and/or abuse
What types of institutions use CPT codes ?Used wherever health care services are provided, such as in physician’s offices, clinics, hospitals, and rehabilitation units.
CPT used for Outpatient Services for Physicians reported electronically in billing systems on what form ?CMS-1500
Symbols in CPT are used to convey ?Information
What is the purpose of a + add on code?Using an additional code to show the furthest extent of the procedure
What is HCPCS, when and who developed itHealthcare Common Procedure Coding System, CMS, 1983
What are codes ending in 99?Unlisted codes Used if no specific Category I or III codes can be used. A special report must accompany submission.
What are the two types of codes used in the CPT manual?Stand-alone codes, Indented codes
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Section 3

Question Answer
▲ Triangle Revised code (Changed since last revision was released)
Lightning BoldPending FDA approval (In Appendix K)
• BulletProcedure is being included in CPT for the first time.
# Pound symbolResequenced code (In Appendix N) code numbers are not in numerical order, out of sequence
Right & Left TrianglesBeginning and End of text changes. Reflects a change in text from the previous release of the CPT
+ PlusAdd-On Code (In Appendix D)
Circle with a lineIdentifies a -51 modifier Exempt code. Appendix E
CircleRecycled or Reinstated Code (Code may have been deleted and it has been recycled/reinstated i.e. used again)
What does a semicolon ( ; ) signify when used with CPT codes ?Alternative anatomic site, procedures or description of extent of service. Used as a major space-saving device. Indicates full description in preceding code.
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Section 4

Question Answer
* Appendix A:Modifiers used to alter or modify codes
* Appendix B: Additions, Deletions, Revisions
* Appendix C:Clinical Examples of EM (evaluation & management) codes
* Appendix D:Add-on codes. Symbol is a +
* Appendix E:Identifies a modifier -51 exempt codes. Symbol is circle with a line through it
* Appendix F:Modifier -63 identifies procedures that are performed on infants who weigh less than 4kg or 8.8 pounds
* Appendix G:Used to include Moderate (Consious) Sedation, delected for 2017 Symbol is a Bullseye
* Appendix H:Category II Codes list of alphabetic Index of Performance Measures by Clinical Condition or Topic. Removed in 2010 from the CPT manual
* Appendix J:Electrodiagnostic Medicine Listing of sensory Motor and Mixed Nerves that identify the sensory, motor, and mixed nerves with the corresponding conduction study code.
* Appendix K:Product Pending FDA Approval. Symbol is a lightening bolt
* Appendix L:Vascular Families (Page 782)
* Appendix M:Deleted CPT codes, lists the current-year code to replace a deleted code.
* Appendix N:Summary of Resequenced CPT codes. Symbol is a # (Code numbers not in numerical order, out of sequence). Introduced in 2010 by AMA.
* Appendix O:Multianalyte Assays with Algorithmic Analyses is a listing of codes for advanced diagnostics, such as ovarian oncology (code 81500), which assays for two proteins (CA-125 and HE4) for a risk factor.
* Appendix P:Telemedicine services reported. Symbol is a *
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Section 5

Question Answer
Stand-alone codes have ? Complete, full descriptions attached to them.
Indented codes are ?Listed under related stand-alone codes. Descriptions for these codes depend on information in the code that precedes them. (i.e. Stop at the semicolon and look below)
Level I CPT Modifiers are how many digits?Two, and are numeric. Does have a monetary value on reimbursement and used by 3rd party payers.
Category I CodesUsed to describe "services and procedures" that have been approved by the FDA and AMA and/or that have proved to have clinical effectiveness. (00100-99607)
Category III CodesTemporairy codes up to 5 years. Identify emerging technology, services, and procedures. Alphanumeric located after "Medicine" secion. May or may not receive future Category I status. Services and procedures that may or may not be approved by the FDA.
Category II CodesAlphnumeric and end with the letter "F". Used for performance measurements. Codes collect data concerning quality of care and test(s) required. Location AMA website. provide supplemental information and are always used in combination with a Category I or Category III code.
What must be done when using an unlisted code (99)A special written report must be done.
Level II HCPCS Modifiers are how many digits?Two, and may be either Alpha, or Alphanumeric (exp. -F1 Left hand, second digit / AS Physician's Assistant)
Codes ending in 99 are ?Unlisted services. No specific Category I or III code. A special report must accompany submission.
Code grouping for HCPCS consist of ?Will start with a letter between A - V followed by a 4-digit number
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