The Three Key Components of E

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School

Bossier Parish Community College *

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200

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Health Science

Date

Oct 30, 2023

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docx

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Uploaded by beverlykruise

1 The Three Key Components of E&M (Evaluation & Management) CODES History, examination, and medical decision-making complexity The levels of E/M services are based on documentation located in patient's medical record and are based on KEY COMPONENTS (history/Hx, examination, & medical decision-making complexity) and CONTRIBUTORY FACTORS (counseling, coordination of care, nature of presenting problem & time) History is the subjective information the patient tells the physician Four elements of a history are chief complaint (CC) history of present illness (HPI) review of systems (ROS) and past, family, and social history (PFSH) Invalid claim is one that is submitted with a transposed member ID number According to CLIA (Clinical Laboratory Improvement Amendments) when billing Medicare for a waived laboratory test what modifier should be QW

2 used What take precedence over ICD-9-CM chapter specific guidelines Coding conventions and instructions what action should be taken when a claim is billed for a level 4 office visit and paid at a level 3 submit an appeal with supporting documentation On a patient's remittance advice, a deductible of $100 has been applied. The provider has requested the patient account personnel to write it off. What describes this scenario FRAUD Patient presents for an incision & drainage of Pilonidal Cyst. what part of the body is it referring to Coccyx (tail bone) Which is a valid ICD-9-CM principal? Code signs and symptoms in the absence of an established diagnosis A patient calls your office and is upset about bill received. Her Insurance company denied claim, You should inform the patient the reason for denial

3 what should you do A billing and coding specialist should understand that the financial record source that is generated by a provider’s office is called a Patient Ledger Account A claim can be denied or rejected for Block 24D containing a diagnosis code? True block 24D is for CPT codes (diagnosis codes go in Block 21) This scenario is most appropriate to submit an electronic claim Claim submitted contains an outpatient procedure What component of an EOB (explanation of benefits) expedites the process of a phone appeal Claim Control Number An example of a diagnostic category code is 541 (3 digits/no decimal point) In managed care organizations PPO (preferred provider option) help control a patient's insurance cost by offering low-cost deductibles

4 Which describes an "implied contract" A patient schedules an appointment with a new provider's office An insurance claims register (aged insurance report) facilitates which follow-up insurance claims by date How does a third-party payer determine timely filing for claims Contract with the provider A woman in her 3rd trimester of pregnancy present to her Dr.’s office with a diagnosis of a sprained wrist w/ swelling due to falling on a wet floor. Dr. documented no relationship between the sprain & pregnancy. What is appropriate coding sequencing Sprained wrist, pregnancy, fall on floor ambulatory surgery centers, home healthcare and hospice organizations, inpatient a non-allowed charge goes in? the adjustment column of the credits Claim to be correctly use 12 pitch (PICA)

5 processed via optical character recognition (OCR) billing & coding specialist should characters What transports oxygenated blood from the Heart Aorta What is the valve that controls opening between the right atrium and right ventricle Tricuspid valve What valve is located between the left atrium and left ventricle Bicuspid valve AKA mitral valve Nocturia is excessive urination at night the duodenum is the first section of the small intestine the ileum is the last section of the small intestine V-codes are used as the 1st listed diagnosis to indicate family history How many behavior classifications are included in Table of neoplasms 6

6 What is the form that contains DOS (date of service), CPT codes, ICD- 9-CM, fees, and copayment info an Encounter form What is the medical term that describes the body's inability to compensate for position change orthostatic hypotension what font is the standard font for the CMS 1500 paper claim 10 pitch (PICA) An integral part of an autopsy is what type of examination gross examination A paper claim should be submitted if a claim contains unlisted procedure codes What organization accepts electronic claims MAC - Medicare Administrative Contractors Because of Medicare NCCI (National Correct Coding Initiative) edits improper code combinations are in what type of claim claim rejection What type of insurance coverage is offered to Medigap coverage

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