MOA115 _Wk3_ Assignment_CSanson_12.1.23
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Fortis Institute, Port Saint Lucie *
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Jan 9, 2024
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MOA115 Medical Records and Insurance Week 3 Assignment CPT Coding Concepts
General CPT Coding Guidelines
1. _
Guidelines
_____________ are found at the beginning of each of the six sections of the CPT coding manual, and the medical assistant refers to them often when coding procedures.
2. Code additions that explain circumstances that alter a provided service or provide additional clarification or detail are called __
Modifiers
_____________________.
3. Define upcoding
and discuss the effects.
_
_
Is the use of a higher level procedure code that is supported in the documentation or medical necessity. False information on their medical records can affect their future ability to get insurance
_______
4. Define down-coding
and discuss the effects.
_
Down-coding refers to coding at a lower level than the level of service supported by medical documentation or medical necessity. This is also known as under-coding and usually results from insufficient documentation. Its impact is given as follows. Under-
coding is damaging to your practice from a compliance perspective.
_____
5. Define medical necessity
as it applies to procedural coding.
_ Insurance companies provide coverage for care, items, and services that they consider to be “medically necessary.” Medicare defines medical necessity as “health-
care services or supplies needed to diagnose or treat an illness or injury, condition, disease, or its symptoms and that meet accepted standards of medicine.
_______
Documentation for CPT Coding 1.
List the sources used for procedural coding. _____
Evaluation & Management, Anesthesia, Surgery, Radiology, Pathology & Laboratory, & Medicine
.______
Steps for Efficient CPT Coding 1.
Describe how to use the most current procedural coding system. __
The CPT codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting and
increase accuracy and efficiency
.__
CPT Coding
1. Jim Angelo, an established patient, saw the physician for a minor cut on the back of his hand. The physician spent approximately 10 minutes with Jim.
__
99212
____________________
2. Dr. Wray saw Tammy Luttrell in the office as a new patient. He took a detailed history
and performed a detailed examination, and then made medical decisions of low complexity.
____
99203
___________________
3. Sylvia Julius, an established patient, saw Dr. Bridges for her allergies. The physician took a problem-focused history, performed a problem-focused examination, and made straightforward decisions regarding her care.
____
99212
_________________
4. Urine pregnancy test __
81025
____________________
5. Human papillomavirus (HPV) vaccine, nine types, three-dose schedule, intramuscular
route__
90651
__________
HCPCS Coding 1. Standard wheelchair __
E1130-E1161
__________
2. Gradient compression stocking below-knee, 40-50 mm Hg each__
A6531
___
3. Above-knee, short prosthesis, no knee joint (stubbies), with articulated ankle/foot, dynamically aligned, right leg
__
Code L5220
___________
4. Disposable contact lens, per lens, one set _
Code S0500
______
5. Ambulance waiting time, 1 hour __
Code A0420
____
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