Ch 6 Procedure Coding

CPT codes are a standardized five-digit numeric method used to precisely describe each service and procedure provided by physicians and allied health care professionals.

• True

• False

Sometimes, in place of a CPT code, a HCPCS code is used to describe a procedure or service.

• True

• False

Fee schedules are listings of procedure code numbers with charges, or pre-established allowances, for specific medical services and procedures, and can vary from each contracted payer.

• True

• False

The various methods of payment by insurance companies and state and federal programs are....

• fee schedules

• usual, customary, and reasonable (UCR)

• relative value units/scale (RVU/RVS)

• all of the above

CPT is published each year, and is released/effective on January 1st. It is extremely important to become familiar with code deletions, new codes, and changes related to the specialty field you are working in.

• True

• False

Ensure that the documentation from the provider supports the code submitted to prevent downcoding by the third-party payer.

• True

• False

Code edits are performed on submitted insurance claims to detect unbundling, splitting codes, and other improper types of improper code submissions.

• True

• False

Use two-digit, add-on modifiers to indicate circumstances in which a procedure as performed differs in some way from that described by the usual five-digit code alone.

• True

• False

Surgical packages include the following items

• local, digital block, or topical anesthesia

• uncomplicated post operative care for the procedure global period

• usual intra-operative services

• all of the above

To accurately coding includes .....

• read the entire encounter completely, once it has been signed off by the provider

• highlight words important to the selection of the code

• Ask the provider to clarify any inconsistencies, then have them add an addendum to the original

• all of the above