NCCI
Functional Limitations
Modifier 59
FAQs
Jimmo vs Sebelius Case
100
How often is the NCCI (Medicare National Correct Coding Initiative) updated?
What is quarterly
100
These are times throughout treatment when a patients functional limitation is required using non-payable G-codes and modifiers
What is the onset of therapy, specified points during the episode, and at discharge?
100
A modifier is composed of ____ digits
What is two?
100
What does FAQ stand for?
What is frequently asked question?
100
What was the date of the Jimmo vs Sebelius case?
What is January 24, 2013.
200
What is a code pair edit?
What is Automated pre-payment edits that prevent improper payment when certain codes are submitted together for part b services
200
Name 2 out of 6 non-payable G-code categories most commonly used by PTs.
What is mobility, changing & maintaining body position, carrying, moving, & handling objects, self-care, other primary functional limitation, and other subsequent functional limitation?
200
Modifier 59 is one of ________ modifiers.
What is 35?
200
What happens if you do not submit functional limitation data to CMS?
What is you do not get reimbursed?
200
What does medicare now cover as of January 14, 2014?
What is maintenance therapy.
300
What is a medically unlikely edit?
What is Max number of units of service allowed under most circumstances for a single code billed by a healthcare professional on a specific date for one beneficiary
300
This reflects the patient's percentage of functional impairment determined by the therapist
What is severity modifier?
300
The service the modifier must be attached to
What is secondary service?
300
How often does CMS require a therapist to submit DATA?
What is first visit, every ten visits, and discharge?
300
What is an example of a medicare beneficiary that would require maintenance therapy?
What is degenerative diseases, MS, PD, Dementia, Alzheimer's disease, terminal cancer, etc.
400
What is the purpose of the Medicare National Correct Coding Initiative?
What is Help healthcare providers with correct coding methods and limits improper coding, which leads to improper payment
400
This is who selected the 14 specific categories the G-codes are organized into
What is CMS from the International Classification of Functioning, Disability, and Health ?
400
A modifier allows the following action to occur
What is bypass NCCI edits to bill for two services on the same day?
400
Name 1 tool CMS recommends for assessment.
What is AM-PAC, FOTO, OPTIMAL, NOMS?
400
What is maintenance therapy?
What is Skilled therapy that is necessary for the performance of a safe and effective maintenance program that will maintain the patient's current condition or prevent/slow further deterioration.
500
If you see a modifier indicator 1, what does that mean?
What is The modifiers associated with NCCI are allowed with the code pair when appropriate
500
This is how PTs determine a patients primary functional limitation
What is determining the most clinically relevant, the quickest progress, & greatest priority for the patient?
500
To properly use modifier 59, the provider must
What is perform a distinct service the same day that another service is performed and document correctly?
500
What does the CPT code 92521 mean?
What is evaluation of speech fluency?
500
How does this affect the PT when documenting? What is an example of something that would be "too vague"?
What is the PT has to document appropriately, otherwise the medicare beneficiary will not get reimbursed. The PT has to show the skilled care can only be given by a PT and not by a non-therapist or unskilled caregiver. Documentation has to be very specific. An example would be: "pt tolerated tx well" "continue with POC" "pt remains stable" etc.
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