A concise statement describing the symptoms, problems, conditions, diagnosis, or other factors that is the reason for the encounter, usually stated in the patient's words.
What is a Chief Complaint
100
Type of service provided by a physician whose:
a. opinion or advice regarding evaluation and/or management of a specific problem is requested by another physician
What is a CONSULT?
100
2 Types of Hospital charges .
One is between 24-48 hrs.
What are Inpatient and Observation charges
100
Book published by the AMA used for assigning procedure codes.
What is the CPT book?
100
A visit in which the patient has not been seen by the practice/provider within last 3 years
What is a NEW patient visit?
200
When counseling and/or coordination of care dominates more than 50% of the physician's patient encounter.
What is: Time Billing
200
3 R's that have to be documented in a chart note to support charging for a consult.
What is the Request, Reason, Report?
200
3 types of Hospital visit for which a provider can charge a professional fee
What are Admit, subsequent visit, and discharge visits
Two words that are often confused when a patient is sent from a primary care physician to a specialist.
What are referral and consult?
300
A medical condition which justifies the reason a procedure or service was performed.
What is Medical Necessity?
300
An individual who participates in an approved graduate medical education(GME) program but that we do not charge for their services using E/M codes
What is A Resident/ Fellow?
300
E/M codes which require all three key components be met or exceeded to support the charge code
What is A New Patient Visit?
400
The Universal claim form developed by HCFA that standardizes the data required by most carriers to process insurance claims is:
What is the HCFA-1500/ CMS 1500?
400
A document that needs to be written after the consult visit.
What is the letter sent back to the Provider requesting the consultation?
400
The codes used for birth through the first 28 days.
What are the Newborn Care Services?
400
Units used with a gross revenue charge that adds value to the payment to providers for their services charged using the E/M codes
What are Jana/ RVU's (Relative Value Units)?
400
DOUBLE JEOPARDY
Sue Morgan, Robin Reynolds, & Lisa Wyatt
Who are the Coding Specialist for the Pediatric Division?
500
Charging at higher levels without supporting doucumentation
What is Maximizing/upcoding/overbilling
500
Pediatrician sees patient and detects a possible heart murmur. He/she then sends the patient to a pediatric cardiologist. The pediatric cardiologist reviews the other providers note and sees request, states the reason for the request, documents his note and how it will be returned.
What is a CONSULT?
500
The time the physician is present on the patient's hospital unit and at the bedside rendering services for the patient.
What is Intra Service Time?
500
National Authority which dictates rules and regulations governing Evaluation and Managment codes.
What is CMS - Centers of Medicare and Medicaid Services?