1
Durable medical equipment (DME), such as wheelchairs, is reported using
HCPCS Codes
In CPT, a lightning bolt symbol next to a code indicates a(n) ________.
code pending FDA approval
How many key components are there when evaluating an E/M code?
3
What type of coding uses a procedure code that provides a higher reimbursement rate than the correct code?
upcoding
What are the three parts of an RBRVS fee?
uniform value, GPCI, and conversion factor
How many characters do HCPCS level II codes have?
5
In CPT, a single code grouping laboratory tests is called a _____.
panel
Most of the surgery section is organized by:
body system
What is providing free services to other physicians and their families?
professional courtesy
The relationship between the diagnosis and the treatment provided is the basis for
medical necessity
How many characters do ICD codes have?
3 to 7
What kinds of services support treatment, like rehabilitation, occupational therapy, and nutrition therapy?
ancillary services
What is separately reporting anything that is included in the bundled code?
unbundling
What type of audit is performed internally before claims are reported?
prospective
What is the fixed prepayment for each plan member in a capitation contract called?
In CPT, what do Category II codes report?
services to track performance measurements
How many CPT codes are required to report an immunization?
2
Who regulates which tests can be complete in an in-office laboratory setting?
CLIA
What type of audit is performed internally after claims are submitted?
retrospective
Who audits Medicare claims to determine if there is an opportunity to recover incorrect payments from previously paid services?
recovery audit contractor
In CPT, what do Category III codes report?
emerging technology, services, and procedures
Which symbol means moderate sedation is part of the procedure performed?
Bullet inside a circle (target)
What type of coding uses diagnoses that are not as specific as possible?
truncated coding
What type of external audit is performed by payers before claims are processed?
prepayment
If balance billing is permitted under a plan, the insured must:
Pay for the difference between the provider's charge and the allowed charge