Medicare
What is covered for Medicare? Part A, Part B, Part D, and what is Part C?
Part A - Inpatient hospital, hospice, Part B - Office visits and outpatient services, Part D - Drugs, andPart C is Medicare Advantage Plans: If you have Part A and Part B, you can join a Medicare Advantage Plan, sometimes called “Part C” or an “MA plan.” This type of Medicare health plan is offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D).
How many characters in CPT?
Always 5
What type of anesthesia numbs the skin that is going to be treated?
Local - injected, or topical - applied to skin
Where are the ICD 10 CM guidelines found in the manual?
At the beginning of the manual and at the beginning of each chapter in the tabular for that section.
Where can you find a list of ROOT OPERATIONS?
In Appendix B of the ICD 10 PCS manual.
What is a MAC?
Medicare Administrative Contractor
How many characters in HCPCS?
Always 5
What type of anesthesia require intubation?
General/Endotracheal anesthesia
What is a "residual effect", "late affect", or "sequelae?
A condition that remains or develops after the acute phase of an illness or injury has passed.
What are the 5 main steps to the revenue cycle?
1) Provider treats the patient 2) A claim is created 3) The claim is sent to the ins co 4)The ins pays and the pmt is applied to pt account 5) The pt is billed the bal.
What is a RAC?
Recovery Audit Contractor
How many characters in ICD 10 CM?
Between 3 - 7 based on specificity
What type of anesthesia is used to "block" pain?
Regional anesthesia: Spinal, epidural, and nerve.
What is a combination code?
A single code to classify... 2 diagnoses, a diagnosis with an associated manifestation, or a diagnosis with an associated complication.
What's the difference between a "new" and an "established" patient?
New - hasn't been seen within 3 years
Estab - has been seen within 3 years
Define Fraud and Abuse
Fraud is intentional deception as a means to collect money.
Some examples of abuse are billing wrong codes, or not refunding overpayments to payer or patient
How many characters in ICD 10 PCS
Always 7
Where would you find the patient status modifiers and qualifying circumstance codes for anesthesia?
Before the anesthesia codes in the anesthesia guidelines pages of the CPT manual.
What is a manifestation code?
A disease process due to an underlying cause (i.e. anemia due to chemotherapy or cancer).
Explain Qualitative vs Quantitative
Qualitative = presence of a drug
Quantitative = how much of a drug
What is the main responsibility of coders?
To accurately code not only for data classification, but for appropriate reimbursement.
What are modifiers?
2 character codes that are added to CPT and HCPCS codes that add additional pertinent information regarding the circumstances of treatment.
Where would you find the modifiers to indicate who administered the anesthesia?
In the HCPCS book on the cover for quick reference.
Where is the best place to start if you are unsure about how to sequence multiple diagnosis codes in a complicated case?
The ICD 10 CM chapter guidelines.
Define the the following: Open fracture with open treatment? Closed fracture with closed treatment? Closed fracture with open treatment?
Open surgical treatment of fracture that broke skin
Closed fracture with manipulation
Closed fracture that requires an open surgery