E/M Services
Established patient E/M, with 15 minutes of encounter time
What is code 99212?
Location, other than a hospital, SNF (or other facilities) where the physician/QHP routinely provides health examinations, diagnosis, and treatment of illness or injury on an ambulatory basis.
What is Place-of-Service 11?
This modifier identifies an unrelated procedure or service by the same provider during the postoperative period.
What is modifier -79?
Removal of impacted cerumen using irrigation/lavage.
What is CPT code 69209?
After the internal audit identifies the practice’s risk areas, the next step is to develop a method for dealing with those risk areas through the practice’s standards and procedures.
What are Practice Standards and Procedures?
The short term for the three components used for determining the level of medical decision making.
What is Diagnosis, Data and Risk?
Time limit for requesting a Redetermination, the first level of a Medicare appeal.
What is 120 days from the date of initial determination?
This modifier identifies services provided by a locum tenens physician.
What is modifier -Q6?
Maternity codes; usually global period does not apply.
What is global indicator MMM?
A practice that either directly or indirectly results in unnecessary cost to the Medicare program.
What is abuse?
Specific documentation required for every E/M service.
What is chief complaint?
A facility owned and operated clinic that is located beyond 250 yards of the main building but within 35 miles radius of the main campus.
What is Place-of-Service 19?
This modifier identifies a significant, separately identifiable E/M service by the same provider on the same day of a minor procedure or other service.
What is modifier -25?
Pneumococcal pneumonia, Influenza Virus, Hepatitis B and COVID-19.
What are vaccinations covered under the Medicare program?
Warnings, reprimands, probation, suspension and termination are options for what?
What is enforcing disciplinary standards through well-publicized guidelines?
Prolonged office E/M beyond the minimum required time for code 99215.
What is code 99417?
A communication tool used to clarify documentation in the medical record for accurate code assignment.
What is a Query?
This modifier identifies a CLIA waived test.
What is modifier -QW?
This NPI qualifier indicates that the provider listed in item 17 ordered the service/supply billed on the claim.
What is NPI qualifier DK?
When a practice determines it has detected a possible violation, the next step is to develop a corrective action plan and determine how to respond to the problem.
What is responding to detected offences and developing corrective action initiatives?
A chronic illness that is acutely worsening, poorly controlled or progressing with an intent to control progression.
Whit is a chronic illness with exacerbation, progression, or side effects of treatment?
Timely filing for a Medicare claim.
What is 365 days?
This modifier is used to identify a drug amount discarded/not administered to any patient.
What is modifier -JW?
CPT code(s) for standing AP X-rays of both knees, with a sunrise and lateral view of the left knee, obtained, and interpreted in the clinic.
What is code 73560-RT and 73562-LT?
Intentionally making false statements or representations of material facts in order to obtain some benefit or payment for which no entitlement would otherwise exist.
What is fraud?