New visit
Otherwise healthy new patient complains of intermittent light-headedness. You reveiw history and then have an ECG done and then review the tracing, which is normal. You order a Holter monitor and schedule the patient for a follow-up visit in one week
What is a level 3 visit (99203)
A patient comes in for an injection of testosterone cypionate IM. He is brought back and the nurse gives him his shot. He is already an established patient and does not require a visit from the physician.
What is a level 1 visit
What is the ICD -10 code for primary hypertension
I10
assigning an inaccurate billing code to (a medical procedure or treatment) to increase reimbursement
What is upcoding
Covers inpatient care in hospitals, including critical access hospitals, and skilled nursing facilities It also helps cover hospice care and some home health care
What is medicare Part A
Patient presents to the office with history of hypothyroidism. Patient is a new patient who was previously on Synthroid 75 mcg with her PCP and returns as her TSH at 5.0. She has a history of hypertension, hyperlipidemia, and DM type 2. She states she still feels fatigued and tired all day. You decide to increase her Synthroid to 87.5mcg, and have her follow up in 6-8 weeks
What is level 4 99204
A 6 year old established boy presents a rash to bilateral arms. Patient's mother states he was out playing the yard yesterday. Patient presents with erythematous linear rash with few vesicles. You diagnosis patient with contact dermitis from poison ivy
level 2 (99212)
What is the ICD-10 code for type 2 diabetes
E11.9
Codes that represent treatments and procedures that are performed by a physician in a 5-digit format.
What are CPT codes
Medicare prescription drug coverage
What is medicare part D
Patient presents to clinic alert and oriented. Patient conversing well, with no acute distress. Patients vitals are 125/82, P 97, RR 19, 98.7. Upon examination of patient, oropharynx is clear with no erythema or edema. Lungs CTA. Patient has clear exudate from nasopharynx. Patient diagnosed with common cold. You prescribe Tylenol PRN, rest, and to push fluids.
Level 2 (99202)
Patient presents to endocrine office with history of diabetes type 2, Hyperlipidemia, hypothyroid, and hypertension. Patient states his blood sugars have been in the 150s in the morning and around the 200s before dinner. Patient is currently taking atorvastatin 20mg, levothyroxine 50mcg, lisinopril 10mg and Farxiga 5mg. Vitals are 150/90, HR 72, RR 18, Temp 98.7. PE unremarkable. You decide to increase his lisinopril to 20mg and increase his farxiga to 10mg. Labs: BUN. 13 Creat. 0.9 Hgb A1C 7.3, LDL 100. You have the patient follow up in 1 month with repeat labs. Have them continue lifestyle modifications including diet and exercise
What is level 4 99214
What is the ICD-10 code for obesity
E66.09
insufficient documentation that fails to assign levels of services to the highest levels of specificity. Often practiced as a defensive tactic against denied claims, E/M audits, and (incorrectly) non-compliance designations.
What is downcoding
Coverage for low income, pregnant women, and children
what is medicaid
Patient presents to office to establish care with a local physician after moving to the area. Patient has a history of diabetes, high cholesterol, hypertension, and obesity. Patient states his BP and DM have been well controlled. Patient has a history of CAD as well with stent placement. Patient is currently on Atenolol 25mg, Ozempic 0.5mg, Farxiga 10mg, Lisinopril 10mg, and Atorvastatin 20mg. After review of history, PE and labs, Patient has well controlled hypertension, stable dyslipidemia, stable CAD, and HGBA1C is 6.8. You plan to continue current medications, and have pt follow up in 3 months with repeat labs, including CBC, renal, LFTs, and microalbumin/Creatine.
What is level 4 (99204)
Patient presents to your office for a follow-up CHF. He has a history of significant ischemic cardiomyopathy with an ejection fraction of 30%. Hypertension has been well controlled on current medications, but the patient has noted worsening lower extremity edema over the past one to two weeks. He also complains of severe SOB over the past three days. CAD has been stable with no active chest pain. The patient states he has been compliant with medications, but has not been watching his salt intake carefully.
Meds: Lasix 40mg BID, KCL 20 BID, Lisinopril 10mg Daily, Coreg 6.25mg PO BID, Imdur 30mg PO daily, ASA 81 mg Daily.
PE: resp distress at rest, but is able to speak full sentences, Vitals 180/90, HR 64. Positive JVD, Lungs- bibasilar crackles, CV- RRR. Extremities- 3+ bilateral lower extremity edema, no digital cyanosis
Labs BUN 32, Creat 1.9, HCO3 24, K 3.8, HGB 12
You decide to increase Lasix to 80mg PO bid x 3 days, increase KCL to 30 BID, repeat renal profile in three days, teach patient the importance of low sodium diet. Return visit in three days with labs.
What is Level 99215
40 minutes of face-to face time
High complexity medical decision making
At least two of
Four problem points
Four data points
High risk
Expanded problem focused exam
What is the ICD-10 code for UTI
N39.0
Type of health insurance wherein the provider is paid for every service they perform. The patient can choose whatever hospitals and physicians they want to receive care in exchange for higher deductibles and co-pays.
what is fee- for service
helps cover doctors' services and outpatient care. It also covers some other medical services that the other parts do not cover, such as some of the services of physical and occupational therapists, and some home health care.
What is medicare part B
this song written by James Pierpoint was written for Thanksgiving not Christmas. It was also the first song sung by astronauts in space in 1965
What is Jingle Bells
Patient presents with complaints of knee pain and has a history of osteoarthritis. Patient has mild swelling to left knee with pain with passive movement. Patient previously on Tylenol 2-3x per day. You decide to start Ibuprofen 400mg PO TID and have the patient come back in 2-3 weeks if no improvement.
What is Level 3 99213
Problem focused Exam
General appearance inspection or palpation
Assessment of ROM with notation of pain, crepitation
Inspection of skin
Medical Decision- Making
Two problem points
Two data points
Low risk
What is the ICD-10 code for upper respiratory infection
J06.9
fraudulent practice of ascribing more than one code to a service or procedure on a superbill or claim form when only one is necessary.
What is unbundeling
This plan requires you to select a primary care physician (PCP) who acts as "gatekeeper."
what is and HMO network