Anatomy & Physiology
What is the largest organ in the human body?
Skin
How does RAF scoring differ between prospective and concurrent models?
Prospective uses previous year's data; concurrent uses current year data.
What is the rule when coding for uncertain diagnosis in an outpatient setting?
Code the symptoms, not the suspected conditions
99202-99499
What must always be present in the documentation to support a diagnosis code?
Provider's clinical Validation(MEAT)
Which Chamber of the heart receives oxygenated blood from the lungs?
Left atrium
What is the "lookback period" used for CMS-HCC data submission?
Jan1- Dec 31 of the previous year.
What do you code first: Acute or chronic condition?
Acute, if both are documented and treated
What does CPT stand for?
Current Procedural Terminology
How long should medical records be retained on average for compliance?
Usually 7-10 years
The sigmoid colon is part of which larger section of the colon?
The large intestine/Distal colon
What type of encounter cannot be used to submit HCCs to CMS
Telephonic or administrative-only encounters(no face-to face provider Visit)
How is the diagnosis coded when a patient has anemia due to chronic Kidney disease?
Code first CKD (N18.x) then D63.1 for anemia in CKD
True or False: CPT codes describe the diagnosis?
False-they describe procedure or services.
What federal law prohibits submitting false claims for payment?
False Claims Act
What is the function of the function of the alveoli in the lungs?
Gas exchange(oxygen and carbon dioxide)
What is the minimum documentation required for a diagnosis to count towards risk adjustment?
MEAT: Monitored, Evaluated, Assessed/Addressed, Treated
How would you code drug-induced parkinsonism due to long-term use of antipsychotic medication
Code both the manifestation(Parkinsonism) and the cause (adverse effect)
G21.11-other drug-induced secondary parkinsonism
T43.505A-Adverse effect of unspecified antipsychotics and neuroleptics, initial encounter
Which CPT code category includes temporary codes for emerging technology?
Category III codes
What federal law prohibits referrals where there's a financial relationship between provider and entity?
The Stark law.
The "SA node" in the heart is also known as what?
The natural pacemaker
What does "no-offset by risk group" mean when an HCC is newly captured?
It increases the risk score because it's not replaced by a previous or lower HCC.
A patient returns for follow-up care for a nondisplaced fracture of the right fibula shaft, routine healing.
S82.424D-Nondisplaced fracture of shaft of right fibula, subsequent encounter for routine healing.
Rationale: 7th character "D" = subsequent encounter for routine healing.
What is the purpose of modifier in CPT coding?
To provide additional information about teh service performed.
What law prohibits offering paying or receiving anything of value for patient referrals
The Anti-Kickback statute