Mixed Deck — All COC Topics Flashcards

Modifier -KX is used in Medicare billing to indicate:

Answer: Specific required documentation is on file to support medical necessity

Modifier -KX attests that the specific coverage criteria for the billed item or service have been met and that the required documentation is on file.

Under the OIG Work Plan, which of the following would be a common audit target for outpatient coding?

Answer: High-frequency E/M code levels (e.g., predominantly billing 99215)

The OIG routinely targets providers who bill a disproportionately high frequency of the highest-level E/M codes, which may indicate upcoding.

Which modifier is appended to a CPT code to indicate that a procedure was performed on the right side of the body?

Answer: -RT

Modifier -RT (Right Side) is used to indicate a procedure was performed on the right side of the body.

A myocardial infarction (MI) occurs when:

Answer: Blood supply to part of the heart muscle is blocked, causing ischemic necrosis

An MI occurs when a coronary artery is blocked (usually by a thrombus), cutting off blood supply to a region of myocardium, causing ischemia and ultimately tissue necrosis.

What does the STARK Law (Physician Self-Referral Law) prohibit?

Answer: Physicians referring patients to entities where they have a financial interest for designated health services

The Stark Law prohibits physicians from referring Medicare/Medicaid patients to entities in which the physician or an immediate family member has a financial relationship, for designated health services.

The rotator cuff of the shoulder consists of which four muscles?

Answer: Supraspinatus, infraspinatus, teres minor, subscapularis

The rotator cuff is formed by four muscles — supraspinatus, infraspinatus, teres minor, and subscapularis — collectively stabilizing the glenohumeral joint.

Which of the following best describes 'medical necessity' in coding compliance?

Answer: Services must be appropriate to the diagnosis, evidence-based, and not excessive

Medical necessity requires that services are clinically appropriate for the diagnosis, consistent with evidence-based standards, and not excessive relative to the patient's condition.

When two or more physicians each perform a portion of a surgical team procedure, the appropriate modifier is:

Answer: -66

Modifier -66 (Surgical Team) is used when highly complex procedures require the concomitant services of several physicians, often of different specialties, plus other highly skilled, specially trained personnel.

Atherosclerosis refers to the buildup of which substance within arterial walls?

Answer: Plaque (lipids, calcium, and fibrous tissue)

Atherosclerosis is characterized by the accumulation of atherosclerotic plaques — composed of lipids, calcium, and fibrous tissue — within arterial walls, narrowing the vessel lumen.

In the context of musculoskeletal coding, what is the difference between a sprain and a strain?

Answer: Sprain = ligament injury; strain = muscle/tendon injury

A sprain involves stretching or tearing of a ligament (connecting bone to bone), while a strain involves injury to a muscle or tendon (connecting muscle to bone).

What is the format of a HCPCS Level II code?

Answer: One letter followed by four numbers

HCPCS Level II codes consist of one alpha character (A–V) followed by four numeric digits.

What distinguishes a consultation from a new patient visit in E/M coding?

Answer: Consultations require a request from another provider and a written report back

A consultation requires a written or verbal request from another provider and mandates that the consultant render a written opinion or report back to the requesting provider.

An established patient is seen in the office, and the physician makes an independent interpretation of an EKG during the visit. How is this reflected in MDM?

Answer: Counted as data reviewed under the 'amount and/or complexity of data' element

Independent interpretation of tests (such as an EKG) by the treating physician is counted as data reviewed under the MDM data element.

When coding an outpatient surgical procedure, how should postoperative complications managed in the office during the global period be reported?

Answer: No separate code — included in global surgical package

Routine postoperative follow-up visits are included in the global surgical package and should not be coded separately.

A patient is seen in the ED for acute exacerbation of COPD with acute bronchitis. How should these conditions be coded?

Answer: Code the combination code J44.0 (COPD with acute lower respiratory infection)

ICD-10-CM provides combination code J44.0 which captures COPD with acute lower respiratory infection, including acute bronchitis.

Which modifier is appended to an E/M code to indicate the service is unrelated to a postoperative period?

Answer: -24

Modifier -24 is used when an unrelated E/M service is provided by the same physician during a postoperative period.

In outpatient coding, a 'chronic condition' may be coded:

Answer: As many times as applicable to the encounter when it affects care

Chronic conditions are coded whenever they are relevant to and affect the management of the patient during the encounter.

When using total time to select an E/M level, what does 'total time' include?

Answer: All time on the date of encounter, including pre/post-visit activities

Under 2021 guidelines, total time for office E/M includes all physician/QHP time on the date of encounter: preparing, face-to-face, and post-visit documentation.

What is orchitis?

Answer: Inflammation of the testes

Explanation: Orchitis refers to inflammation of the testes, typically caused by an infection. It can result in pain, swelling, and discomfort in the affected testicle.

Which of the following is false?

Answer: The meninges from the inner layer to the outer layer are the dura mater, arachnoid, and pia mater.

Explanation: The meninges serve as a protective covering for the brain and the spinal cord. The meninges from the inner layer to the outer layer are the pia mater, arachnoid, and dura mater. The "dura mater" means "hard mother", and is the outer layer where the toughest layer is needed. In contrast, "pia mater" means "tender mother".