Knowledge Skill Flashcards

A patient is seen for a sprained ankle sustained while playing basketball. Under ICD-10-CM, which code category captures the external cause of injury?

Answer: Y93

Category Y93 captures activity codes, such as playing basketball, as external cause supplemental information.

Which CPT code range is used for anesthesia services?

Answer: 00100–01999

CPT anesthesia codes are found in the 00100–01999 range and are reported by anesthesiologists and CRNAs.

When a patient has a condition that is both acute and chronic, ICD-10-CM guidelines instruct the coder to:

Answer: Assign a single combination code if available, otherwise code both

ICD-10-CM guidelines direct coders to use a combination code if one exists; otherwise, sequence the acute condition first.

What does HCPCS Level II primarily cover that CPT does not?

Answer: Durable medical equipment, supplies, and non-physician services

HCPCS Level II codes cover items like DME, orthotics, prosthetics, drugs, and ambulance services not found in CPT.

Modifier -59 is used to indicate:

Answer: A distinct procedural service not typically reported together with another code

Modifier -59 identifies procedures/services not normally reported together but appropriate under the circumstances.

In CPT, a 'separate procedure' designation means:

Answer: The procedure may be billed alone but not with related services on the same day

A 'separate procedure' is integral to a larger service and should not be billed separately when performed with related procedures.

Which federal law primarily governs fraudulent billing practices in healthcare, including false claims submitted to Medicare and Medicaid?

Answer: The False Claims Act

The False Claims Act imposes liability on individuals and companies that knowingly submit false claims to federal healthcare programs.