Documentation & Record Keeping Flashcards
7 cards from real CPT practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Documentation & Record Keeping flashcards as text
A prior authorization for a prosthetic device expires before delivery is completed. What is the correct action?
Answer: Request a new or extended authorization before delivery
Delivering and billing for a device after prior authorization has expired can result in claim denial and fraud allegations; a new authorization must be obtained.
Which HCPCS code category is used for most lower-limb prosthetic devices billed to Medicare?
Answer: L codes
L codes (L5000–L5999) are the HCPCS Level II codes designated for lower-limb prosthetic devices.
What is the purpose of a functional outcomes assessment tool like the PLUS-M in prosthetic documentation?
Answer: To objectively measure the patient's prosthetic mobility
The PLUS-M (Prosthetic Limb Users Survey of Mobility) quantifies a patient's functional mobility, supporting clinical justification in the medical record.
When a prosthetic component is replaced under warranty, which documentation is still required?
Answer: A new prescription and updated medical necessity documentation
Even warranty replacements require updated documentation including a new or reaffirmed prescription and evidence of continued medical necessity.
In prosthetic records, 'episode of care' documentation typically ends when:
Answer: The patient achieves functional goals or is discharged
An episode of care is closed when the patient achieves stated functional goals or is formally discharged from prosthetic care.
A technician notices that a co-worker has been entering fabrication times that appear inflated. The correct response is to:
Answer: Report the concern through the facility's compliance process
Suspected fraudulent documentation must be reported through the facility's compliance or ethics reporting process to protect the patient and organization.
Which of the following best supports the medical necessity of a dynamic response prosthetic foot?
Answer: Documented functional goals requiring energy return during ambulation
Documented functional goals and activity level expectations are the clinical basis for justifying an energy-storing/returning foot over a standard device.