Documentation and Billing Flashcards
7 cards from real CTP 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 and Billing flashcards as text
What is the primary purpose of documenting the 'chief complaint' in a telehealth SOAP note?
Answer: To establish medical necessity for the level of service billed
The chief complaint is fundamental to establishing medical necessity, which payers require to justify the billed E/M level for any service including telehealth.
A telehealth claim is submitted with the wrong Place of Service code. The payer denies it. What is the FIRST step the biller should take?
Answer: Correct the POS code and resubmit the claim within the payer's timely filing window
Administrative denials for coding errors like wrong POS codes are typically correctable by resubmitting with the accurate code, provided it is done within the payer's timely filing deadline.
Under CMS guidelines, which of the following patient locations was traditionally NOT eligible as an originating site for Medicare telehealth before COVID-19 waivers?
Answer: The patient's own home (for non-end-stage renal disease patients)
Prior to COVID-19 PHE waivers, the patient's home was generally not an approved Medicare originating site; patients had to travel to an approved facility in a rural area.
Which documentation element helps differentiate a new patient telehealth visit (99202–99205) from an established patient visit (99212–99215) when audited?
Answer: Evidence that no professional service was provided by the provider or group in the past 3 years
A new patient is defined as one who has not received a professional service from the provider or any other provider of the same specialty in the same group within the past 3 years.
A provider bills a 30-minute psychiatric telehealth session. Which CPT code family is most appropriate?
Answer: 90832–90838 (psychotherapy add-on codes)
CPT 90832 (30 minutes) is part of the psychotherapy codes used for interactive complexity sessions, appropriate for a 30-minute psychiatric therapy telehealth visit.
Which federal agency oversees and sets Medicare telehealth billing policies, including eligible services and provider types?
Answer: Centers for Medicare & Medicaid Services (CMS)
CMS is the federal agency responsible for administering Medicare and issuing coverage, coding, and billing rules for telehealth services under the Medicare program.
What does the term 'distant site' refer to in the context of Medicare telehealth billing?
Answer: The location of the rendering provider during the telehealth visit
The distant site is the location of the healthcare provider delivering the telehealth service, as defined by CMS for Medicare telehealth billing.