FREE Certified Coding Associate Professional Questions and Answers
In response to a sizable worrisome nevus on her back, a 76-year-old woman went to her dermatologist's clinic. The nevus was removed by the dermatologist, who then sent it for analysis to the pathology lab. Due to the great size of the excision site, the patient experienced agony and was given pain medication. What two Medicare insurance components would the patient be required to pay for the dermatologist visit and the prescription costs?
The patient will be required to pay for the following two Medicare insurance components: B and D parts of Medicare. Medicare Part D pays pharmacy or prescription costs, which in this case would cover the patient's pain medication costs. Medicare Part B supports outpatient office visits, which in this case would cover the dermatologist's office visit costs. Medicare Part C is a combined program that combines Medicare A and B services while Medicare Part A exclusively covers inpatient services, such as inpatient hospital or hospice care.
In a worldwide package, which of the following is NOT normally included?
Typically, a global package does not include appointments for issues unrelated to the surgery. The surgical procedure itself, any follow-up appointments made throughout the global period, and appointments for issues relating to the surgical treatment are all included in global packages for surgical services. Whether they take place during the worldwide time or not, appointments for issues unrelated to the surgery are always subject to separate fees.
Typically, Tricare Prime patients are required to see a doctor:
Patients on Tricare are often required to visit doctors at their military hospital. The patient may be able to see a doctor off-site depending on their Tricare plan, but they usually have to go to the military hospital on post. If a patient has Tricare Prime Remote or a non-availability statement allowing them to see a doctor off-base, they can visit a private practice doctor.
When the words "separate procedure" appear after the code description in a CPT code, you should:
If a CPT code follows the code description with the words "separate procedure," you should only code for it if it was the only procedure carried out. Only if they are the only procedures conducted on that area of the body on the scheduled day can codes that are labeled as "separate procedures" be coded. The "separate procedure" code should be used if any further procedures were carried out on that portion of the body; otherwise, they are bundled into the principal procedure.
HIPAA stands for what?
The Health Insurance Portability and Accountability Act is known as HIPAA. HIPAA is not a group or association; it is a law passed by Congress. Those who disregard HIPAA regulations risk legal action. In order to make sure that everyone involved in patient healthcare abides by its rules, HIPAA also collaborates with other organizations.
After seeing Natasha in the office, the doctor determined that she had acute bronchitis and COPD. What ICD-9 diagnosis code would be appropriate for her condition?
491.22 is the right ICD-9 diagnosis code for Sylvia's condition. Only code 491.22 (Obstructive Chronic Bronchitis with Acute Bronchitis), in accordance with ICD-9 coding criteria, should be given. It is not required to assign code 466.0 as well (Acute Bronchitis). Code 491.21 (Obstructive Chronic Bronchitis with Acute Exacerbation), which solely denotes an exacerbation of the chronic bronchitis rather than acute bronchitis, is also unsuitable.
The GPCI factors the following factors into the RBRVS calculation:
The GPCI considers a practice's or provider's geographic location when calculating the RBRVS. Geographic Practice Cost Index, or GPCI, takes into account the relative pricing variations caused by location. The RBRVS (Resource Based Relative Value Scale), which determines an appropriate charge for procedures, includes the GPCI as one of its components.
Why is it important to include ICD-9 codes on a claim?
ICD-9 numbers are required on a claim since they describe the service's medical necessity. CPT codes are used to code charges as well as to report the procedures on a claim. The connection between a claim's procedures and diagnosis is made by code linkage. Code linking also shows that a service is medically necessary, although ICD-9 codes alone do not show a code linking because they need to be connected with a procedure code.
After an automobile accident, Mr. Cheng had to get checked out in order to file an insurance claim. Which modifier should be applied to the claim?The proper modifier to apply to the claim is modifier-32. When an operation is carried out at the request of an official authority, such as an auto or life insurance company, the modifier-32, required services, is used. Modifier-22 is ideal for an unusual procedural service, while Modifier-51 and Modifier-99 are utilized for various procedures and modifiers, respectively.
The proper modifier to apply to the claim is modifier-32. When an operation is carried out at the request of an official authority, such as an auto or life insurance company, the modifier-32, required services, is used. Modifier-22 is ideal for an unusual procedural service, while Modifier-51 and Modifier-99 are utilized for various procedures and modifiers, respectively.
What does it signify when a CPT code is preceded by the symbol #?
A CPT code that has the symbol # in front of it is one that is not listed in numerical order. Every time a numerical CPT code appears with the # symbol throughout the CPT book, it has been rearranged so that it is not included with the other CPT codes in that section in numerical order.
Which of the following is a CPT code from the surgery section?
Given that it is within the surgery section code range of 10021 to 69990, 1100 is a surgery section CPT code. A radiology section CPT code is 70020, a pathology and laboratory section CPT code is 85025, and an assessment and management section CPT code is 99212.
What ICD-9 code should be used to diagnose a history of personal heart attacks?
ICD-9 code 412 is the correct one to use when diagnosing someone with a history of heart attacks. Myocardial infarction is the medical term for a heart attack, and code 412 (Old Myocardial Infarction) is used when a patient has previously had one but is no longer showing any symptoms. It is also applied to patients who have recovered from a myocardial infarction. In either scenario, the proper code is 412.
What does a comA compliance plan's goal is to assist your office in adhering to the right coding and billing procedures. A compliance plan is a document, or set of documents, that outlines the HIPAA regulations that your practice must adhere to. The compliance plan describes, among other things, how frequently your office should audit, how staff should be instructed on confidentially, and how to choose a compliance manager to make sure that all compliance plan components are carried out.pliance plan serve?
A compliance plan's goal is to assist your office in adhering to the right coding and billing procedures. A compliance plan is a document, or set of documents, that outlines the HIPAA regulations that your practice must adhere to. The compliance plan describes, among other things, how frequently your office should audit, how staff should be instructed on confidentially, and how to choose a compliance manager to make sure that all compliance plan components are carried out.
An elderly 90-year-old man named Thiago has spent the last six months confined to his bed. The doctor observed a pressure ulcer on the back of his leg muscle during his most recent examination. The ulcer was already advanced, and the rear of the calf's epidermis had experienced partial thickness skin loss. Theodore's doctor advised that he be turned upright to reduce pressure on his calf muscle and avoid infection. If the pressure ulcer doesn't heal, your doctor in Thiago can suggest utilizing a healing chamber to stop the wound from getting worse. What kind of coding should be used to describe Theodore's pressure sore?
Thiago pressure ulcers should be coded with 707.09 and 707.22. ICD-9 coding recommendations state that pressure ulcers must be reported using at least two codes. The first code, in this example 707.09 (Pressure Ulcer of Other Sit), should identify the pressure ulcer, and the second code, in this case 707.22, should identify the stage in which the pressure ulcer is located (Pressure Ulcer Stage II).
What is the main diagnosis in an outpatient setting?
In an outpatient setting, the patient's primary diagnosis served as the basis for the visit and the day's services. The first code a doctor lists may not always be the primary diagnosis because the doctor may not be familiar with the coding standards. Although not all diseases result in pain, the issue that causes the patient the most discomfort will only be the primary diagnosis if it is the reason the patient needs care. Additionally, diagnosis codes have no bearing on reimbursement; only operation codes do.
In preparation for a kidney transplant, a 20-month-old baby with end-stage renal illness was getting dialysis twice a week. The patient had dialysis once a day for the last month of his life. The period of dialysis went from June 1 to June 14. Daily face-to-face counseling about the patient's care and ESRD status was provided to the patient's parents. Which code is appropriate for the patient's dialysis treatment?
The patient's dialysis care should be coded with 90967 (X14) (ESRD-related Services for Dialysis Less than an Full Month of Service, Per Day; for Patients Younger than 2 Years of Ages). Because the patient only got dialysis care from June 1 to June 14, the code 90967 (X14) is utilized. In addition, code 90967 (X14), which refers to the 14 separate days of service, must be reported with 14 units.