2. During an emergency room visit, Sally was diagnosed with pneumonia. She was admitted to the hospital observation unit and treated with 500 mg of
|
|
- Dayna Leonard
- 5 years ago
- Views:
Transcription
1 1. A patient received a 12 sq. cm. dermal tissue substitute of human origin, dermagraft. This treatment was completed due to a burn on the abdomen. How would you report the supply? a. Q4107x12 b. Q4105 x12 c. Q4106x12 d. Q4111x12 2. During an emergency room visit, Sally was diagnosed with pneumonia. She was admitted to the hospital observation unit and treated with 500 mg of Zithromax through an IV route. How would you report the supply of this drug? a. J0456 b. Q0144 c. J1190 x 2 d. J2020 x 2 3. Alice had to have a replacement for her soft interface in her protective helmet. How would you report this supply? a. A8004 b. A8000 c. A8001 d. A Which code describes an addition to the lower extremity, knee disarticulation, and leather socket? a. L5624 b. L5640 c. L5105 d. L5850 1
2 5. A nursing home s x-ray machine was not working. A portable x-ray machine and personnel was transported to the nursing home to test nine patients. How would you report the transportation of equipment? a b. S9999 c. R0070 x 9 d. R What modifier would best describe a blepharoplasty to the upper right eyelid? a. E1 b. 51 c. E3 d. RT 7. When using the CPT index to locate procedures, which of the following are considered primary classes for main entries? a. Procedure or service; organ or other anatomic site; condition; synonyms, eponyms, and abbreviations b. Abbreviations; signs and symptoms, anatomic site; and code assignment c. Conventions; code ranges; modifying terms d. Procedure or service; modifiers; clinical examples; and definitions 8. Which of the following code and modifier combinations are correct? a. 0165T-25 b c d. None of the above year-old Medicare patient, who has a history of ulcerative colitis, presents for a colorectal cancer screening. The screening is performed via barium enema. What HCPCS Level II code is reported for this procedure? 2
3 A. G0106 B. G0105 C. G0120 D. G The patient presents to the office for an injection. Joint prepped using sterile technique. Muscle group location: gluteus maximus. Sterilely injected with 1 cc Kenalog-40, 2 cc Marcaine and 2 cc lidocaine 2%. Sterile bandage applied. Choose the HCPCS Level II code for this treatment. A. J3301 x 4 B. J3301 C. J3300 x 40 D. J year-old-male sustained a Colles fracture in which the pediatrician performs an application of short arm fiberglass cast. Identify the HCPCS Level II code that would be reported. A. Q4012 B. A4580 C. A4570 D. Q year-old-female is having an IUD insertion. The IUD type: Mirena. The HCPCS Level II code is: A. S4989 B. J7302 C. A4264 D. J Local coverage decisions are published to give providers information on which of the following? A. Information on modifier use with procedure codes B. A list of CPT and HCPCS Level II codes representing covered procedures C. Fee schedule information listed by CPT code D. Medical necessity exclusions to coverage 14. What is the HCPCS Level II code for wound closure using tissue adhesive(s) only? A. A6250 B. G0168 C. A4452 D. A4450 3
4 15. A patient has an insulin pump of 100 units. The pump is filled. Which code reports the supply? A. J1817 B. J1815 x 20 C. J1817 x 2 D. J A 78-year-old patient, with known arrhythmia, presented to an outpatient clinic for the insertion of a cardiac event recorder. What is the proper HCPCS Level II code for this device? A. C1767 B. C1764 C. C1777 D. C The physician performed manipulation of a closed fracture of the distal radius on a 12- year-old male. He placed a short arm fiberglass cast. What is the HCPCS Level II code for the supply? A. Q4012 B. Q4011 C. Q4010 D. Q c ANSWERS 2. a You can find this answer by referring to the Table of Drugs in the HCPCS Level II manual. 4
5 3. a You can find this answer in the index of the HCPCS Level II manual under Helmet, head. 4. b You can find this answer in the index of the HCPCS Level II manual under Prosthetic additions, lower extremity. Once you find this code range, review the codes to determine the correct code. 5. d You can find this answer in the index HCPCS Level II manual under Transportation, x- ray (portable). Review of code R0075, indicates... more than one patient seen. 6. c Modifier -E3 describes upper right eyelid. You can find this modifier in the HCPCS Level II manual or the front inside cover of the CPT Professional Edition. 7. a You can find the four primary classes of main entries listed at the beginning of the index section in the CPT Professional Edition. 8. d The coding concepts for modifiers are complicated. In this question none of the codes and modifier combinations are correct. All of the codes listed in this question are add-on codes. Modifier descriptors are also incorrect with the codes listed: -25 could be attached only to an evaluation and management code, -21 could only be appended to the highest level evaluation and management code within a given category, and modifier -51 should not be attached to add-on codes. See the definitions of these modifiers in Appendix A of the CPT Professional Edition. 9. C This patient is qualified by Medicare to be a high risk by having a history of ulcerative colitis. A note is found under code G0105 that states: An individual with ulcerative enteritis or a history of a malignant neoplasm of the lower gastrointestinal tract is considered at highrisk for colorectal caner, as defined by CMS. This eliminates multiple choices A and D. The screening was performed via barium enema eliminating multiple choice B. 10. A The injection given is Kenalog eliminating multiple choices C and D. Kenalog-40 provides 40 mg of triamcinolone acetonide. Code J3301 is reported for 10 mg so it will have to be reported four times to cover 40 mg. If 1cc Kenalog-10 was given, J3301 is only reported once since that provides 10 mg of triamcinolone acetonide. 11. A The patient being 10 years-old that is getting a short arm fiberglass cast guides you to code Q
6 12. B HCPCS code J7302 is reported specifically for the Mirena intrauterine contraceptive device. 13. D Local Coverage Decisions are Medicare Administrative Contractor rules that link procedure codes to diagnoses that are not considered medically necessary for a specific procedure. Most LCDs also provide a list of diagnosis codes for which a procedure may be covered; however, because other issues factor into payment, coverage is not guaranteed. Modifier guidelines and fee schedule information is included in the annual Medicare Physician Fee Schedule. 14. B. Look up the description for each code. G0168 reports a wound closure using tissue adhesives. 15. C. In this scenario we are selecting a code to report the refill of insulin pump. J1815 reports insulin but not for a pump. J1817 is insulin through a pump which is the correct code. J1817 reports 50 units. Two units are reported to account for 100 units of the insulin. 16. B. The only code provided as an option that describes an event recorder is C1764. The other code options are for generators, pacemakers, or cardioverter-defibrillators. 17. C. To select the correct code for casting supplies, you need to know the type, material and age of the patient. In this case the patient is a 12-year-old, which eliminates Q4011 and Q4012. The cast is made of fiberglass, which makes Q4010 the correct answer. 6
Sample page. Contents
CODING COMPANION 2018 Oncology/Hematology A comprehensive illustrated guide to coding and reimbursement POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years. Visit optum360coding.com.
More informationCoding and Payment Guide for Chiropractic Services. A comprehensive coding, billing, and reimbursement resource for chiropractic services
Coding and Payment Guide for Chiropractic Services A comprehensive coding, billing, and reimbursement resource for chiropractic services 2014 Contents Introduction...1 Coding Systems... 1 Claim Forms...
More informationNY EPO OA 1-09 v Page 1
PLAN FEATURES Deductible (per calendar year) Member Coinsurance (applies to all expenses unless otherwise stated) Maximum Out-of-Pocket Limit (per calendar year) Lifetime Maximum (per member lifetime)
More informationChapter. CPT only copyright 2009 American Medical Association. All rights reserved. 31Radiation Therapy Services
Chapter 31Radiation Therapy Services 31 31.1 Enrollment...................................................... 31-2 31.2 Benefits, Limitations, and Authorization Requirements...................... 31-2
More informationChapter. CPT only copyright 2008 American Medical Association. All rights reserved. 30Radiation Therapy Services
Chapter 30Radiation Therapy Services 30 30.1 Enrollment...................................................... 30-2 30.2 Benefits, Limitations, and Authorization Requirements...................... 30-2
More informationHC 1930 HC 1930 ICD-9-CM III/CPT Coding II
South Central College HC 1930 HC 1930 ICD-9-CM III/CPT Coding II Course Information Description Total Credits 4.00 Total Hours 80.00 Types of Instruction This course is a continuation of HC 1920, 1925,
More informationEmpire BlueCross BlueShield Professional Reimbursement Policy
Subject: Global Surgery NY Policy: 0012 Effective: 02/01/2014 05/31/2014 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria
More informationLong Term Care Hospital Clinical Coverage Policy No: 2A-2 Services (LTCH) Amended Date: October 1, Table of Contents
Long Term Care Hospital Clinical Coverage Policy No: 2A-2 Services (LTCH) Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements...
More informationEssentials for Clinical Documentation Integrity 2017
Essentials for Clinical Documentation Integrity 2017 Prepared and Published By: MedLearn Publishing A Division of Panacea Healthcare Solutions, Inc. 287 East Sixth Street, Suite 400 St. Paul, MN 55101
More informationGLOBAL DAYS POLICY. Policy Number: SURGERY T0 Effective Date: January 1, 2018
GLOBAL DAYS POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: SURGERY 011.37 T0 Effective Date: January 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE LINES OF BUSINESS/PRODUCTS...
More informationHealth Informatics. Health Informatics professionals treat technology as a tool that helps patients and healthcare professionals.
Health Informatics Health Informatics professionals treat technology as a tool that helps patients and healthcare professionals. 3.02 Understand health informatics 2 Health Informatics A career area that
More informationPayment Policy: Problem Oriented Visits Billed with Preventative Visits
Payment Policy: Problem Oriented Visits Billed with Preventative Visits Reference Number: CC.PP.052 Product Types: ALL Effective Date: 11/1/2017 Last Review Date: Coding Implications Revision Log See Important
More informationGlobal Days Policy. Approved By 7/12/2017
Global Days Policy Policy Number 2018R0005A Annual Approval Date 7/12/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible for submission of accurate
More informationThe World of Evaluation and Management Services and Supporting Documentation
The World of Evaluation and Management Services and Supporting Documentation Presented by Cahaba Government Benefit Administrators, LLC Provider Outreach and Education May 14, 2009 Disclaimers Disclaimer
More informationCLINICAL MEDICAL POLICY
CLINICAL MEDICAL POLICY Surveillance of Implantable or Wearable Cardioverter Policy Name: Defibrillators (ICDs): Office, Hospital, Web, or Non-Web Based (L34087) Policy Number: MP-052-MC-KY Responsible
More informationSummary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx]
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits [Silver Access+ HMO 1750/55 OffEx] [Silver Local Access+ HMO 1750/55 OffEx] Group Plan HMO Benefit
More informationSummary of Benefits Platinum Trio HMO 0/25 OffEx
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits Platinum Trio HMO 0/25 OffEx Group Plan HMO Benefit Plan This Summary of Benefits shows the amount
More informationCoding Analysis Related to Commercialization of the XPANSION Skin Grafting Instruments Provided by The Institute for Quality Resource Management
The codes provided would be recognized as active payable codes by The Centers for Medicare and Medicaid Services (CMS) and private insurance as well. The payment amounts will vary for private insurance
More informationtoday! Visit or call 800/
The bestselling Certified Coder Boot Camp is now available online! Register today! Visit www.hcprobootcamps.com or call 800/750-0584. Register 30 days in advance and save $200! Call HCPro at 800/750-0584
More informationNon-Chemotherapy Injection and Infusion Services Policy, Professional
Non-Chemotherapy Injection and Infusion Services Policy, Professional Policy Number Annual Approval Date 3/14/2018 Approved By Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy
More informationSummary of Benefits Platinum Full PPO 0/10 OffEx
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits Platinum Full PPO 0/10 OffEx Group Plan PPO Benefit Plan This Summary of Benefits shows the amount
More informationPayment Policy: High Complexity Medical Decision-Making Reference Number: CC.PP.051 Product Types: ALL
Payment Policy: High Complexity Medical Decision-Making Reference Number: CC.PP.051 Product Types: ALL Effective Date: 6/2017 Last Review Date: See Important Reminder at the end of this policy for important
More informationSee the Time chapter for complete instructions on how to code using time as the controlling factor when selecting an E/M code.
2015 EM Survival Guides Chapter 4: Initial Hospital Care (99221-99223) You should select the appropriate-level initial hospital care code (99221-99223) using the key E/M criteria of history, examination
More informationPayment Policy: Assistant Surgeon Reference Number: CC.PP.029 Product Types: ALL
Payment Policy: Reference Number: CC.PP.029 Product Types: ALL Effective Date: 01/01/2014 Last Review Date: 03/01/2018 Coding Implications Revision Log See Important Reminder at the end of this policy
More informationUniCare Professional Reimbursement Policy
UniCare Professional Reimbursement Policy Subject: Global Surgery Policy #: UniCare 0012 Adopted: 07/15/2008 Effective: 08/01/2017 Coverage is subject to the terms, conditions, and limitations of an individual
More informationTop 10 audio questions
Top 10 audio questions Question 1 Scenario: A patient is admitted to the ED for acute abdominal pain. The documentation states that he receives the following: Infusion normal saline, 22:30 Zofran IV push,
More informationOBSERVATION CARE EVALUATION AND MANAGEMENT CODES POLICY
OBSERVATION CARE EVALUATION AND MANAGEMENT CODES POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 232.10 T0 Effective Date: March 1, 2017 Table of Contents Page INSTRUCTIONS
More informationPROFESSIONAL MEDICAL CODING AND BILLING WITH APPLIED PCS LEARNING OBJECTIVES
The Professional Medical Coding and Billing with Applied PCS classes have been designed by experts with decades of experience working in and teaching medical coding. This experience has led us to a 3-
More informationEmpire BlueCross BlueShield Professional Commercial Reimbursement Policy
Subject: Global Surgery NY Policy: 0012 Effective: 10/01/2016 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria listed below.
More informationAnesthesiA. a P2, b P2, c , 00834, P2. d
AnesthesiA 1. An anesthesiologist provides general anesthesia for a 72-year-old patient with mild systemic disease who is undergoing a ventral hernia repair. How would you report the anesthesia service?
More informationICD 10 Preparation for NSMM
This document explains regulation changes coming in 2014 that will impact how we collect and document clinical appropriateness using diagnosis codes (ICD-9 conversion to ICD-10). Please familiarize yourself
More information2006 Clinical Coding Workout 5/3/2006 MISSING QUESTIONS Chapter 5, Intermediate Ambulatory Page 1
Chapter 5, Intermediate Ambulatory Page 1 CPT Modifier Use 5.81. Dr. Raddy, staff radiologist, interprets a chest x-ray that was obtained in the hospital Radiology Department. Dr. Raddy is contracted with
More informationOptima Health Provider Manual
Optima Health Provider Manual Supplemental Information For Ohio Facilities and Ancillaries This supplement of the Optima Health Ohio Provider Manual provides information of specific interest to Participating
More informationAnthem Blue Cross and Blue Shield Commercial Professional Reimbursement Policy
Subject: Global Surgery IN, KY, MO, OH, WI Policy: 0012 Effective: 01/01/2018 Coverage is subject to the terms, conditions, and limitations of an individual member s programs or products and policy criteria
More informationCoding Companion for Primary Care. A comprehensive illustrated guide to coding and reimbursement
Coding Companion for Primary Care A comprehensive illustrated guide to coding and reimbursement 2009 Contents Getting Started with Coding Companion... i Integumentary...1 Breast...67 General Musculoskeletal...68
More informationModifier -25 Significant, Separately Identifiable E/M Service
Manual: Policy Title: Reimbursement Policy Modifier -25 Significant, Separately Identifiable E/M Service Section: Modifiers Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM028 Last Updated:
More informationSummary of Benefits Full PPO Savings Two-Tier Embedded Deductible 1500/2700/3000
Summary of Benefits Full PPO Savings Two-Tier Embedded Deductible 1500/2700/3000 Group Plan PPO Savings Benefit Plan This Summary of Benefits shows the amount you will pay for Covered Services under this
More informationUNIVERSITY OF MICHIGAN BZK Effective Date: 01/01/2018
UNIVERSITY OF MICHIGAN 68712000 0070051870000-06BZK Effective Date: 01/01/2018 This is intended as an easy-to-read summary and provides only a general overview of your benefits. It is not a contract. Additional
More informationSummary of Benefits CCPOA (Basic) Custom Access+ HMO
Blue Shield of California is an independent member of the Blue Shield Association Summary of Benefits CCPOA (Basic) Custom Access+ HMO CCPOA Effective January 1, 2019 HMO Benefit Plan This Summary of Benefits
More informationProcedure Codes Assigned to Surgical Benefit Categories
Manual: Policy Title: Reimbursement Policy Procedure Codes Assigned to Surgical Benefit Categories Section: Surgery Subsection: None Date of Origin: 1/1/2000 Policy Number: RPM023 Last Updated: 4/5/2017
More informationMember Services: Authorizations: Option #2 Authorization Fax:
Allergy 100% covered Office visit $10 co-pay 100% covered Allergy injections no co-pay Immunotherapy or other therapy -no co-pay Cardiac Rehab 100% covered 100% covered 100% covered Contraceptives Covered
More informationIMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY
Global Surgery Policy Number GLS03272013RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 04/09/2014 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to UnitedHealthcare
More informationModifiers 58, 78, and 79 Staged, Related, and Unrelated Procedures
Manual: Policy Title: Reimbursement Policy Modifiers 58, 78, and 79 Staged, Related, and Unrelated Procedures Section: Modifiers Subsection: None Date of Origin: 9/22/2004 Policy Number: RPM010 Last Updated:
More informationALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-14 FAMILY PLANNING TABLE OF CONTENTS
Medicaid Chapter 560-X-14 ALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-14 FAMILY PLANNING TABLE OF CONTENTS 560-X-14-.01 560-X-14-.02 560-X-14-.03 560-X-14-.04 560-X-14-.05 560-X-14-.06 560-X-14-.07
More informationGOLD 80 HMO NETWORK 1 MIRROR
GOLD 80 HMO NETWORK 1 MIRROR Summary of Benefits Group An independent member of the Blue Shield Association (Intentionally left blank) Gold 80 HMO Network 1 Mirror Summary of Benefits The Summary of Benefits
More informationSCOPE OF PRACTICE PGY 1-6
PGY1 Complete history and physical on each patient admitted as assigned by the attending surgeon. Participate in daily ward rounds. Assist operating surgeons and senior residents in the operating room
More informationSample page. Podiatry. A comprehensive illustrated guide to coding and reimbursement CODING COMPANION
CODING COMPANION 2018 Podiatry A comprehensive illustrated guide to coding and reimbursement POWER UP YOUR CODING with Optum360, your trusted coding partner for 32 years. Visit optum360coding.com. Contents
More informationInappropriate Primary Diagnosis Codes Policy
Policy Number 2017R0122H Inappropriate Primary Diagnosis Codes Policy Annual Approval Date 11/8/2017 Approved By Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible for submission
More information6/14/2017. Evaluation and Management Coding. Jeffrey D. Lehrman, DPM, FASPS, MAPWCA
Evaluation and Management Coding Jeffrey D. Lehrman, DPM, FASPS, MAPWCA APMA Coding Committee APMA MACRA Task Force Expert Panelist, Codingline Fellow, American Academy of Podiatric Practice Management
More informationSkilled nursing facility visits
Modified Premier HMO 20 Non Union This Summary of Benefits is a brief overview of your plan's benefits only. For more detailed information about the benefits in your plan, please refer to your Certificate
More informationBilling Guide Hospital Outpatient Department (HOPD and ASC)
Billing Guide 2018 Hospital Outpatient Department (HOPD and ASC) Osiris Reimbursement Hotline Phone: 866-988-3491 Fax: 866-304-6692 443-472-4274 443-545-1705 Osiris Customer Support Phone: 888-674-9551
More informationSPECIALTY SPECIFIC OBJECTIVES
Family Medicine Residency Internal Medicine In-house II Rotation Rotation Goal Admission, evaluation, treatment and appropriate specialty consultation of adult hospitalized patients from either the ER,
More information8/19/2017. The OIG Report
This presentation was created by me with the best intentions and believable resources. I however am not a lawyer, doctor or self-proclaimed expert, but I have watched plenty on TV. The information and
More informationGold Access+ HMO 500/35 OffEx
An Independent Member of the Blue Shield Association Gold Access+ HMO 500/35 OffEx Benefit Summary (For groups 1 to 100) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective
More informationCoding Guidelines for Certain Respiratory Care Services January 2018 (updates in red)
Coding Guidelines for Certain Respiratory Care Services (updates in red) Overview From time to time the AARC receives inquiries about respiratory-related coding and coverage issues through its Help Line
More informationQuarterly CERT Error Findings Report WPS GHA Part A J8 MAC ~ Indiana and Michigan ~
Quarterly CERT Error Findings Report WPS GHA Part A J8 MAC ~ Indiana and Michigan ~ This report provides details of Comprehensive Error Rate Testing (CERT) errors assessed April 1, 2017, through June 30,
More informationPlatinum Trio ACO HMO 0/20 OffEx
Platinum Trio ACO HMO 0/20 OffEx Benefit Summary (For groups 1 to 100) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2017 THIS MATRIX IS INTENDED TO
More informationRelative Values for Physicians. Relative Value Studies, Inc.
Relative Values for Physicians Relative Value tudies, Inc. 2012 Contents Contents...1 Introduction...1 User Guide... 1 Definitions of Terms in Relative Values for Physicians... 1 The Period... ervices
More informationHUSKY Health Benefits and Prior Authorization Requirements Grid* Hospital Outpatient Effective: January 1, 2012
Cardiac Rehab 100% covered 100% covered 100% covered Dialysis 100% covered 100% covered 100% covered Emergency Care Covered no co-pays for Emergency Room visits Covered no co-pays for Emergency Room visits.
More informationPRESSURE-REDUCING SUPPORT SURFACES
Status Active Medical and Behavioral Health Policy Section: Allied Health Policy Number: VII-54 Effective Date: 04/23/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members
More informationCore Services Provided in Federally Clinical Coverage Policy No: 1D-4 Qualified Health Centers and Amended Date: October 1, 2015 Rural Health Clinics
Qualified Health Centers and Amended Date: October 1, 2015 Rural Health Clinics Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Federally Qualified Health Centers... 1
More informationBlue Cross provides administrative claims services only. Your employer or plan sponsor is financially responsible for claims.
HOPE COLLEGE - HOURLY ORANGE 007013084/0011/0012/0013/0014/0015/0016/0017 Simply Blue PPO HSA ASC Effective Date: On or after July 2018 Benefits-at-a-glance This is intended as an easy-to-read summary
More informationFAQ for Coding Encounters in ICD 10 CM
FAQ for Coding Encounters in ICD 10 CM Topics: Encounter for Routine Health Exams Encounter for Vaccines Follow Up Encounters Coding for Injuries Encounter for Suture Removal External Cause Codes Tobacco
More informationInstitute on Medicare and Medicaid Payment Issues March 28 30, 2012 Robert A. Pelaia, JD, CPC
I. Introduction Institute on Medicare and Medicaid Payment Issues March 28 30, 2012 Robert A. Pelaia, JD, CPC Senior University Counsel for Health Affairs - Jacksonville 904-244-3146 robert.pelaia@jax.ufl.edu
More informationBlue Shield Gold 80 HMO
Blue Shield Gold 80 HMO Uniform Health Plan Benefits and Coverage Matrix Blue Shield of California Effective January 1, 2017 THIS MATRIX IS INTENDED TO BE USED TO HELP YOU COMPARE COVERAGE BENEFITS AND
More informationPayment Policy: Visits On Same Day As Surgery Reference Number: CC.PP.040 Product Types: ALL Effective Date: 03/01/2018
Payment Policy: Visits On Same Day As Surgery Reference Number: CC.PP.040 Product Types: ALL Effective Date: 03/01/2018 Revision Log See Important Reminder at the end of this policy for important regulatory
More informationMRI Patient Screening and History
Griffin Imaging, LLC 220 Rock Street Griffin, GA 30224 (770) 229-4660 Fax:: (770) 229-4632 Specializing In Open MRI, CT & Ultrasound MRI Patient Screening and History Patient Information Sheet PATIENT
More informationCompliant Documentation for Coding and Billing. Caren Swartz CPC,CPMA,CPC-H,CPC-I
Compliant Documentation for Coding and Billing Caren Swartz CPC,CPMA,CPC-H,CPC-I caren@practiceintegrity.com Disclaimer Information contained in this text is based on CPT, ICD-9-CM and HCPCS rules and
More informationWILLIS KNIGHTON MEDICAL CENTER S2763 NON GRANDFATHERED PLAN BENEFIT SHEET
BENEFIT SHEET GENERAL PLAN INFORMATION Coordination of Benefits Customized COB Dependents Children birth to 26 Filing Limit 12 months For employees that work in a WKHS location within the primary HealthPlus
More informationICD Codes health health health
1-10-2017 Encounter for screening for malignant neoplasm of cervix. 2016 2017 2018 Billable/Specific Code Female Dx POA Exempt. Z12.4 is a billable/specific ICD-10. ICD-10 is the 10th revision of the International
More informationBlue Shield Gold 80 HMO 0/30 + Child Dental INF
Blue Shield Gold 80 HMO 0/30 + Child Dental INF Benefit Summary (For groups 1 to 100) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2017 THIS MATRIX
More informationBlue Shield $0 Cost-Share HMO AI-AN
Blue Shield $0 Cost-Share HMO AI-AN This plan is only available to eligible Native Americans 1 Uniform Health Plan Benefits and Coverage Matrix Blue Shield of California Effective January 1, 2017 THIS
More informationGold Access+ HMO $30 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix)
Gold Access+ HMO $30 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2015 THIS MATRIX IS INTENDED TO BE USED
More informationMEDICAL POLICY Modifier Guidelines
POLICY: PG0011 ORIGINAL EFFECTIVE: 10/30/05 LAST REVIEW: 12/12/17 MEDICAL POLICY Modifier Guidelines GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated by
More informationCARE PLAN OVERSIGHT POLICY
CARE PLAN OVERSIGHT POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 171.12 T0 Effective Date: June 1, 2017 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE
More informationGlobal Surgery Fact Sheet
DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services Global Surgery Fact Sheet Definition of a Global Surgical Package This fact sheet is designed to provide education on the
More informationE & M Coding. Welcome To The Digital Learning Center. Today s Presentation. Course Faculty. Beyond the Basics. Presented by
Welcome To The Digital Learning Center Presented by Your Partner In Building High Performance Practices Today s Presentation E & M Coding Beyond the Basics Course Faculty R. Thomas (Tom) Loughrey, MBA,
More informationAnthem Blue Cross and Blue Shield Commercial Professional Reimbursement Policy
Subject: Injection and Infusion Administration and Related Services & Supplies IN, KY, MO, OH, WI Policy: 0015 Effective: 05/01/2017 Coverage is subject to the terms, conditions, and limitations of an
More informationPlatinum Local Access+ HMO $25 OffEx
Platinum Local Access+ HMO $25 OffEx Benefit Summary (For groups 1 to 50) (Uniform Health Plan Benefits and Coverage Matrix) Blue Shield of California Effective January 1, 2015 THIS MATRIX IS INTENDED
More informationChapter 9 Section 1. Ambulatory Surgical Center (ASC) Reimbursement
Ambulatory Surgery Centers (ASCs) Chapter 9 Section 1 Issue Date: August 26, 1985 Authority: 32 CFR 199.14(d) Copyright: CPT only 2006 American Medical Association (or such other date of publication of
More informationProgramming a Spinal Cord Neurostimulator
Programming a Spinal Cord Neurostimulator August 10, 2017 My surgeon wants to bill 95972 for programming along with placement of a spinal neurostimulator. Isn t the programming inclusive to the surgical
More informationOUTPATIENT DOCUMENTATION IMPROVEMENT
OUTPATIENT DOCUMENTATION IMPROVEMENT Pam Brooks, MHA, COC, PCS, CPC Coding Manager Wentworth-Douglass Hospital Dover NH Disclaimer This presentation is for general education purposes only. The information
More informationUser Manual. MDAnalyze A Reference Guide
User Manual MDAnalyze A Reference Guide Document Status The controlled master of this document is available on-line. Hard copies of this document are for information only and are not subject to document
More informationCenter for Clinical Standards and Quality/Survey & Certification Group
DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop C2-21-16 Baltimore, Maryland 21244-1850 Center for Clinical Standards and Quality/Survey
More informationArkansas Department of Health and Human Services Division of Medical Services P.O. Box 1437, Slot S-295 Little Rock, AR
Arkansas Department of Health and Human Services Division of Medical Services P.O. Box 1437, Slot S-295 Little Rock, AR 72203-1437 Fax: 501-682-2480 TDD: 501-682-6789 & 1-877-708-8191 Internet Website:
More informationGLMS UHC IIRC Thursday, December 10, 2015 GLMS/First Floor Boardroom 7:30AM
GLMS UHC IIRC Thursday, December 10, 2015 GLMS/First Floor Boardroom 7:30AM Committee Members in Attendance in Bold Brian Sosnin, DO UHC IIRC Chair Julie Daftari, MD UHC KY Medical Director Billy McCord
More informationReview Process. Introduction. Reference materials. InterQual Procedures Criteria
InterQual Procedures Criteria Review Process Introduction As part of the InterQual Care Planning family of products, InterQual Procedures Criteria provide healthcare organizations with evidence-based clinical
More informationCapturing E/M Services in the HOPD
Capturing E/M Services in the HOPD AAPC Regional Conference Anaheim, CA Linda Martien, COC, CPC, CPMA September 2016 Introduction A part of the Federal Balanced Budget Act of 1997 required HCFA (now CMS)
More informationOctober 2016 News Bulletin
2016 October October 2016 News Bulletin Claims tip of the month New Policy: Reimbursement for Maximum Units Per Day effective January 1, 2017 Amerigroup Washington, Inc. allows reimbursement for a procedure
More informationModifier 53 Discontinued Procedure
Manual: Policy Title: Reimbursement Policy Modifier 53 Discontinued Procedure Section: Modifiers Subsection: none Date of Origin: 9/13/2007 Policy Number: RPM018 Last Updated: 5/8/2017 Last Reviewed: 5/12/2017
More informationSee the Time chapter for complete instructions regarding how to code using time as the controlling E/M factor.
2015 EM Survival Guides Chapter 1: Office or Other Outpatient Visit (99201-99215) You should apply 99201-99215 for E/M visits in the office or other outpatient setting. These codes distinguish between
More informationMLN Matters Number: MM6740 Revised Related Change Request (CR) #: Related CR Transmittal #: R1875CP Implementation Date: January 4, 2010
News Flash Flu Season is upon us! CMS encourages providers to begin taking advantage of each office visit to encourage your patients with Medicare to get a seasonal flu shot; it s their best defense against
More informationPREFERRED CARE. combination of family members; however no single individual within the family will be subject to more than the individual
PLAN FEATURES Deductible (per plan year) $500 Individual $1,000 Family Unless otherwise indicated, the Deductible must be met prior to benefits being payable. The family Deductible is a cumulative Deductible
More information2018 Hospital Outpatient Prospective Payment System Final Rule Summary
On November 1, 2017, the Centers for Medicare & Medicaid Services (CMS) released the 2018 Hospital Outpatient Prospective Payment System (HOPPS) final rule. Comments on the proposed rule are due December
More informationFlorida Health Care Association 2013 Annual Conference
Florida Health Care Association 2013 Annual Conference The Westin Diplomat Resort & Spa Session #38 Transitioning from ICD-9 to ICD-10 Wednesday, August 7 10:30 to 11:30 a.m. Atlantic 3 Upon completion
More informationOutpatient Observation Services
Outpatient Observation Services Presented by: Gina Hobert, MBA, CHC, CPC-I, CPMA, CEMC, CRC Sr. Manager, Baker Newman Noyes Definition MCR Benefit Policy Manual, CMS 100-02, Chapter 6, 20.6 A. Outpatient
More informationChapter 13 Section 2. Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups
Outpatient Prospective Payment System (OPPS)-Ambulatory Payment Classification (APC) Chapter 13 Section 2 Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups Issue Date:
More informationNational Fee Analyzer. Charge data for evaluating fees nationally
National Fee Analyzer Charge data for evaluating fees nationally 2013 Contents Introduction...1 Key to Proper Reimbursement... 1 The Medical Coding System... 1 What This Book Has to Offer... 2 A Coding
More informationThe New World of Value Driven Cardiac Care
1 The New World of Value Driven Cardiac Care Disclosures MPA Healthcare Solutions is an analytic health care consultancy that provides clients with insight into clinical performance; aids them in the evaluation,
More informationThe Impact of Healthcare-associated Infections in Pennsylvania 2010
The Impact Healthcare-associated Infections in Pennsylvania 2010 Pennsylvania Health Care Cost Containment Council February 2012 About PHC4 The Pennsylvania Health Care Cost Containment Council (PHC4)
More information