1. Upcoding
    The deliberate increase in a CPT-4 code to receive higher reimbursement
  2. E/M codes were added to CPT in ...
  3. Who always bills for E/M services?
    Specialty physicians
  4. E/M codes represent what percent of Medicare Part B payments to doctors?
  5. What services are included in the E/M section?
    • *well and sick visits
    • *case mgmt services
    • *preventative and prolonged services
  6. 3 components of E/M codes
    history, examination, medical decision making
  7. What is a Chief Complaint (CC)?
    A concise statement describing the symptoms, problem, condition, Dx that describes the reason for the visit, usually stated in the pt's own words
  8. Define concurrent care.
    The provision of similar services (Example: hospital visits to the same pt by more than one doctor on the same day)
  9. History of Present Illness:
    chronological description of the development of the patient's present illness from the first symptom to the present
  10. System Review:
    Inventory of body systems obtained through a series of questions seeking to identify signs and symptoms that the patient may be experiencing
  11. New patient:
    completely new patient OR a patient who hasn't been seen for 3+ years
  12. Established patient:
    Patient who has received care within the last 3 years
  13. Is there is distinction made between new or established patients for an emergency department visit?
  14. Categories of E/M (there are 7 listed)
    • *office/outpatient
    • *hospital observation services
    • *hospital inpatient
    • *consultations
    • *emergency department services
    • *nursing facility services
    • *home service
  15. Define morbidity.
    state of being diseased
  16. Define comorbidity.
    a disease coexisting with the primary disease
  17. example of comorbidity
    primary Dx: cancer & the comorbidity is emphysema
  18. E/M services include:
    Exams, evaluations, treatments, conferences with or concerning patient, preventative pediatric and adult health supervision
  19. Name the 6 components that are used in defining the levels of E/M services.
    history, exam, medical decision making, counseling, coordination of care, nature of presenting problem, time... the first three are KEY COMPONENTS when selecting the code
  20. Which 2 components of the 7 (that are used to define the levels of E/M services are considered contributory factors in the majority of visits?
    counseling, coordination of care, nature of presenting problem
    Pt history is needed (all four types-- problem focused, expanded problem focused, detailed history, comprehensive history)
  22. What is the difference between detailed history and comprehensive history?
    • -Detailed includes CC, extended history of patient illness, extended system review, PERTINENT past, family and/or social history
    • -comprehensive includes all of these but includes COMPLETE past family and social history
  23. Presenting problem definition: minimal
    problem may not require the presence of the doctor but service is provided under the doctor's supervision
  24. Presenting problem definitions: self-limited or minor
    Problem that runs a definite prescribed course
  25. Presenting problem definitions: low severity
    Problem where risk of morbidity without treatment is low
  26. Presenting problem definitions: moderate severity
    problem where risk of morbidity without treatment is moderate
  27. Presenting problem definitions: high severity
    Problem where risk of morbidity without treatment is high to extreme
  28. Do you use a dash or just a space when adding a modifier?
    just a space
Card Set
Medical office management coding 2