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Coding

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Superbill

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Date created

Mar 1, 2020

Cards (44)

Section 1

(44 cards)

Superbill

Front

A form used by medical practitioners that can be quickly completed and submitted to an insurance company or employer for reimbursement It generally has both CPT codes and ICD10 codes that are frequently used in your practice in a check-box format

Back

Radiology

Front

an X-ray code for a film assumes that both the technical and professional components are included If a film is taken elsewhere, but interpreted by a provider, use same code + professional component modifier

Back

PFSH documentation guidelines

Front

Pertinent - at least 1 specific item from any of the three history areas must be documented Complete - established patient: at least 1 from 2 of the 3 history areas - new patient: at least 1 of all 3 of the history areas

Back

HCPCS

Front

Health care financing administration's Common Procedural Coding System HCFA now CMS is the governing agency of Medicare and Medicaid

Back

MDM

Front

- straight forward - low -moderate -high

Back

Suturing coding tips

Front

The length of wound is always documented and measured in cm When there is more than 1 wound in the same classification, add the length of the wounds and code it as one repair Repairs involving nerves, tendons, and blood vessels are coded differently

Back

Cardiovascular

Front

Largest group in medicine section

Back

Pathology and Lab

Front

Certain "panels" have 1 code for related blood tests Everything in the panel will be listed with the code

Back

Modifier 51, Multiple procedures

Front

List the major procedure first, with the additional lesser procedures secondary with the modifier

Back

Medicine section

Front

Immunizations, Therapeutic injections, Dialysis

Back

Mod 25

Front

Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service

Back

ICD10 code

Front

International Classificaation of Disease. Why services were provided. AKA diagnosis code

Back

Medical necessity

Front

CMS guidelines = "Medical necessity of a service is the overarching criterion for payment in addition to the individual requirements of a CPT code. It would not be medically necessary to bill a higher level of evaluation and management services when a lower level of service is warranted.

Back

Outpatient E/M services

Front

Problem visit/preventative visit, consultations

Back

ICD9 v. ICD10

Front

ICD10 incorporates greater clinical detail and specificity into the codes. Are updated to reflect current medical understanding and classification of diseases

Back

Suturing

Front

Simple repairs - suturing of superficial tissues where would requires simple 1 layer closure. Local anesthetic included in charge. If wound is closed with adhesive strips, use E/M code instead Intermediate repairs - when repair involves layer closure of 1 or more of the subcutaneous tissues and superficial fascia. Heavily contaminated wounds requiring extensive cleaning and simple closure Complex repairs - repairs requiring more than layered closure. Scar revision, debridement

Back

Coding rules

Front

Code to the highest level of certainty and use the most specific code possible. Only code the reason for the encounter and those conditions that affect the care delivered

Back

Mod 57, decision for surgery

Front

An E/M service that resulted in the initial decision to perform surgery

Back

Billing based on time

Front

Time is only a factor if >50% of the time is spent in counseling/coordination of care - you must document the total amount of time spent and indicate that >50% of that time was spent in counseling/coordination of care

Back

For E/M visits different code sets describe

Front

Where the visit occurred, preventative v problematic, and new v established patient

Back

Modifier 22 - unusual procedural services

Front

When the service provided is greater than usually required for the listed procedure - EX: obesity

Back

How to code

Front

Look at the presenting problem, then determine the level of MDM, then make sure documentation of history and PE support that level of service

Back

ICD10 code history

Front

Initially developed by WHO as a way to report morbidity and mortality stats worldwide. Maintained and updated yearly by the National Center for Health Statistics

Back

The 3 CPT categories

Front

Category 1 = evaluation and management - history and physical, no other procedures Category 2 = performance measurement codes Category 3 = New/emerging technology codes

Back

Bundling

Front

Many procedure codes also include procedures and supplies that are routinely necessary to perform the procedure Only services not typically performed, or materials not typically used, should be billed separately Providers need to be aware of precisely what materials and processes are included in the procedure codes they use Charging for these items separately, known as unbundling or fragmenting, is against the law

Back

Coding rules continued

Front

Do not use "rule out" or "suspected" diagnosis. Instead, use a code describing the symptom. Make sure the ICD10 code supports the CPT code

Back

HCPCS

Front

Created by Medicare in 1983. Coding system required by all insurance companies to use

Back

CPT category 1

Front

E/M services - Describe services provided to evaluate patients and manage their care These codes are widely used and cover a large portion of the medical care provided to patients

Back

MDM comprised of 2 of 3:

Front

Risk Number of diagnoses Data reviewed

Back

Consultations

Front

"Type of service provided by a physician whose opinions or advice regarding evaluation and/or management of a specific problem is requested by another physician or other appropriate source 3 Rs to a consult = Reason, Request, Reply

Back

HCPCS level 2 - National Codes

Front

Created by CMS. Services and supplies not found in the CPT code set Ambulance services and durable medical equipment, prosthetics, orthotics, and supplies

Back

Surgery

Front

Starred procedures - procedures in which the follow-up is generally non-existent or varies with the patient - When billing for a starred procedure, the charge does not include any pre or post-operative care

Back

Three levels of HCPCS

Front

1. CPT (Common procedural terminology) 2. National codes or alpha-numeric codes: used for supplies or something that you gave to your patient 3. Local codes

Back

Unspecified v. Other

Front

Unspecified = the provider doesn't have enough information to be more specific Other = The provider has specific info but there is not a code to represent it.

Back

CPT codes are descriptive of:

Front

E/M services, procedures, labs, x-ray tests

Back

Coding

Front

The application of a number of systems used to uniformly document and track health care services delivered

Back

Preventative medicine servies

Front

May include: - Anticipatory guidance - nutrition, hygiene, stress management, sex ed - Risk factor reduction - balanced diet, regular exercise, tobacco, alcohol - Immunizations/Screenings/ Ancilliary studies: labs, radiology

Back

Modifier

Front

Allows you to get paid for all the things that you do

Back

E/M Codes

Front

Choose code based on the location where you saw the patient (specific to setting and whether it is a new or established patient) Codes are based on what was done in three areas: history, PE, Medical decision making

Back

CPT codes

Front

CPT codes account for majority of the HCPCS coding system, published annually by the AMA

Back

Anesthesia

Front

Left to the anesthesiologists

Back

Modifiers

Front

2-digit numeric code Used to indicate that a procedure has been altered by some specific circumstance, but not changed in its definition

Back

Exam guidelines

Front

Problem focused Expanded problem focused Detailed Comprehensive - a notation of "abnormal" w/o elaboration is no sufficient - a notation of negative or normal is sufficient

Back

CPT code

Front

Common Procedural Terminology - history + physical OR procedure

Back