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AAPC chapter 19
E/M
| Question | Answer |
|---|---|
| Preventative E/M codes: typically used with diagnosis ____ codes. | Z |
| Diagnosis can be acute, chronic, or acute phase of chronic. When acute phase of chronic: if there's a code to describe each of the phases list the _____ code 1st. | acute |
| The reason for the visit is _____ diagnosis of E/M services. | primary |
| If some condition is described as both acute and chronic and separate sub entries exist in Alphabetic index at the same indentation leve, code ____ and sequence the acute code 1st. | both |
| When pt with multiple conditions seen, code only those conditions ______ care or requiring care or management. | affecting |
| CPT E/M coding: divided into categories: place of service, ____ of service, status of pt (new, established, etc). | type |
| CPT: 1st step is to determine what category/subcategory of _____ being done. | service |
| Considered new pt if hasn't recieved any face-to-face professional services from physician or HC professional within the last _____ years. | 3 |
| When codes apply to new and established pts: then may be differentiated by ____ service or subsequent service. | initial |
| If seen by another provider in the same group that's same specialty in same stay the ____ provider reports subsequent service. | 2nd |
| When pt seen at another site of service (ER etc.), and inpatient or observation service done at that site the service at _____ site may be separately reported with modifier _____. | initial, 25 |
| If pt seen at different site before _____ the provider may ask consultant to see pt once admitted. When provider reports separate site of service and consultant is _____ to see pt for inpatient visit, the consultant reports a susequent service. | initial, 1st |
| Hospital inpatient and d/c day management services: report the total ____spent by the physician on the date of d/c. | time |
| D/C services are time based and ____ be documented in pts record. Even if physician time spent isn't ______ still report total time. | must, continuous |
| For office or outpatient consults: if another physicain or HC provider requests an opinion or advice on the _____ condition or a new condition for the same pt, the consulting provider again may report ____ code. | same, consultation |
| Inpatient consult codes: only reported by the same doctor (s) in the same practice seeing the same pt _____ per admission. | once |
| Inpatient consult: when consult is mandated by 3rd party payer or by the _____ or regulatory requirement: append modifier ___ "Mandated services" | government, 32 |
| Medicare doesn't pay for consultation codes except: _____ consults and requires consultation services to be billed with the most appropriate ____ code other than consult codes. | telehealth, E/M |
| Outpatient consults: reported by selecting the appropriate level code from the _____ or outpatient services. | office |
| Inpatient consults: reported with initial hospital inpatient or observation code for _____ or subsequent f/u visits. | initial |
| Inpatient consults: for physician who admitted pt to hospital should append modifier _____ "Principal physician of record" | AI |
| ED services: don't diferentiate between _____ and established pts. | new |
| CPT bundles many critical care services, procedures not bundled: provider must document they are _____ and not included in critical care time. | separate |
| Critical care services codes: based on time the physician ____ dedicated and directly available to the pt. | spent |
| Physician can't work on another pt during critical care services, but this time doesn't have to be _____. When less than 30 mins _____ report critical care code. | continuous, don't |
| Prolonged services: coded based on ____ of service, if the service performed on same day as E/M service and the total ____ on date of service. | location, time |
| Standby services: must be ____ mins long. Cannot be reported if the physician performs procedure with a _____ package. | 30, Global |
| Case management services: includes medical team conference, these codes are based on whether pts ____ is present and if not present, code based on _____ of provider (Physician or QHP). | family, type |
| Care plan oversight services: coding based on location of pt and amount of ____ spent within a 30 day period to oversee the pts care. | time |
| Preventative Medicine services: also referred to as ____ visits. Codes determined based on pt's _____ and whether new or established. | well, age |
| During preventative Medicine exam: if provider has to do more than normally performed: E/M code with Modifier ____. | 25 |
| Counseling- Risk factor behavior change: codes based on the face-to-face time spent with pt and whether the counseling is provided to individual or ____. | group |
| Telephone service not resulting in visit: the call must be initiated by an _____ pt or their gaurdian. | established |
| Telephone service resulting in a visit with physician within ____ hours considered part of the service and not reported separately. | 24 |
| Online digital eval: codes reported ____ for cumulative time of the service during ____ day period. | once, 7 |
| Remote physiologic monitoring and treatment: codes based on _____. | time |
| Newborn care services: codes based on location of delivery and episode of _____ (initial or subsequent). | care |
| Inpatient neonatal and pediactric critical care: codes based on ___ and if initial or subsequent encounter. | age |
| Care management services: 3 categories- chronic, ____ and principal. | complex |
| Chronic care management services: pts have ___ or more chronic continuous or episodic conditions, expected to last at least 12 ____. | 2, months |
| Complex care management services: addresses all of pt's medical conditions, requires at least _____ mins of staf time. | 60 |
| Principal care management services: addresses a single, complex, chronic condition, expected to last at least ____ months. | 3 |
| Transitional care services: pt d/c to home, assisted living etc, may need transitional care to ____ re-admit. These codes can only be reported ___ in a 30 day period. | prevent, once |
| ______ care planning: coded based on time. | Advanced |
| "Per day" services: are billed on a "per day" bases. If there are ______ visits on the same day it's reported as one service. | multiple |
| Multiple visits in different settings or facilities: time ____ counted twice for multiple E/M services- this time can be counted toward the total time for the ____ of encounter. When ED services not reported and another E/M service reported ______. | not, date, instead |
| When pt d/c and re-admitted in same day: considered as one _____ stay. | continuous |
| Levels of E/M codes: level 1,2,3 etc. Selection based on: the level of _____ making as defined for each service or the total time for ____ services done on the date of encounter. | decision, E/M |
| MDM: medical _____ making. The amount of _____ provider performs during E/M service. | decision, work |
| MDM: 4 levels-straight forward, low, ____ and high. Selected based on ____ and complexity of problem addressed, the amount and complexity of data to be reviewed, the ____ of complications and morbidity or mortality of pt management. | moderate, number, risk |
| Amount and complexity of data reviewed: combination of the ____ and complexity of categories determins one of ____ levels possible for the level of amount and complexity of data reviewed- minimal, limited, moderate, extensive. | number, 4 |
| Totaling the MDM: at least 2 of the components- number and complexity of _____, amount and complexity of data to be reviewed, ____ of complications a morbidity for that level must be met. | problems, risk |
| An office or other outpatient visit: code must fall into _____ time ranges. | specified |
| New pt visits: total time less than ____ mins do not code. Time 75 mins or longer- report ____ E/M service code in addition to primary E/M code. | 15, prolonged |
| Established pts: if total time is less than ____ mins: don't code for time. If time is 55 mins or longer- report ____ E/M service in addition to primary E/M code. | 10, prolonged |
| Review of systems: a series of ____ regaurding s/s associated with pt's cheif ______. | questions, complaint |
Created by:
mlovest
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