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AAPC chapter 19

E/M

QuestionAnswer
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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