Step-by-Step chapter 14-15

Step-by-Step chapter 14-15

Modifiers may affect
The way payment is made by a third-party payer.
Modifiers are used to indicate what type of information.
Bilateral procedure, multiple procedures, service greater than usually required – ALL OF THE ABOVE!
Modifier -57, decision for surgery is used on what type of service?
E/M
Modifier -79, unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period, is used on what type of service
Surgery.
Modifier -51, multiple procedure, is used on what type of service.
Surgery.
Modifier -80, assistant surgeon is used when?
A second surgeon provides assistance to the primary surgeon.
Modifier -32 is used to indicate a service is mandated. Which of the following is an example of when a service is “mandated.”
An insurance company requires a second opinion prior to surgery.
Modifier -25, significant, separately identifiable E/M service by the same individual on the same day of the procedure or other srevice, is used to report an E/M service that was
Provided on the same day as a minor procedure performed by the same individual.
Modifier -59, distinct procedure, is used to indicate that
Services that are usually bundled into one payment were provided as separate procedures.
Modifier -58, staged or related procedure or service by the same physician during the postoperative period, is used to indicate
That a subsequent surgery was planned at the time of the first surgery.
Modifier -52 reduced services is used to indicate
A service was reduced without changing the definition of the code.
The modifier “-AA” is an example of what type of modifier
HCPCS
Multiple modifiers are indicated with which modifier
-99
The modifier that indicates only the professional component of the service was provided by
-26
Mr. Jones is admitted to the ohsp by the orthopaedic surgeon for severe hip pain. The ortho surgeon provides an initial hospital visit during which it is determined that Mr. Jones had a fractured hip that will require surgical intervention. Mr. Jones is taken later that day to the OR where Dr. Ortho performs the surgical procedure to repair Mr. Jones’ hip. Which modifier would you use for the hospital visit
-57
Mrs. Smith presented to her physician’s office for an office for an upper respiratory infection. The physician examines the patient and prescribes antibiotics. The physician notices the patient has a suspicious looking mole. The physician examined the mole and determined that it should be removed. The mole was removed during the same office visit. The physician bills both an E/M code and a procedure code. which modifier would you use on the E/M code
-25
Mrs. Roberts falls at work. She claims that she is alright, but her employer’s worker’s compensation policy requires that she see a physician to confirm she was not injured when she fell. The physician files a claim to the worker’s compensation carrier. Which modifier would you use when reporting the physician’s service to the patient?
-32
Mr. Coslett has multiple surgeries performed during the same operative session. Which modifier would you use.
-51
What modifier would you use if you were coding only for the professional component of a diagnostic procedure.
-26
Modifier _______ is used to indicate that services of an outside laboratory were used.
-90
These elements would be part of the _____ history; employment, education, use of drugs.
Social
Bruising would be an element of review of this organ?
Hematologic.
The level of E/M service is based on?
Documentation, key components, contributing factors – ALL OF THE ABOVE.
The examination is the _____ portion ofthe E/M service
Objective.
Medical decision making is based on the ____ that the physician must consider about the management of a patient’s condition
Number of diagnoses, risk of morbidity, amount of data – ALL OF THE ABOVE.
The hospital inpatient services subsection is used for patient’s admitted to
An acute care facility.
The request for advice or opinion from one physician to another physician is this type of service
Consultation.
Critical care codes are reported based on
Time
Codes from the E/M subsection nursing facilities service are used to report services provided in nursing facilities that used to be known as
Skilled nursing facility, intermediate care facility and long-term care facility – ALL OF THE ABOVE
When a physician performs a preventive service, the extent of the exam is determined by the
age.
According to information in 99468, what is the age of a neonate
28 days or younger.
According to E/M guidelines, a(n) _____ exam encompasses a complete single specialty exam or a complete multisystem exam.
Comprehensive
Mr. Smith presents to the emergency department at the local hospital for chest pain and is seen by the ED physician on duty. The physician obtains an extended HPI, an extended ROS, and a pertinent PFSH. What is the level of history.
Detailed.
The physician performs an extended exam of the affected body areas and related organ systems. what is the level of the examination.
Detailed.
The physician must consider multiple diagnoses and management options. There is a moderate amount of date to be reviewed and the risk of complications or death is moderate. What is the level of the MDM.
Moderate.
A new patient presents to he physician’s office at which time the physician provides a comprehensive history and exam with a high complexity MDM
99205
An initial inpatient consultation with a detailed history, detailed exam and MDM of low complexity.
99253
A 40-year-old established patient presents to the physician office for a preventive care exam
999396
History and exam of the normal newborn infant in a hospital setting.
99460.
A 7-year-old female established patient to the pediatrician complaining of ear pain x3 days. A detailed history is then taken. She has associated fever of 101. Mom treated her with Tylenol. The fever this a.m. is 99. She has had some chills and cough as well as some difficulty. No nausea or vomiting. No prior history of otitis. Brother was sick earlier this week. The physician performed a detailed exam of the ENT as well as limited exam of GI, lungs and heart. Vital signs were taken in the office. The physician diagnosed the patient with otitis media and a upper respiratory infection and prescribed an antibiotic. MDM is stated to be moderate.
99214
Clinic note: CC: Patient presents for routine examination. Subjective: Sally is a 42-year-old female patient who presents today for a routine physical exam. Objective: BP 120/80. Pelvic exam normal external genitalia. Vagina without discharge except for a scant amount of white discharge that appears normal. Cervix: Multiparous. Bimanual exam is unremarkable. All systems are within normal limits. ASSESSMENT: Normal BP. Normal pelvic exam. PLAN: endotracheal in 1 year or as needed.
99396