1. The three goals of the Physicians Payment Reform are to decrease Medicare expenditures. As well as redistribute physician’s payments more equitably. Also to ensure quality health care at a reasonable rate. 2. I would use modifier -57, decision for surgery with the E/M code for this case. Due to the E/M service and the decision for surgery were made earlier that same day. 3. There are three components of the relative value unit the first component is work, which is the amount of time, the intensity of effort and the technical expertise required for the physician to provide the service.
The second would be the overhead component also known as the practice expense, it is identified as the allocation of cost associated with the physicians practice (ex. Staffing) that must be expended in order to provide a service. The third component is malpractice and is identified as the cost of the medical malpractice insurance coverage/ risk associated with providing the service. 4. People age 65 and older, along with patients who are experiencing end-stage renal disease are both eligible for Medicare.
As well as people who are eligible for disability benefits from social security, they are too covered by the Medicare program. 5. To find the main terms in the index of the CPT you must use these basic location methods, you must search by the service or the procedure, the anatomic site, condition or disease. You also could use synonyms, eponym’s or abbreviations to find main terms in the index. 6. The E/M code 99253 would be used to report an initial impatient consultation. With a detailed history and exam along with a MDM of low complexity. 7. There are many elements when considering the correct E/M code.
There are four elements of history which include chief complaint, history of present illness, as well as review of symptoms and past, family, and/or social history. 8. The complexity of medical decision making is base doff of three elements which are the number of diagnosis or management options. These options can be minimal, limited, multiple or extensive. The nest element is the amount and/or the complexity of data to review. The data can be minimal or none, limited, moderate or extensive. The last element of medical decision making is the risk of complication or death if the condition goes untreated. This risk can be minimal, low, moderate or high.
Kayla Kuebler 21597852 38177400 Page 2 of 4 9. The correct CPT code is 99214 due to the detailed history. As well as the detailed exam and a MDM of moderate complexity. 10. There are three key components present in every patient’s case except counseling encounters and/or time based codes. The three components are the history, the level of examination, the level of medical decision making. These components allow us coders to choose the appropriate level of service. 11. The correct CPT code is 99396. Due to the Preventive Medicine Services Codes are mostly based on age. 12.
The correct CPT code is 99341. Due to it being a new patient appointment in the patient’s home with twenty minutes face- to- face and MDM is straightforward. 13. There are four types of history levels, the level is based on the extent of history during the history-taking portion of the physician-patient encounter. The first level is a problem focused history where the physician focuses on the chief complaint and a brief history of the present problem of a patient. The second level is expanded problem focused where the physician focuses on a chief complaint, obtains a brief history of present problem and performs a problem pertinent review of systems.
The third level is a detailed history, where the physician focuses on chief complaint, obtains an extended history of the present problem (4 or more of the 8 elements), an extended review of systems and a pertinent psfh. The last level is a comprehensive history, which is most complex and physician documents chief complaint, obtains extended history of present problem, does complete review of systems and obtains complete pfsh. 14. The correct codes for this emergency room scenario are CPT code 99281.
The ICD-9 code is 918. 1. 15. The correct CPT code for this hospital scenario is 27125. 16. If a patient was discharged from the hospital with a diagnosis of probable myocardial infarction without a history of MI in the past the correct ICD-9 code would be 410. 91. This is because if a diagnosis at time of discharge is uncertain it is still coded as if it existed or was established. 17. The correct codes for this case are CPT codes 13121, 13160. The ICD-9 code is 998. 31. 18.
Inpatient and outpatient have different measures of time. Outpatient visits are measured as direct face-to-face time which is the time physicians spend directly with a patient during an office visit. This includes obtaining history, performing an examination and discussing the results. Inpatient time is measured as the unit/floor time and describes the time a physician spends in the hospital setting dealing with the patients care. Unit/floor time includes care given to the patient at bedside as well as at other settings on the unit floor. Kayla Kuebler 21597852 38177400 Page 3of 4 19. The correct CPT code is 25500. Due to it being a closed fracture without any manipulation. 20.
There are many graft types represented in the musculoskeletal subsection. A couple of types are cartilage grafting and tendon grafting. As well as autogenous bone grafting and fascia lata grafts. 21. The correct CPT codes for this operative report from an inpatient hospital are 20661, 97140. 22. 93458 is the correct CPT code for this scenario. Due to these procedures being bundled. 23. 33208 is the correct CPT code, for the placement of a dual-chamber pacemaker. 24. 33228 is the correct CPT code, for the replacement of a pulse generator with removal of the old one, 25. 58558 is the correct CPT code and 677.
1 is the correct ICD-9 code for this inpatient hospital scenario. 26. 77057 is the correct CPT code, for this clinic scenario for a bilateral screening mammogram. 27. 70548 is the correct CPT code for this outpatient hospital scenario for the MRI of brain with contrast. 28. 90945 is the correct CPT code for this inpatient hospital scenario. 29. 94620 is the correct CPT code for this pulmonary walking stress test. 30. Physical status modifier P3 indicates a patient with severe systemic disease. 31. 01215-P2, 99100, are the correct CPT codes and modifiers for this service. 32.
The main term in the diagnosis of “fractured clavicle” is fractured. 33. The main term in the diagnosis of “globe adhesions” is adhesions. 34. The main term in the diagnosis of “urinary retention” is retention 35. The main term in the diagnosis of “acute pneumonia” is pneumonia. 36. V12. 71 is the correct ICD-9 code for “personal history of peptic ulcer”. Kayla Kuebler 21597852 38177400 Page 4 of 4 37. V16. 3 is the correct ICD-9 code for “family history of breast cancer, female”. 38. V72. 82, 574. 20, 496 are the correct ICD-9 codes for a preoperative evaluation for elective cholecystectomy due to gallstones.
This patient is seen by a pulmonologist because of COPD. 39. 12014 is the correct CPT code for a simple repair of a superficial wound of the nose measuring 5. 2 cm. 40. In order to correctly code lesion excision you need to know the site, number, and size of the excised lesion(s) and if the lesion(s) is malignant or benign. 41. 21899 is the correct code for an unlisted procedure of the neck or thorax. 42. Appendix C of the CPT manual contains examples of clinical evaluation and management codes. 43. I489. 1 44. K520 45. 583. 89 46. 733. 0, 733. 1.