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CPC Practice Exam and Study Guide Package

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What makes a good CPC Practice Exam? Questions and Answers with Full Rationale

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Laureen shows you her proprietary “Bubbling and Highlighting Technique”

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2016 CPC Practice Exam Answer Key 150 Questions With Full Rationale (HCPCS, ICD-9-CM, ICD-10, CPT Codes) Click here for more sample CPC practice exam questions with Full Rationale Answers

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Click here for more sample CPC practice exam questions and answers with full rationale

Newly Credentialed CPC-A Seeking Coding Position!

Medical Billing and Coding Forum

New to Urology Coding

I’m new to Urology coding, I’ve done basic urology coding with anesthesia, but now I’m getting more into the field and need a little assistance.

the provider performed: CO2 Laser Condyloma Ablation penile, Penile Biopsy and Cystoscopy. The op report reads: "Procedure:* Genitalia prepped appears fashion.* Lidocaine jelly placed per urethra.* Inspection of the penis revealed the 2 more prominent condylomatous lesions and then several flat condylomatous lesions about 3 millimeters x 4 millimeters.* Couple other small areas that look like new condylomatous lesions.* I did use dilute ascetic acid.* I did not see any other areas of his acetowhite.* I used local anesthesia to numb up the areas on the penis.*

Then placed flexible cystoscope per urethra bladder. He did have a ring stricture at the bulbar urethra.* Narrowed but just let the cystoscope pass.* Once inside the bladder trabeculations noted.* Circumferential protrusion of the prostate was noted.* No tumors no stones no diverticuli.* Pulling into the prostatic urethra he had reasonably open bladder neck but elements of potential early median lobe as well as lateral lobe hypertrophy noted.* Visual obstruction of bladder neck noted.

Then used the scalpel to remove a condylomatous lesion.* Ventral mid shaft distal.* Sent this for by pathology.* The remaining lesions were treated using CO2 laser ablation 2.5-3 watts.* Lesions treated in their entirety.* Good hemostasis.* At the ventral aspect with a biopsy used silver nitrate stick for hemostasis.* Excellent hemostasis.* Antibiotic ointment applied."

I believe this should be coded: 54057, 11420, 52000.

Any input would be helpful…

Thanks

Medical Billing and Coding Forum

Coding skin cancer removal from ear with delay of pedicle flap

I’m not sure how to code. Dr. removed a cancer from patients ear then constructed a pedicle flap with delayed inset. Do I code the surgery with the skin lesion removal and formation of pedicle flap and the delay of flap at post op when the wound is closed?

Medical Billing and Coding Forum

Kareo Blog – 3 Medical Coding Modifiers You Probably Need to Brush Up On

AAPC National Advisory Board Member Angie Clements  CPC, CPC-I, CEMC, CGSC, COSC, CCS, helped bring clarity to three medical coding modifiers that are most problematic to physician practices. The three challenging modifiers include -59, -25, and -24. Clements advises coders to review documentation to ensure it supports the modifier. Read Clements’ tips on the Kareo blog.
AAPC Knowledge Center

Coding and Billing for NP and PA Providers in Your Medical Practice

 

Coding and Billing for NP and PA Providers in Your Practice

How to Bill for Nurse Practitioners and Physician Assistants

You would be hard pressed to find a medical practice in 2017 that does not use Physician Assistants (PAs) and Nurse Practitioners (NPs), also referred to as physician extenders or non-physician practitioners (NPPs).

Understanding how to properly bill and code for services provided by NPPs is imperative to running a cost-effective and efficient medical practice.  Regulations vary by insurance companies and states, so both the physician and the NPP’s must stay current with practice guidelines and ongoing changes.

Nurse Practitioners and Physician Assistants have increasingly become a staple in most medical practices.  NPs are nurses who hold a Master’s Degree or Doctor of Nursing Practice (DNP).  PAs are certified (PA-C), usually holding a Master’s Degree as well.  There are a number of reasons that medical practices utilize these mid-level providers:

  • Reduced Salary expenses (as compared to a physician)
  • Lower overhead costs
  • Higher patient volumes
  • Reduced insurance and liability costs

There are 3 basic types of reimbursement that Medicare provides for these non-physician providers (NPPs). 

Direct Pay

Direct pay is when the NPP holds their own Provider Identification Number (PIN). This reimburses the NPP (or practice) at 85% of the billable physician rate. It is very important that each of your mid-level providers receives his/her own National Provider Identifier (NPI) and be credentialed with each payer to bill under his/her PIN number, if possible, based on payer rules and regulations.  However, many payers will not credential NPPs. Having the NPP credentialed allows practices to bill insurance companies directly when the “supervising physician” is either not on site or has not provided any care or input into patient’s plan of care.

“Incident to”

“Incident to” billing is a way of billing outpatient services rendered in a physician’s office located in a separate office or in an institution, or in a patient’s home provided by a non-physician practitioner (NPP) (See MLN Matters SE0441).  With incident to billing, the physician bills and collects 100% of Medicare’s allowable reimbursement.  This type of billing is used when an NPP sees a patient in which the physician has performed the initial service and has initiated a Plan of Care or treatment plan.  There are specific rules for this type of billing, the physician must be on site, in the suite, not just in the building, and provides direct supervision (the rules for home visits varies).

By filing a claim “Incident to”, the physician can collect 100% of the Medicare Physician Fee Schedule (MPFS) instead of 85% of the MPFS for care provided by a qualified NPP.  New patients should be seen by the physician to set up the Plan of Care and this would be billed under the rendering physician.  After the initial visit, the NPP can provide follow-up care based on the Plan of Care, billing for direct care as “Incident to”.  If adjustments are made to the plan of care such as medication changes, then the physician should see the patient face to face in order to adjust the original plan of care, otherwise, the visit may not qualify for “Incident to” billing.

“Incident to” billing was developed by Medicare and not all commercial insurance carriers follow Medicare guidelines, therefore knowing payer regulations regarding “Incident-to” billing is imperative prior to providing patient care.

Split/Shared Expenses

Split/shared expenses:  “A split/shared E/M visit is defined by Medicare Part B payment policy as a medically necessary encounter with a patient where the physician and a qualified NPP each personally perform a substantive portion of an E/M visit face-to-face with the same patient on the same date of service. A substantive portion of an E/M visit involves all or some portion of the history, exam or medical decision making key components of an E/M service. The physician and the qualified NPP must be in the same group practice or be employed by the same employer.”

Billing for shared/split services allows the practice to bill under the qualified physician versus the NPP at their lower reimbursement rate.   As long as the criteria are met, billing for shared/split services allows for that extra 15% reimbursement.

Documentation is paramount in this type of billing.  Each practitioner must thoroughly document the care they provided to substantiate reimbursement under the split/share guidelines allowing both parties to bill for care.

According to the Centers for Medicare and Medicaid Services (CMS), shared/split visits are applicable for services rendered in the following settings:

  • Hospital inpatient or outpatient
  • Emergency department
  • Hospital observation
  • Hospital discharge
  • Office or clinic (when “incident-to” requirement are met)

Shared/split visits are not allowed:

  • In a skilled nursing facility or nursing facility setting
  • For consultation services
  • For critical care services
  • For procedures
  • In a patient’s home or domiciliary site

Conclusion

With shifts in healthcare spending, patient care, and reimbursement, and physician shortages, the need for Nurse Practitioners and Physician Assistants is greater than ever.  A Proper understanding of the billing and reimbursement guidelines for individual payers is necessary.  Charting and documentation requirements must be met.

Does your medical practice use NPs or Pas? Are you billing “Incident to”? Let me know in the comments below. 

Sources
http://www.sccm.org/Communications/Critical-Connections/Archives/Pages/Nurse-Practitioner-and-Physician-Assistant-Coding-and-Billing.aspx http://www.napnapcareerguide.com/np-billing-coding-reimbursement/ http://profitable-practice.softwareadvice.com/nurse-practitioners-and-physician-assistants-why-you-should-hire-one-or-the-other-0513/

 

— This post Coding and Billing for NP and PA Providers in Your Medical Practice was written by Manny Oliverez and first appeared on Capture Billing. Capture Billing is a medical billing company helping medical practices get their insurance claims paid faster, easier and with less stress allowing doctors to focus on their patients.

Capture Billing

CRT-P and CRT-D coding help

I normal do not code for cardiology , but I have a staff member asking of CPT-codes for Lead Impedance, Pacing Capture Thresholds, and Phrenic Nerve Stimulation. I have look every where and I can not find any codes that fit them all. Is there just one single code for all these test, or is there individual codes for each. If anyone knows, please pass on your advise.

Thank you,
Felicia Knox, CPC, CPB, AAPC Professional

Medical Billing and Coding Forum

Answering common questions for OB coding in ICD-10-CM

By Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC
 
As we continue to learn and embrace ICD-10-CM, many coders are still feeling uncertain in their ability to code OB delivery and ancillary services as easily as we did using ICD-9-CM. In addition, ICD-10-CM has presented some new documentation challenges.
 
I recently presented a webcast about how to unbundle the pregnancy package and use the coding concepts available in ICD-10-CM. I got some great questions, but simply didn’t have enough time to get to all of them during the presentation. I think a lot of coders are probably asking similar questions, so I’ve answered them below. I will follow up with additional questions and answers in a future column.  
 
Q: During the delivery, if the physician documents group B strep (GBS) positive on the delivery note, do you code O99.824 (streptococcus B carrier state complicating childbirth) and Z3A.- (weeks of gestation)?
 
A: Yes, this is proper coding for the GBS notation, however the provider also needs to document that this was complicating the pregnancy. A positive GBS culture is considered a pregnancy complication, it is not considered a high-risk pregnancy complication. Within the documentation, the provider should have noted the care associated with GBS, such as the usage of antibiotics prior to or during the delivery itself.
 
If the provider notes that the patient is a GBS carrier, or does not consider this to be a complication of the pregnancy, then code Z22.330 (carrier of group B streptococcus) should be used rather than a complication code. As a coder, if it is unclear whether the provider is considering GBS a complication at the time of delivery, a query may be in order to clarify.
 
16. Documentation of Complications of Care; Code assignment is based on the provider’s documentation of the relationship between the condition and the care or procedure. The guideline extends to any complications of care, regardless of the chapter the code is located in. It is important to note that not all conditions that occur during or following medical care or surgery are classified as complications. There must be a cause-and-effect relationship between the care provided and the condition, and an indication in the documentation that it is a complication. Query the provider for clarification, if the complication is not clearly documented.
 
Q: Do we have to put the ICD-10-CM Z3A.- weeks of gestation codes on every single encounter for OB patients?
 
A: According to the American Health Information Management Association, the Z3A.- weeks of gestation codes do not have to be appended at every single encounter. However this provides an amazing amount of information and data tracking, not only for your office, but also as transparency for the patient, the payer, and the physician. It is incredibly helpful to see that the patient had her first-trimester ultrasound at 11 weeks, just by reviewing the claim and/or patient data.
 
Q: What code are you using when there is a current condition that the mother has, e.g., rheumatoid arthritis?
 
A: Upon delivery, if the patient has another current condition that is affecting the delivery itself, it is appropriate to code the sign, symptom, or diagnosis. However, the documentation in a delivery record needs to clearly state whether or not it is a “complication” to the pregnancy or simply a coexisting medical diagnosis.
 
In the case you mention, where the mother has rheumatoid arthritis but it is not specifically noted as a complication, and the patient has a non-complicated birth, the codes below could be considered:
  • O80, encounter for full-term uncomplicated delivery
  • M06.9, rheumatoid arthritis, unspecified
  • Z37.-, birth status
  • Z3A.- 
 
However, if the provider is documenting that the mother’s rheumatoid arthritis is currently complicating the pregnancy and/or delivery, then the following ICD-10-CM codes could be considered based upon the provider’s actual documentation or information after a query:
 
  • O26.89-, other specified pregnancy-related conditions
  • M06.9, unless you have more specificity regarding the rheumatoid arthritis
  • Z37.-
  • Z3A.-
According to the ICD-10-CM Official Guidelines for Coding and Reporting:
c. Pre-existing conditions versus conditions due to the pregnancy; Certain categories in Chapter 15 distinguish between conditions of the mother that existed prior to pregnancy (pre-existing) and those that are a direct result of pregnancy. When assigning codes from Chapter 15, it is important to assess if a condition was pre-existing prior to pregnancy or developed during or due to the pregnancy in order to assign the correct code. Categories that do not distinguish between pre-existing and pregnancy-related conditions may be used for either. It is acceptable to use codes specifically for the puerperium with codes complicating pregnancy and childbirth if a condition arises postpartum during the delivery encounter.
 
 
Q: If patient is admitted to the hospital for a complication in the second trimester, how do we indicate this is not a delivery? When the patient delivers, we want to ensure we are not denied for it being already paid as part of the global package.
 
A: When you are billing for your complication in the second or third trimesters and the patient is still pregnant (undelivered), the appended ICD-10-CM codes document this. If and when the patient actually delivers, you will append the outcome of delivery codes to the claim, as per the ICD-10-CM coding guidelines.
The guidelines state:
 
  • Outcome of delivery; A code from category Z37, Outcome of delivery, should be included on every maternal record when a delivery has occurred. These codes are not to be used on subsequent records or on the newborn record.
 
Codes in this category are:
·         Z37.0, single live birth
·         Z37.1, single stillbirth
·         Z37.2, twins, both liveborn
·         Z37.3, twins, one liveborn and one stillborn
·         Z37.4, twins, both stillborn
·         Z37.5-, other multiple births, all liveborn
o   Z37.50, multiple births, unspecified, all liveborn
o   Z37.51, triplets, all liveborn
o   Z37.52, quadruplets, all liveborn
o   Z37.53, quintuplets, all liveborn
o   Z37.54, sextuplets, all liveborn
o   Z37.59, other multiple births, all liveborn
·         Z37.6-, other multiple births, some liveborn
o   Z37.60, multiple births, unspecified, some liveborn
o   Z37.61, triplets, some liveborn
o   Z37.62, quadruplets, some liveborn
o   Z37.63, quintuplets, some liveborn
o   Z37.64, sextuplets, some liveborn
o   Z37.69, other multiple births, some liveborn
·         Z37.7, other multiple births, all stillborn
·         Z37.9, outcome of delivery, unspecified
 
Q: In ICD-10-CM, can you bill codes O35.5- (maternal care for [suspected] damage to fetus by drugs) and O99.33- (smoking [tobacco] complicating pregnancy, childbirth, and the puerperium) at the same encounter? What about code O99.32- (drug use complicating pregnancy, childbirth, and the puerperium)?
 
A: In ICD-10-CM, as with all coding, pay close attention to what the code is actually stating and look at the key verbiage within the code set.
 
Code O35.5- denotes that the provider is concerned with care provided to the mom, due to “suspected” damage to the fetus from drugs (e.g., the provider may need the mom to have a higher-intensity ultrasound of the fetus or have alternative prescription or social work intervention for a suspected issue with the fetus).
 
Code O99.33- is for use when the provider specifically notes that the mother’s use of tobacco is complicating her pregnancy care and oversight. Code O99.32- is for use when drug usage by the mother (this can be any type of drug, e.g., prescription necessitated, over the counter, herbal, legal, illegal) is complicatingthe pregnancy care.
 
All three of these codes can be coded together, however, when coding O35.5- the provider is required to document the suspicion that there may be damage to the fetus from the usage of a particular drug (e.g., the patient is pregnant and currently prescribed drugs for a seizure disorder that may be harmful to a fetus).
 
 
Q: When twins are born via cesarean on different dates (e.g., past midnight), how do I report this?
 
A: In this instance, the cesarean procedure date and time will be noted on your claim, and with a twin cesarean, modifier -22 (increased procedural service) will be appended on the mother’s record. The coding would similar to this:
 
  • CPT code 59514-22 (cesarean delivery only, with increased procedural service)
  • ICD-10-CM code O82.0, encounter for cesarean delivery without indication
  • ICD-10-CM code Z37.2 
  • ICD-10-CM code Z3A.- 
 
However, if twin A is born at 11:58 p.m. and twin B is born at 12:02 a.m. (the next day) the twins’ records will be denoted with the two different dates. The insurance carrier may deny this, so be prepared to submit records with this type of claim. On each of the twin’s records, the date of service should correspond to the actual date of delivery.
 
 
Q: In regard to fetal non-stress tests (FNST), if the physician has not done an interpretation but two RNs have reviewed and documented it, can the hospital facility fee be charged?
 
A: The answer is yes. The rationale is the hospital owns the FNST equipment and all equipment and supplies must be billed for when used in the facility. The physician bears the responsibility of doing the interpretation of the test and documenting the medical necessity/indicator for the testing procedure. For the RNs who reviewed the test, their responsibility lies in getting the service for the usage of the equipment posted in the chargemaster so it will be billed.
 
 
Q: Would you code Category ll or Category lll fetal heart tones if mentioned in the delivery chart? What needs to be documented to show this affects the management of the mother?
 
A: In regard to the actual ICD-10-CM coding for Category II or Category III fetal heart tracing, it depends on what the provider has actually documented. The ICD-10-CM codes do not correspond to the terms “Category II” or “Category III.” ICD-10-CM does have codes to represent abnormalities in fetal heart rate and fetal stress. These codes are found in the code range O76–O77.9.
 
It is the provider’s responsibility to provide appropriate documentation of the FNST and he or she needs to include the medical necessity for the testing (i.e., diagnosis). The clinical documentation from the provider must also support the findings if the testing is noted as Category I, II, or III and how management of the patient is impacted due to the findings within the test.
 
According to the National Institute of Child Health and Human Development workshop report on electronic fetal monitoring, a Category I tracing is characterized by a FNST or fetal heart rate (FHR) during labor (continuous or intermittent) with:
  • A baseline rate of 110–160 beats/min
  • Moderate variability
  • No late or variable decelerations
  • Early decelerations being present or absent
  • Accelerations being present or absent
 
A Category II tracing definition is given to all FHR patterns that cannot be assigned to Category I or Category III. A Category II tracing is neither normal nor definitively abnormal. For Category II tracings:
  • If FHR accelerations or moderate variability are detected, the fetus is unlikely to be currently acidemic
  • If fetal heart accelerations are absent and variability is absent or minimal, the risk of fetal acidemia increases
  • Category II tracings should be monitored closely and evaluated carefully
 
 
A Category III tracing shows aclearly abnormal tracing and is associated with increased risk of fetal acidemia, neonatal encephalopathy, and cerebral palsy. A Category III tracing is characterized by:
  • Absent variability plus any one of the following:
    • Recurrent late decelerations
    • Recurrent variable decelerations
    • Bradycardia
 
Recurrent late or variable decelerations are defined as those decelerations that occur with 50% or more of contractions. A sinusoidal pattern—characterized by a smooth, sine wave-like, undulating pattern with a cycle frequency of 3–5 waves per minute that persists for 20 minutes or longer is also classified as a Category III tracing.
 
Editor’s note: Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, CDIP, COBGC, AHIMA-approved ICD-10-CM/PCS trainer, is an E/M and procedure-based coding, compliance, data charge entry, and HIPAA privacy specialist, with more than 20 years of experience. Lori-Lynne’s coding specialty is OB/GYN office/hospitalist services, maternal fetal medicine, OB/GYN oncology, urology, and general surgical coding. She can be reached via email at [email protected] or find current coding information on her blog: http://lori-lynnescodingcoachblog.blogspot.com. For more information, see the HCPro webcast Unbundle the Pregnancy Package and Manage ICD-10 Changes.

 

HCPro.com – JustCoding News: Outpatient