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2018 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

Practice Exam

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

Proper coding for patients seen by a specialist during their observation stay

I just wanted to confirm with the panel the correct way to bill for an exhisting pateint who was seen in the hospital during the observation stay portion prior to being formally admitted as an inpatient. We are an oncology practice and one of our oncologist was asked to consult on a patient for Hematology reasons, while the patient was still registered as being in observation. The physician obliged and saw the patient, but marked teh encounter as an initial inpatient visit (99221-99223).

Per CMS guidelines (PUB 100-04 Claim Processing Manual, Transmittal 2282, section 30.6.8 Payment fo Hosptial Observation Services and Observation of Inpateint Care Services (including admission and discharge), "Payment for an initial observation care code is for all the care rendered by the ordering physician on the date the patient’s observation services began. All other physicians who furnish consultations or additional evaluations or services while the patient is receiving hospital outpatient observation services must bill the appropriate outpatient service codes."

Unfortunately, it does not go into detail on how to code if the patient being seen was already and exhisting patient of the consulting physician. Since we are told to use the appropriate outpatient codes (99211-99215, 99201-99205), the question was asked which would be the more appropriate code type of code, exhisting or new patient? I think an argument could be made for both code types, but my gut feeling is that we are bound by the 3yr rule when using the outpatient codes. Is this the more prudent way to approach these scenarios?

Greg Quinn, CPC, CPPM, CHONC

Medical Billing and Coding Forum

IM Consult during Obsterics Hospital IP stay; diagnosis help

Hello,
I am having issues deciding on a principal diagnosis for an IM visit in the course of an OB visit.
I am currently billing for an IM physician who is seeing a patient for a consult for Hyperthyroidism and Grave’s disease. The patient was IP for a 39 week delivery with fetal demise.
Since the patient was originally there for her delivery would the principal diagnosis be the reason the IM Dr. saw her or would it be the obstetric diagnoses?
Thanks.

Medical Billing and Coding Forum

Established patient codes (99211-15) vs Subseq hosp codes (99231-33) for outpt stay

Question pertaining billing established patient codes versus subsequent hospital codes for an outpatient stay, POS 22:

Why we would use E/M 99212-99215 with POS 22 instead of the subsequent observation care codes 99224-99226? Is there an advantage of using one set of codes over another, or specific rules for why we would use one set over the other?

Thanks in advance for any advice–

Medical Billing and Coding Forum

Region 1 – Stay Connected and Network

Staying connected and networking can be very valuable tools when advancing your career within the coding industry. Often, we turn to each other for advice when it comes to each other’s coding expertise and by seeking advice we are doing a few things. One, we are showing that we are humble and that we do […]
AAPC Knowledge Center

Stay Compliant with Medicare Requirements

Staying profitable in the wake of Medicare reimbursement cuts is an ongoing struggle.

During Fiscal Year (FY) 2017, OIG’s report reveals recoveries of more than $ 4.13 billion in health care fraud judgments and settlements. The report also mentions exclusions of 3,244 individuals and entities from participation in Federal health care programs; which means you need to be extra careful to avoid billing errors and stay out of OIG hit list.

Missing a single update can cost you; whether it’s a fee schedule change, a new form, proposed rule or an added documentation requirement.

What you need to know is:

  • Hot Reimbursement Strategies That Will Optimize Results.
  • Ace E/M Reimbursement with These Top Tips.
  • Do Not Fear Federal Audit Scrutiny… Embrace It and Stay Out of Hot Water.
  • Don’t Let Legislation, Rules, and Regulations Intimidate You: Collect the Revenue You Deserve.
  • Technology and Security Know‑How Keeps You Compliant.
  • Sharpen Your Coding Skills to Maximize Reimbursement.
  • More Expert Advice to Add to Your Arsenal.

This is where our bi-monthly newsletter — Medicare Compliance & Reimbursement — comes into play .We want you to stay on top of CMS updates, while also treading cautiously to avoid compliance pitfalls and OIG target areas, which can be tough, especially when economic worries are already forcing healthcare settings across the country to slide into the red.

Mentioned below are some of the topics we cover with each issue of Medicare Compliance & Reimbursement Alert :

  • Medicare Fee Schedule Updates
  • QPP Year 2 Updates: MIPS, Advanced APMs, scoring, payments, reporting, bonuses, penalties, and more
  • Get Ready for These Medicare Overhauls
  • Regulatory Updates: Stark, AKS, FCA,CMPL, and regulatory reforms
  • E/M Coding: Incorrect Codes, Poor Notes, and Setting Debacles Add to E/M Fails
  • Manage MSP Issues with Stronger Claims’ Policies
  • Telehealth: Know These Bipartisan Budget Act Changes Impacting Telehealth
  • OIG Offers New Gadgets for Compliance Inquiry
  • CMS Market Saturation Tool Helps Determine Provider Density
  • Check Your 2018 MIPS Status with New Tool
  • OIG Adds Statistical Sampling To Work Plan
  • Anthem Opts Not to Change Modifier 25 Policy
  • Avoid Denials with This LT and Reciprocal Billing Primer
  • HIPAA: Put HIPAA Training at the Top of Your Spring To-Do List
  • Ace the Medicare Card and Number Transition From Day 1
  • Be Part of the Conversation on E/M Documentation Change
  • HHS Focuses On Value-Based Care for Medicare Reimbursement
  • CMS Revises Medical Student E/M Documentation Policy
  • Is the Stark Law Headed for the Chopping Block?
  • Gain Improvement Activity Credits By Participating in MIPS Study
  • Compliance: Conquer Claims Reviews with These 5 Tips
  • Anthem’s Controversial ED Policy Impacts 3 More States
  • Practice Management: Manage Your Online Image or Suffer the Consequences
  • New Medicare Texting Guidance Spells Out Dos and Don’ts
  • Medicare Errors: Back Up Your Claims with Accurate Notes — Or Risk Paybacks

if interested, subscribe now to this bi-monthly newsletter using the subscription link below :

CLICK HERE TO SUBSCRIBE NOW

The post Stay Compliant with Medicare Requirements appeared first on The Coding Network.

The Coding Network

CRNA does not stay for the entire case – can I still bill for them?

Good Morning, Everyone

Here is the scenario: MD1 and the CRNA began the case. CRNA left after 46 minutes. MD 2 appears to have given MD 1 a break midway through the case – my question is do I ONLY bill for MD1 with the AA modifier, or do I bill for MD1 (QY) AND the CRNA (QX) ?

Name: MD 1
Start Time: 02/26/18 14:10:00 Stop Time: 02/26/18 15:59:00 Total Time: 109
Name: MD 2 Activity: Supervisor Concurrency/Res: 1/0
Start Time: 02/26/18 16:00:00 Stop Time: 02/26/18 16:18:00 Total Time: 18
Name: CRNA
Start Time: 02/26/18 14:10:00 Stop Time: 02/26/18 14:56:00 Total Time: 46
Any and all help is greatly appreciated!!
M

Medical Billing and Coding Forum

Extended stay recovery coding

Can someone tell me if there is such a thing as "Extended Stay Recovery" in the hospital billing? I have been told that there is a Extended Stay Recovery for out patients in a hospital setting to keep them in the hospital for up to 24 hours. The only coding I know is out patient observation codes. This Extended Stay Recovery is supposedly used for Medicare Patients only.

Medical Billing and Coding Forum

Table of Risk for inpatient stay with multiple physicians managing conditions

I need some help with the table of risk and whether it pertains to the patient’s risk or the provider. In the inpatient setting there may be multiple physicians managing the patient’s different conditions. So my question, for example, is if a patient is seen daily by an internist for say, pneumonia and also has stable stage 3 chronic kidney failure, and then develops acute kidney failure on top of that, and the AKI is now being managed by a nephrologist, the AKI falls into the high category for presenting problem, but since the internist is not the one managing the AKI can it still be counted as high on the table of risk for the internist?

Medical Billing and Coding Forum