The HPCPS Level II manual has two sections. When the description is found in the Index, the code or codes should be verified by looking in the:

tabular list.

CPT codes 00100-01999, and 99100-99140 represent:

anesthesiology.

In some instances, a specific procedure or service might need to be slightly altered, and if this is the case, instructions and Appendix A explain the use of:

modifiers

When an unlisted code is reported, what must also be sent so that the payer can determine what was performed and then determine the appropriate reimbursement?

a copy of the operative note

What type of codes are related to medical services as opposed to surgical services?

Evaluation and management

If a service is not documented within the medical record, then:

it should not be coded.

Use of ICD-10-CM codes establishes the _____ or the services and procedures provided to the patient.

medical necessity

Which of the following is a general rule for assigning CPT codes?

Always cross-reference the code or codes found in the index with the actual code descriptions.

Title XVIII of the Social Security Act, Section 1862 (a) (1) (A) states "No payment may be made under Part A or Part B for expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." This is known as which of the following?

Medical necessity

Which of the following is true about Volume I of the ICD-10-CM manual?

It is a tabular list, organized into 22 chapters.

Which of the following is true about the ICD-10-CM code format?

It contains 3-7 characters.

Anyone knowingly submitting a false claim or creating a false record or statement to receive payment from the federal government will be fined a civil penalty of not less than $5,500 and not more than ____ per false claim submitted.

11,000

specificity

detailed, providing more specifies

unbundling

reporting multiple codes for a service when there is one code that will report the entire service.

HCPCS

comprised of CPT and National codes

Upcoding

reporting a higher level code than is appropriate for the service that was rendered resulting in higher reimbursement

Primary diagnosis

the reason for the patient visit

sequenced

relation to the intensity and level of service provided

reimbursement

this is based on the codes that are submitted

reason rule

reason for patient visit (encounter) always coded first

modifier

inform third-party payers that circumstances for that paticular code have been altered

general equivalence mapping

crosswalks designed to make the transition to ICD-10-CM/PCS somewhat smoother

downcoding

A payer practice in which a reported evaluation and management service is reduced to a lower level based strictly on the diagnosis code reported

key components

comorbidity

other issues the patient presents with

contributory factors

time, nature of presenting problem, counseling, and coordination of care

bundle

the arbitrary practice of some insurance carriers to group codes, by which they either ignore additional codes reported on a claim and reimburse one of the lesser codes

carrier

company who provides the insurance policy