Codeing Scenarios
Inpatient coding and outpatient scenarios 1. List the tree goals of Physician Payment Reform. Decrease Medicare expenditures, redistribute physician’s payments more equitability, and ensure quality health care at a reasonable rate. 2. Mr. Jones is admitted to the hospital by the orthopedic surgeon for severe hip pain. The ortho surgeon provides an initial hospital visit during which it’s determined that Mr. Jones has a fractured hip that will require surgical intervention. Mr. Jones is taken later that day to the OR, where the doctor performs the surgical procedure to repair Mr. Jones’ hip. Which modifier would you use for the hospital visit? Modifier -57
3. List and define the three components of the relative value. Work – relative level of time, skill training and intensity to provide a given service Practice expense – the costs of maintain a practice including rent, equipment, supplies and non-physician staff costs; uses “bottom up” method where the direct costs of providing a services are calculated (staff, supplies and equipment time) and indirect costs are allocated. Malpractice – smallest component values and represent payment for the professional liability expenses. 4. List the three types of persons eligible for Medicare. The disabled, the blind, and those who are 65 years old and over. 5. Name the six basic location methods to locate main terms in the index CPT. Procedure/service, synonym, eponymous, anatomic site, condition of disease, abbreviations 6. An initial inpatient consultation with a detailed history, detailed exam, and MDM of low complexity would be coded to what E/M code? 99253 7. What are the four elements of history? Chief complaint (CC), history or present illness (HPI), review of systems (ROS), past present family and/or social history (PFSH) 8. The complexity of medical decision making is based on what three elements? a) Number of diagnoses or managements
3. List and define the three components of the relative value. Work – relative level of time, skill training and intensity to provide a given service Practice expense – the costs of maintain a practice including rent, equipment, supplies and non-physician staff costs; uses “bottom up” method where the direct costs of providing a services are calculated (staff, supplies and equipment time) and indirect costs are allocated. Malpractice – smallest component values and represent payment for the professional liability expenses. 4. List the three types of persons eligible for Medicare. The disabled, the blind, and those who are 65 years old and over. 5. Name the six basic location methods to locate main terms in the index CPT. Procedure/service, synonym, eponymous, anatomic site, condition of disease, abbreviations 6. An initial inpatient consultation with a detailed history, detailed exam, and MDM of low complexity would be coded to what E/M code? 99253 7. What are the four elements of history? Chief complaint (CC), history or present illness (HPI), review of systems (ROS), past present family and/or social history (PFSH) 8. The complexity of medical decision making is based on what three elements? a) Number of diagnoses or managements