NAME:_____________________ INSTITUTE HEALTH ED [IHE ...



FINAL EXAMINATION * [Version #6]

SECTION I: MATCHING DIRECTIONS: { HEALTH CARE REIMBURSEMENT }: Match the following terms or phrases on the left hand column with their equivalent definitions found on the right hand column. In the `space' provided place `only' letters!

1. Comprehensive code____________ A). this is a performance number that each physician or provider gets for each group office or clinic in

which he or she practices. In medicare each member has an eight character PPIN which collabor-

ates to that groups location in addition to the group number.

2. UNBUNDLING ____________________ B). this is a medicare lifetime 10 digit number issued to providers. When adopted it is recognized by

Medicaid, Medicare, Tricare & CHAMPVA programs and eventually will be used by private

insurance carriers.

3. CLEAN CLAIM ____________________ C). this is the code sign for “a new or revised text”.

4. MODIFIER _______________________ D). this is any medicare claim that contains complete, necessary information but is illogical or incorrect.

5. (( _______________________ E). this means that the claim was submitted within the program or policy time limit and contains all the

necessary information so it can be processed and paid promptly.

6. PPIN number ____________________ F). this code sign implies “service includes surgical procedure only”.

7. [pic] ____________________________ G). this is a carrier assigned number that every physician uses to render services to patients when

submitting claim forms for insurance purposes.

8. NPI NUMBER _____________________ H). term used to define coding and billing numerous CPT codes to identify procedures that usually are

described by a single code.

9. ( __________________________ I). A single code that describes or covers two or more component codes that are bundled together as

one unit.

10. UPIN NUMBER ___________________ J). this can be any medicare claim missing required information. It is generally identified to the

provider so that it can be resubmitted.

11. ⊘ ___________________________ K). permits the physician to indicate circumstances in which a procedure as performed differs in some

way from that described by its usual code.

12. CUSTOMARY FEE ________________ L). this is a claim submitted with errors or one requiring manual processing for resolving problems or

one rejected for payment. Pending or suspense claims are placed in this category because

something is holding the claim back from payment (review)

13. INCOMPLETE CLAIM _____________ M). this is a number issued by the medicare fiscal intermediary to each physician who renders medical

service to medicare recipients used for identification purposes on CMA 1500 claim forms.

14. ( ___________________________ N). this fee meets the criteria of the usual fee and is in the opinion of the medical review committee,

justifiable, considering the special circumstances of the patient and case.

15. DINGY CLAIM ____________________ O). this code sign indicates “ a revised code”.

16. ( ___________________________ P). this claim happens when the medicare contractor cannot process a claim for a particular service or

bill type.

17. REASONABLE FEE ______________ Q). this is the code sign for an “add on code”.

18. DIRTY CLAIM ____________________ R).this fee is in the range of the fees charged by providers of similar training and experience in a given

geographic area.

19. INVALID CLAIM ___________________ S). this is the code sign for a modifier which generally has a negative sign with two digit number.

20. PIN NUMBER ____________________ T). this is the code sign for a “new code”.

SECTION II: DIRECTIONS: MULTIPLE ANSWER QUESTION (MAQ) { HEALTH CARE REIMBURSEMENT }: Place a circle around the `letter' containing the `best' and most applicable answer. One answer only !

21. Name the five minimum information requirements needed by third party payers for completion of insurance claim forms:

a). _________________ b). __________________ c). ___________________

d). _________________ e). __________________

22. Name the five situations in which the confidentiality between physician and patient may be automatically waived (breach of confidential

communication):

a). _________________ b). __________________ c). ___________________

d). _________________ e). __________________

23. Name the four basic pre-approval requirements that many private insurance carriers and pre-paid health plans have and which must be

met before they approve hospital admissions, surgeries or elective procedures:

a). ______________ b). ______________ c). ______________ d). ______________

24. List the five (5) types of presenting problems from the most risk and least recovery to the least risk and most recovery:

a). ______________ b). ______________ c) ______________ d) ______________ e) ______________

25. List the four (4) types of medical decision making, in order of complexity from most to least complex:

a). ______________ b). ______________ c. ______________ d) ______________

26) MATCHING: Referring to the ICD-9-CM, match the following appendices given to the information contained.

1. Appendix A _________ a). Industrial Accidents

2. Appendix B _________ b). Classification of Drugs

3. Appendix C _________ c). Morphology of Neoplasms

4. Appendix D _________ d). Three-digit Categories

5. Appendix E _________ e). Was deleted in 2004

27. MATCHING: Referring to the ICD-9-CM, match the following appendices given to the information contained.

1. Volume I____________ a). Tabular List of Procedures & Alphabetic Index to Procedures

2. Volume II___________ b). Diseases: Alphabetic Index

3. Volume III__________ c). Diseases: Tabular List

28. DIRECTIONS: Identify the format of the chapters in the ICD-9-CM Volume I, Tabular List, in the proper sequence, from 1st to last:

1. _____________ a. subcategory

2. _____________ b. chapter

3. _____________ c. subclassification

4. _____________ d. section

5. _____________ e. category

29. If a diagnosis is not treated or addressed during an encounter and is stated on a patient’s record, you should ____?

a. Not list the diagnosis

b. List the diagnosis as secondary

c. List the diagnosis as probable

d. None of the above

30. Until a definitive diagnosis is determined, which of the following diagnoses should be used ?

a. Rule out

b. Suspicious for

c. Possible

d. None of the above

31. Some claims require attachments such as _____?

a. Clinic notes

b. Operative reports

c. Discharge summaries

d. All of the above

SECTION III: FILL-IN BLANK DIRECTIONS: { MEDICAL CODING -1 } Fill-in the blank spaces with the most appropriate words or phrases that best completes the sentences. (Claims Management )

32. Describe how the name on the claim should be typed for the following patients:

a. The name on the ID card reads: James M. Apple, II ANS:____________________________________

b. The name on the ID card reads: Charles T. Treebark, Jr. ANS:____________________________________

c. The name on the ID card reads: David J. Hurts, III ANS:____________________________________

d. The name on the ID card reads: Jake R. Elbow, Sr. ANS:____________________________________

33. What are three questions that must be asked to code surgeries properly?

a. __________________________________________________________________________

b. __________________________________________________________________________

c. ___________________________________________________________________________

34. CPT divides surgical procedures into which two main groups ?

a). __________________________________ b). ___________________________________

35. List three services/procedures included in a surgical package

a). ____________________ b). ___________________ c). ___________________

36. On what basis are minor surgical procedures to be billed? __________________________________

37. Briefly describe “Unbundling”

_____________________________________________________________________________

_____________________________________________________________________________

38. Define the following:

A) Skin Lesion- ___________________________________________________________________________

B) Excision of a Lesion- _____________________________________________________________________

C) Destruction of a Lesion- __________________________________________________________________

39. List five things you must know when reporting the excision or destruction of lesions

1) __________________________________________________________

2) __________________________________________________________

3) __________________________________________________________

4) ___________________________________________________________

5) ___________________________________________________________

40. Layered closure requires the use of 2 codes. One is for the ________________________ and one for the

_______________________________________

41. If a physician reports the size of a lesion in inches, what must the coder do? _______________________________________

42. When converting the size of a lesion, one inch = _____________________________________________________________

43. When there are multiple lacerations, which repair should be listed first? ____________________________________________

SECTION IV: FILL-IN BLANK DIRECTIONS: { MEDICAL CODING -1 }: Fill-in the blank spaces with the most appropriate words or phrases that best completes the sentences. DIRECTIONS: MULTIPLE ANSWER QUESTION (MAQ): Place a circle around the `letter' containing the `best' and most applicable answer. One answer only !

44. Define the term “Balance Billing ? ______________________________________________________________________

________________________________________________________________________________________________

45. What is the purpose of obtaining an ABN ? __________________________________________________________

________________________________________________________________________________________________

46. List three forms of MSP Medicare beneficiaries often purchase to cover the Medicare deductible and coinsurance

requirements:

a). ______________________________________________________________________

b). ______________________________________________________________________

c). ______________________________________________________________________

47. List five advantages of joining a Medicare HMO ?

a). ______________________________________________________________________

b). ______________________________________________________________________

c). ______________________________________________________________________

d). ______________________________________________________________________

e). ______________________________________________________________________

48. For HMO authorized fee-for-service specialty care, the claim is sent directly to ?

a. The patient

b. Medicare

c. The HMO

d. Only a and b are correct

e. All of the above are correct

f. None of the above are correct

49. What is the deadline for filing Medicare HMO claims ?

a. 90 days

b. 60 days

c. 45 days

d. one year

e. All of the above are correct

f. None of the above are correct

SECTION V: ADVANCED CODING: DIRECTIONS: Using the ICD or CPT, assign codes to the following:

50. Removal of foreign body in tendon sheath, simple. Code(s): ___________

51. Puncture aspiration of cyst of breast. Code(s): ___________

52. Incision and drainage of thyroid gland cyst. Code(s): ___________

53. Abrasion, single lesion. Code(s): ___________

54. Destruction of four flat warts. Code(s): ___________

55. Incision and drainage of ankle abscess. Code(s): ___________

56. Incision and drainage of wrist hematoma. Code(s): ___________

57. Aspiration thyroid cyst. Code(s): ___________

58. Laparoscopy with bilateral total pelvic lymphadenectomy and periaortic lymph node biopsy. Code(s): ___________

59. Acute prostatitis due to streptococcus. Code(1): ___________ Code(2): ____________

60. Gangrene, left great toe, due to Diabetes Mellitus type I. Code(1): ___________ Code(2): ____________

61. Vitamin D-resistant Rickets. Code(s): ___________

62. Newborn female delivered in the hospital by cesarean delivery

with evidence of cleft palate and cleft lip. Code(1): ___________ Code(2): ____________

63. Flaccid hemiplegia affecting the dominant side due to cerebrovascular accident 4 months ago.

Residual and cause are flaccid hemiplegia, dominant side, CVA. Code(s): ___________

64. Tumor abdomen, uncertain behavior. Code(1): ___________ M-Code(2): ___________

65. Hepatocellular adenoma. Code(1): ___________ M-Code(2): ___________

66. A 62 year – old male admitted to the hospital with acute subendocardial myocardial infarction. Code(s): ___________

67. A 24 year – old woman at 28 weeks’ gestation has hypothyroidism. Code(1): ___________ Code(2): ____________

68. Cellulitis left foot and ankle due to staphylococcus. Code(1): ___________ Code(2): ____________ Code(3): ____________

69. Newborn female delivered in the hospital by cesarean delivery with evidence of cleft palate and cleft lip. Code(1): _________ Code(2): ________

70. A patient develops gastrointestinal bleeding while taking Motrin as prescribed for abdominal cramping

(Hint: Generic Motrin). Code(1): _________ Code(2): ________

71. Acute renal failure develops in a patient following a cardiac catheterization and the patient is admitted for dialysis.

Code(1): _________ Code(2): ________

SECTION VI: ADVANCED CODING: REPORTS / DIRECTIONS: Interpret and assign codes to the following report (you may use the ICD or CPT Code books):

OPERATIVE REPORT:

PREOPERATIVE DIAGNOSIS: Mass, Right Breast.

POSTOPERATIVE DIAGNOSIS: Mass, Right Breast.

OPERATIVE PROCEDURE: Right Breast Mass Excision

PROCEDURE: Witih the patient under general anesthesia, the breast and chest were prepped and draped in a sterile manner. An elliptical incision was made in the central portion of the breast about the palpated mass, including the area of the nipple. This was of then excised all the way down to the fascia of the breast and then submitted for frozen section. Frozen section revealed a carcinoma of the breast with what appeared to be a good margin all the way around it. We then maintained hemostasis with electrocautery and proceeded to close the breast tissue using 2-0 and 3-0 chromic. The skin was closed using 4-0 Vicryl in a subcuticular manner. Steri-strips were applied. The patient tolerated the procedure well and was discharged from the operating room in stable condition.

PATHOLOGY REPORT LATER INDICATED: Primary, malignant neoplasm.

72. Code(1): ___________ 73. Code(2): ___________ + M-___________ 74. Code(3): ____________

SECTION VII: MATCHING DIRECTIONS: { CLAIMS PROCESSING }: Match the following terms or phrases on the left hand column with their equivalent definitions found on the right hand column. In the `space' provided place `only' letters!

75. UNEMPLOYMENT COMP. DIS._____ A). A state, federal and local program that provides health care benefits to indigent persons

on welfare (public assistance), the elderly who meet who meet certain financial require-

ments, and the disabled.

76. HEALTH MAINT ORGANIZATION____B). In some regions, this program is referred to as the Medi-Medi Program.

77. MEDICARE/MEDICAID____________ C). Organization of physicians, sponsored by a state or local medical association, concerned

with the development and delivery of medical services and the cost of health care.

78. DISABILITY INCOME INS. __________D). a government sponsored program that provides non-military hospital & medical services

for dependents and spouses of active service personnel, the retired & their dependents,

and the dependents of deceased from active duty.

79. EXCLUSIVE PROVIDER ORG._______E). form of health insurance that provides payments to replace income if the insured is unable

to work because of illness, injury or disease

80. WORKER'S COMP. INS. __________ F). organization that provides a wide range of comprehensive health care services for a

specified group at a fixed periodic payment. The emphasis is on preventive care.

Physicians are reimbursed by capitation. An HMO may be sponsored by a wide variety of

organizations.

81. FOUNDATION FOR MED. CARE_____G). type of managed care plan in which the subscriber members are eligible for benefits only

when they use the services of a limited network of providers.

82. PREFERRED PROVIDER ORG. _____H). A state and federal program for children under 21 years with special health care needs.

83. INDEPENDENT (INDIVIDUAL)

PRACTICE ASSOCIATION_________ I. This type of plan contracts with a number of physicians who agree to provide treatment in

their own offices or clinics for a fixed capitation payment per month.

84. MATERNAL & CHILD HLTH PGM____J). This is a form of contract medicine by which a large employer or any other organization

that can produce a large number of patients contracts with a hospital or group of physi-

cians to offer medical care at a reduced rate.

85. MEDICAID_______________________K). . this is a non-state program that insures a person against on-the-job injury or illness.

86. COMPETITIVE MEDICAL PLAN______L). an insurance for veterans that shares the medical bills of spouses and children of veterans

with the total, permanent and service connected disabilities and also covering dependents

of deceased veterans.

87. MEDICARE______________________M). . a three part program that is hospital insurance, supplemental medical insurance or a plus

choice program for people 65 years of age and created by the 1965 Social Security Act.

88. POINT OF SERVICE PLAN ________ N). a managed care plan consisting of a network of physicians and hospitals that provides an

insurance company or employer with discounts on its services.

89. TRICARE_______________________O). a state program that is essentially insurance that covers off-the-job injury or sickness and

is paid for by deductions from a person's paycheck.

90. CHAMPVA _____________________P). . medical plan created by the 1982 Tax Equity and Fiscal Responsibility Act that allows for

enrollment of medicare patients into managed care plans.

SECTION VIII: MATCHING DIRECTIONS: { CLAIMS PROCESSING }: Match the following terms or phrases on the left hand column with their equivalent definitions found on the right hand column. In the `space' provided place `only' letters!

SECTION VIII (A): Match the abbreviations, punctuations, symbols, words, or typeface to the correct descriptions:

91. ________ [ ] A) Incomplete term that needs one of the modifiers to make a code assignable

92 ________ NOS B) Used in Volume 2 to enclose the disease and procedure codes that are recorded with

93. ________ : the code they are listed with

94 ________ § C) Typeface used for all codes and titles in Volume 1

95 _______ Italics D) Information is not available to code to a more specific category

96. _______ Excludes E) Encloses a series of terms that are modified by the statement to the right

97. _______ Includes F). Encloses synonyms, alternative words, or explanatory phrases

98 _______ } G) Equals unspecified

99 _______ NEC H) Typeface used for all exclusion notes

100. _______ ( ) I) Footnote or section mark

101. _______ [ ] J) Appears under a 3 digit code title to further define or explain category content

102. _______ BOLD TYPE K) Encloses supplementary words and does not affect the code

L) Indicates terms that are to be coded elsewhere

SECTION VIII (B): Match the convention to the definition:

103. _________ See Category A) Indented under main term and are essential to code selection

104. _________ Modifiers B) Terms in parentheses that are nonessential

105. __________ See C) Explicit direction to look elsewhere

106. _________ Notes D) Follows terms to define and give instructions

107. __________ Subterms E) Directs coder to look under another term since all information is not under the first

108. __________ See also term

109. _________ Eponym F) Directs coder to Volume 1

G) Disease/ syndrome named for a person

SECTION IX: MAQ & FILL-IN QUESTIONS: { COMPUTERIZED MEDICAL BILLING }: Answer the following Multiple Answer & Fill-in the Blank Questions:

110. What do the following Medical / Medical Billing Abbreviations mean ? ( ½ pt ea)

a). q.i.d. = ________

b). B/F = ________

c). p.p.a. = ________

d). a.c. = ________

e). d = ________

f). c/a * = ________

g). s.o.s. = ________

h). p.r.n. = ________

i). q.o.d. = ________

j). D. = ________

k). H.S.(hs) = ________

l). ck * = ________

m). ad lib = ________

n). OS = ________

o). def * = _______

p). cr * = _______

q). adj = _______

DIRECTIONS QUESTIONS #32-35: After each group of names, indicate the order in which they would be arranged in an alphabetical file. The second line of the example shows the patients' names as they would appear on file labels. EXAMPLE: (a) J. T. Jefferson; (b) John Thompson; (c) Mrs. T.J. Brown (Marsha) ANS:___CAB_____

111. (a) Hugh M. MacAdoo; (b) Bruce T.McCall; (c) Robert A. Macall _______

112. (a) J.W. Winn, M.D., 1404 Rosealea Rd., Cleveland, Ohio: (b) James W. Winn,

1203 Venetta Drive, Cleveland, Ohio; (c) J.W. Winn, IV, 18 Maple St., Cleveland, Ohio ________

113. (a) Mary Sue Shelton; (b) Marth Lee Shelton-Alston; (c) Sheila-Lynn Alston (Mrs. Shelton A.) ________

114. (a) Jas. E.McBean; (b) J.L. MacBeen; (c) Jason McBean ________

115. (a) W. L. Arther-Davis; (b) Carolyn Archer (Mrs. David): (c) Sister Aeletta-Marie _________

116. (a) Mrs. Loretta Maggio; (b) Nokker T. Magallon, Sr.; (c) B.L. Magill, Rev. _________

117. In the ‘transactions’ section of medisoft, which of the following must be entered in order to complete the transactions for a patient ?

a). All of the charges

b). All of the payments, adjustments and/or comments

c). The CPT codes

d). The amounts charged for each procedure

e). Only ‘a’ and ‘b’ are correct

f). Only ‘c’ and ‘d’ are correct

g). All of the above are correct

h). None of the above are correct

118. What three basic things must be added to CPT in medisoft in order to process your transactions ?

a). A Comment

b). INSPAY

c). COPAY

d). Assigned Provider

e). Referred Provider

f). ICD-9 (Dx)

g). Only ‘a, b,’ and ‘c’ are correct

h). Only ‘c, d,’ and ‘e’ are correct

i). All of the above are correct

j). None of the above are correct

119. While doing the ‘transactions’ section of medisoft, if you obtained charges of $105, with payments of $ 165 and a balance of [ - $ 55 ], what does this balance obtained mean ?

a). An error made by the person entering data

b). A wrong amount entered for the COPAY

c). An amount that must be returned to the patient

d). A wrong amount entered in the ‘applications’ (apply)

e). Only ‘a’ and ‘b’ are correct

f). Only ‘a’ and ‘d’ are correct

g). All of the above are correct

h). None of the above are correct

120. Which of the following represents the information that must be entered in medisoft in order to complete processing of the

transactions section ?

a). The Practice Information

b). Patient information with Cases

c). The CPT Codes

d). Assigned Provider

e). ICD-9 (Dx)

f). Insurance Carriers

g). Only ‘a, b, c’ and ‘e’ are correct

h). Only ‘a, b, c’ and ‘f’ are correct

i). Only ‘a, b, c’ and ‘d’ are correct

j). All of the above are correct

k). None of the above are correct

121. What does the amount placed on INSPAY in medisoft represent ?

a). All CPT’s performed

b). A justification of charges in transactions

c). The total charges for all procedures

d). Only ‘a’ and ‘b’ are correct

e). Only ‘b’ and ‘c’ are correct

f). All of the above are correct

g). None of the above are correct

122. When entering information on the “Patient Screen” segment of medisoft, which of the following must be entered in order to complete this screen ?

a). New Case g). Only ‘b’ and ‘c’ are correct

b). Diagnoses h). Only ‘c’ and ‘d’ are correct

c). Assigned Provider i). All of the above are correct

d). CPT Codes j). None of the above are correct

e). Signature on File (SOF)

f). Only ‘a’ and ‘b’ are correct

SECTION X: CASE STUDY: { MANUAL & ADVANCED CODING }: ( 7 PTS): DIRECTIONS:

DIRECTIONS:

Using the case presentation attached, you are to do the following:

1. Define the patient record abbreviations (below) indicated as well as the additional coding in section II.

2. Using the Patient Record No. 13-5, on a separate blank sheet of paper make an outline of all the charges (page #6) to be made for this patient in the format of Date, Charge Explanation, Code number and Amount Charged and turn this in with your work.

3. Complete an CMS 1500 claim form for this TRICARE case posting all relevant data.

4. Complete a Financial Accounting Record with posted transactions.

SPECIFIC INDICATIONS:

1. After completion of your manual format for the case history along with charges and codes found as well as abbreviations, complete the CMS 1500 using OCR guidelines for this TRICARE case. Direct the claim to the Tricare Fiscal Intermediary, 100 North Philadelphia Avenue, Omaha Nebraska 10567. This assignment may or may not require more than one CMS 1500 claim form for completion. Hand in both when done. Refer to the attachment listing of amount charges for procedures to be used on the ledger and claim form. Date the claim Feb 3. Dr. Ulibarri (Tax ID #C658764) is accepting assignment in this case. The patient met her deductible last November when seen by a previous physician.

2. Use your CPT and ICD-9 code books to look up all code numbers needed in this case. Record all transactions on the financial record and indicate when you have billed the primary insurance carrier.

3. On Jan 24th the patient made an advanced payment of $575 (check #387) on this claim. Indicate this amount on your forms with appropriate justifications and balances. Post this payment on the financial accounting record and indicate the balance that will be billed to Tricare on the following day. The explanation of benefits from this case is to be sent to Tricare with a completed CMS1500 claim form. Also post a 15 % Courtesy Adjustment for this claim. The Tricare formula for this claim is 30/70 %.

4. Abbreviations pertinent to this patient’s record: [ Graded Component ]

a. Pt_ ____________________

b. D______________________

c. PX_____________________

d. HX_____________________

e. UA_____________________

f. WBC___________________

g. LC_____________________

h. MDM___________________

i. PF_____________________

j. rec_____________________

k. SF_____________________

l. C______________________

m. RBC____________________

n. cc______________________

o. lab_____________________

p. Rx_____________________

q. caps____________________

r. t.i.d.____________________

s. Rem____________________

t. Dx_____________________

u. M_____________________

v. surg___________________

w. ofc____________________

x. PO____________________

y. OV____________________

z. rtn_____________________

aa. PRN____________________

ab. sched.__________________

ac. EPF____________________

ad. MC_____________________

ae. FBS____________________

af. CBC____________________

5. Pertinent Fee Schedules:

FEE SCHEDULES

Knee Surgery $650

EKG $45

OV#1 (99201) $75

MEDS $35

I & D Skene Glnd $75

Injection $35

U / A $35

CBC $25

CBC+Diff $45

X-rays $20

Cholangiogram $90

U/A + Culture $60

Nitro Pads $55

Diuretics $40

MEDS (bactrim) $22.50

Ventolin $11

Double X-rays $40

Chest P&A $45

Lat. X-Rays $45

Digoxin Inj. $25

B12 Inj. $40

Nitro (meds) $40

Bronchogram $150

CXR(AP/Lat) $75

OV HCN PF

Hx /SF MDM $134.99

[MEDICARE]

ABG O2 $85

PFT”s $125

OV C hx/exam

MC MDM $138.50

IV MEDS $25

OV PF

Hx /SF MDM $36.80

Cult Abscess (Skene) $45

MRI (s contrast) $175

Suture 2-5 cms Laceratiion $125

ER and/or Physician Consult $85

Cauterization $65

Suture Removal Kit $45

Septoplasy $653

Professional Courtesy (-$55)

C x R (2views) $65

Elect Panel SMAC12 $45

CT Thorax/Contrast $125

IM Inj. Drug $25

C & S Test $45

Excision Skene $165

U/A Non-Auto Micro $55

MEDS (Terramycin) $22.50

Handling/Transport $35

5. Section II: Additional Coding and Fee Calculations: [ Graded Component ]

(1).- Refer to Ms. Drew’s medical record, abstract information, and code procedures that would be billed by outside providers.

Site Description Code

a. Drainage Skene’s Gland _______________________ _________________

b. Handling/Transport Culture _______________________ _________________

c. Excision Skene’s Gland _______________________ _________________

d. Abscess Drainage _______________________ _________________

(2).- Use your diagnostic code book and code the symptoms that the patient presented with in the clinic.

Symptom Code

a. _______________________________ __________________

b. _______________________________ __________________

c. _______________________________ __________________

(3).- On the surgery of Jan 24, 20xx), assume that Tricare Fiscal Intermediary paid $658.45:

a. What would be posted in the financial statement ? ________________________________________.

b. What would the patient responsibility be ? __________________________________________.

c. What would the Courtesy Adjustment be at 15 % ? ______________________________________.

PATIENT MEDICAL RECORD:

[pic]

STATEMENT [ FINANCIAL ACCOUNT ]

( GRADED COMPONENT )

[pic]

HEALTH INSURANCE CLAIM FORM (CMS-1500)

( GRADED COMPONENT )

[pic]

MANUAL RECORDING OF CHARGES: [ GRADED COMPONENT ]

-----------------------

OLD PATIENTS (Established)

99211 OV#1 Level 1 $16.07

99212 OV#2 Level 2 $28.55

99213 OV#3 Level 3 $40.20

99214 OV#4 Level 4 $61.51

99215 OV#5 Level 5 $96.97

NEW PATIENTS

99201 OV#1 Level 1 $33.25

99202 OV#2 Level 2 $51.91

99203 OV#3 Level 3 $70.92

99204 OV#4 Level 4 $106.11

99204 OV#5 Level 5 $132.28

EMERGENCY DEPARTMENT

(New/Established Patient)

99281 PF hx/exam SF MDM $24.32

99282 EPF hx/exam LC MDM $37.02

99283 EPF hx/exam MC MDM $66.23

99284 D hx/exam MC MDM $100.71

99285 C hx/exam HC MDM $158.86

HOSPITAL

(Observation Svcs / New or Established)

99217 Discharge $66.88

99218 D hx/exam SF / LC MDM $74.22

99219 C hx/exam MC / MDM $117.75

99220 C hx/exam HC / MDM $147.48

DATE: CHARGE EXPLANATION: CODE #: AMOUNT CHARGED:

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