ࡱ>   ` )Dbjbjss HM& ^^^^l|!8<4<AAAhBD</hJJ" K K KKKK///////$1h3.6/9^ԌKK 6/^^ K Ko/FFF^ K^ K/FԌ/FF^^ KJ CANT "/0/&^4N 44&K{`F/o zKKK6/6/^KKK/ԌԌԌԌ<<<@<<<@<<<^^^^^^ MEDICAL BILLING HANDOUT EXERCISES I. Career Opportunities The skills learned in this Medical Insurance Billing Specialist class can apply to various career job descriptions, including: Reception-Appointments Desk Patient Registration/Registrar Insurance Verification, Authorizations Front-Office Insurance Biller Insurance Clerk Insurance Coder Patient Accounts Collections Claims Adjuster-Examiner Claims Auditor AND still MORE! Some or all of these positions can be found in Physician/Doctor Offices, Acute Care Hospitals, Long Term Care Facilities, Outpatient Clinics, Chiropractic Offices, Physical Therapy Offices, Alternative Health Care Clinics, Freestanding Laboratories, Radiology Centers, Medical Equipment Vendors, Billing Services and Insurance Companies. In Acute Care Inpatient Hospitals, the billing is done by the Business Office. The coding is done in Medical Records/Health Information Management. Inpatient coding usually requires very specific medical training and certification (CCS/RHIT) which may take years to complete. Of the bulleted job descriptions, which ones do you think would require the most contact with patients? ________________________________________________________. When interacting with patients you need: A compassionate attitude and The desire to help the patient through medical, economic and insurance problems. This is called Patient Advocacy. Using the job descriptions in bold type above, search the internet (indeed.com or craigslist.org) and find at least five job listings nearest you. For each listing, note the: Job Title and Responsibilities. Hourly or Annual Wage. Amount of Education and Experience Required Whether it involves telecommute options. Attach the Job Description to this homework. From the job listings, identify ten or more common job duties: II. Insurance Issues 1) When employees or members of the same organization or association obtain insurance together for a reduced rate, this is called __________ insurance. 2) When somebody does not have group insurance but buys health insurance directly from an insurance company or a broker, this is called _____________ insurance. 3) The person who took out the insurance policy is called the _________ holder or the __________ed or __________er. People added to the policy are dependents. 4) On government claims, the person receiving medical insurance coverage is called the Beneficiary in what plan? (__________________) Recipient in what plan? (__________________). 5) The generic word that includes doctor, therapist, laboratory, clinic, hospital, equipment vendor, and any care-giver or supplier is: ________________. 6) In commercial insurance, the written agreement between the provider and the insured to allow the insurance to pay the provider is the ____________ of benefits. In government plans, the provider accepts assignment which means they have to agree to the government payment rates before they can receive a government payment. 7) The money the insured pays monthly to the insurance company for insurance coverage is called the _____________. The amount of covered medical expense the patient must pay out of pocket each year before insurance begins to pay is called the ______________. 8) When the patient is a minor or dependent, the person responsible for payment of their medical bill (or any balances left after insurance payment) is called the _______________. 9) When determining whether the patient currently has insurance coverage you are checking _______________. Dont forget to ask if there are pre-existing conditions. When determining whether the CPT or HCPCS service code must be authorized in advance by the insurance company, you are requesting _______________. 10) In Medicaid/Medi-Cal, Workers Compensation, Disability Evaluations, Pre-Employment or Pre-Insurance Physical Exams, the contract (obligation to pay) is between the provider and the _______________. It is not the patients obligation. Therefore the patient is NEVER responsible for a balance in those situations. In nearly all other situations, the contract is between the provider and the patient or guarantor. III. ICD-9-CM Coding Issues Why do you think it was important to track disease and death (morbidity and mortality) statistics before there was such a thing as health insurance? _____________________________________________________________. The World Health Organization is responsible for ICD-9 and ICD-10 codes internationally. Their purpose is not only for claims but to help identify health risks on a global level. In the USA, the American Hospital Association and the Centers for Medicare and Medicaid Services are responsible for ICD-9-CM or ICD-10-CM (the US clinical modification). What will likely happen if I fail to put the ICD-9 code on the medical claim or fail to reference it to the procedure billed? Claims can be__________, or there may be a penalty or _________. What are the two volumes of the ICD-9 book? Volume One, __________ _______ List, Volume Two, Alphabetic_______. Often, ICD-9 books may have Volume Two listed before Volume One. NOS = Not Otherwise Specified. Use this when the ________________ does not specify any more information about the condition. NEC = Not Elsewhere Classified. Use this when the ____________ does not classify the specific condition. What coding system is scheduled to replace ICD-9 in 2013? __________. If the your codebook indicates you need additional digits, is it a suggestion or a mandatory requirement?_________________________. If you cant find the fifth digits, can you just add numbers anyway? ___ Where are the fifth digit categories found in the book?________________. What is an Eponym? When a disease is named after a _________or a _____. What does Etiology mean? The disease process that is an underlying _______ of another disease. Slanted brackets [] indicate a manifestation code that is to be used after an etiology code. You never code any diagnosis that is described as likely suspected rule-out questionable probable. Physicians only code what is known. If the diagnosis has not yet been made, you may code with the patients _____________. Where do you find the Hypertension Table, the Neoplasm Table and the Table of Drugs and Chemicals? In or after the___________________. You would use a V code to describe the reason for the health service when the patient is not currently ______ or presents for specific treatment. You would use an E code to describe how a patient was injured or poisoned. Can an E code be a primary diagnosis? _Yes/No_. The steps for finding an ICD-9-CM code are: Go to the Alphabetic _______ and look up the _____ term. Indented under that term you will find the Subterm. Write down the code(s) given and look them up in the _______ list. Read any special instructions such as Excludes or Includes or See and any symbols instructing you on how many digits you need to add to the code. Copy down the code and then _____-read it for accuracy. Indentations: Any code description that starts with a small-case letter and is indented, includes the ___________ of the code that is not indented above it. Circle main term, underline subterm, list *complete* ICD-9 code: Hip fracture _________ Corneal abrasion _________ Abscess in left axilla region _________ Acute cerebrovascular accident (CVA) _________ Bells palsy facial paralysis _________ Insulin dependent diabetes mellitus (IDDM) _________ Acute Myocardial Infarction MI), First Episode _________ Chronic serous otitis media (OM) _________ Duodenal ulcer with hemorrhage _________ Abnormal blood level of iron _________ Acute upper respiratory infection (URI) _________ Foreign body, eye _________ Secondary carcinoma lung, lower lobe _________ Urinary tract infection (UTI) _________ Benign essential hypertension _________ Coronary arteriosclerosis _________ Primary carcinoma, face _________ Malignant hypertensive renal disease with renal failure _________ Abdominal pain LLQ _________ Diabetes mellitus, juvenile type, uncontrolled _________ Diverticulosis, small intestine with hemorrhage _________ Spontaneous fracture, vertebra (collapse) _________ North American blastomycosis _________ Complication due to transplanted bone marrow _________ Laceration elbow with tendon involvement _________ Calcification of shoulder joint _________ Cleft lip with cleft palate _________ Anaerobic septicemia _________ Christmas disease _________ Dysplasia of cervix (uteri) _________ Pitting edema of bilateral ankles _________ Gastrojejunocolic fistula _________ Nuns Knee _________ Tennis Elbow _________ Abnormal weight loss _________ Dislocated shoulder _________ Contusion of upper arm _________ Fracture, right tibial shaft _________ Advanced Concepts and Problems Colles' Fracture _________ Cervical stenosis, (C3 C4 spine vertebra) _________ Follow-up exam for Myocardial Infarction (MI) of 6 week duration, posteriolateral _________ ECG on patient with history of MI a year ago: _________ AIDS (symptomatic) _________ HIV positive, non-symptomatic _________ Malignant neoplasm of ovary _________ Multiple Code Situations Diabetes Mellitus (DM), adult onset, on insulin _________ and _________ Diabetes Mellitus, juvenile onset (IDDM), with complication of glaucoma: _________ and _________ Kyphosis due to tuberculosis of spine _________ and _________ Familial cardiomyopathy due to Chagas disease _________ and _________ Normal vaginal delivery, with episiotomy and single live-born baby _________ and _________ Vaginal delivery complicated by prolonged labor with unknown outcome _________ and _________ Kaposis Sarcoma due to AIDS _________ and _________ LATE EFFECTS: Mal-union fracture, right tibia shaft _________ and _________ Traumatic arthritis following fracture of right knee _________ and _________ Burns 1st and 2nd degree burns of face, neck (6%) and hands (4%), 2nd and 3rd degree burns of trunk (9%) _________ and _________ and _________ and _________ V Codes Screening for alcoholism _________ Special screening exam for heavy metal (chemical) poisoning _________ Special screening for sickle cell anemia _________ Routine infant well baby health check-up _________ Routine laboratory exam (adult) _________ Hemodialysis treatment encounter _________ E Codes Motor vehicle accident (MVA), collision with horse-carriage, injuring carriage occupant _________ Fall from elephant _________ Burn by boiling soup _________ Legal execution capital punishment _________ Accident while aboard spaceship _________ IV. CPT Coding Issues CPT/HCPCS codes are for services. They are like invoice numbers for a catalog of things a doctor or provider can bill to an insurance company. There are CHARGES for CPT/HCPCS codes. ICD-9 codes are illnesses, and illness is free of charge! The CPT/HCPCS code answers the question, What treatment or service is the doctor charging for? Remember, ICD-9 codes simply answer the question, Why did the patient go to the doctor? HCPCS Level One is CPT numeric codes, maintained by _____________. HCPCS Level Two is Medicare alpha-numeric, maintained by _____________. HCPCS Level Three is Medi-Cal alpha-numeric X-Z, maintained by _____________. How often are the CPT/HCPCS code books reprinted/revised? _____________. What does CPT stand for? _____________________________. What are the names of the seven major sections of the CPT codebook? 1) _____________. These codes start with ________ and end with _________. 2) _____________. These codes start with ________ and end with _________. 3) _____________. These codes start with ________ and end with _________. 4) _____________. These codes start with ________ and end with _________. 5) _____________. These codes start with ________ and end with _________. 6) _____________. These codes start with ________ and end with _________. Additionally, there are two more sections: Category II codes (optional survey) and Category III codes (mandatory temporary codes for services not in sections 1-6). CPT codes have an indented code rule much like the ICD-9 rule. However, the indented code *only includes the description of the non-indented code above up to the SEMICOLON (;). Another convention of CPT is the ADD-ON code. Add-on codes are designated with a plus symbol (+) to the left of the code. Add-on codes may NEVER be billed alone. They are always in addition to another code. Examples would be the Prolonged Services codes in E/M, or the Lesion Destruction codes (17000 and +17003) in surgery. When using the CPT book, you should start by looking up the description of the service in the index. The index will usually give you a range of codes. If they are separated by a dash (like 99201-99205) it is a range of all the codes. If they are separated by a comma (like 99201,99205) it is sending you only to those two codes and not the full range in between. Write down the codes from the index and look them up in the appropriate section. The book is in numerical order, except for Evaluation and Management, which is in the front when it numerically would be expected to be at the end. It is always necessary to read the guidelines for the section, and the additional guidelines for the subsection you are working with. Read the description of all codes in the indexed range before choosing one, and read any parenthetical notes as well. EVALUATION AND MANAGEMENT (VISITS) An established patient has seen the doctor OR a doctor of the same specialty in the same practice within the last three years. A new patient hasnt! At what point does a patient previously seen become a new patient all over again? If they have not been seen by this doctor or another doctor of the same _______ in the group for ___ years. Circle the correct answer. Jane was seen at the hospital for a consult with Dr. Williams. Two weeks later she was seen for treatment at Dr. Williams office. New patient Established patient While Dr. Halibut was on a fishing vacation, his partner, Dr. Bass, saw Dr. Halibuts patient in the office for a sore throat. Dr. Bass was acting as Locum Tenens. New patient Established patient John and his family have just moved into town. John has asthma and requires medication to control the problem. Dr. Yokohama has received his records from the previous doctor back in Johns old neighborhood. New patient Established patient Tom was in the army for two years. During that time he did not see Dr. Teacup. The office policy is to place any inactive files on microfilm after 18 months of inactivity. After Tom finished his tour of duty and returned home, he made an appointment to see Dr. Teacup again.  New patient Established patient How many of the key components (history, physical exam, medical decision-making) must be met or exceeded for new patient services? ______ How many for established patient services? _________. For evaluation and management, you need to first consider the ________ where the service occurred. Was it Office or Outpatient Hospital Clinic? Inpatient Hospital? Nursing Home? Hospital Emergency Department? Or is it a Consultation situation where one doctor is asking your doctor to examine the patient and write a report advising the requesting doctor how to treat the patient? Once you have selected your location/situation, you often need to know if your patient is New or Established (seen by the doctor or another doctor of the same specialty in the same practice within the last three years) and approximately how much time the doctor spent with the patient and what kind of medical history and physical examination were done as well as something about how complicated the doctors decision making process was. Most services are at the first three levels of service. 99211 may be used if the service was so simple a physician was not required (shots, suture removals, vitals). Levels of service 4 and 5 should only be used after reviewing medical documentation and looking at the clinical examples in the back of the CPT book to verify you are not up-coding or overcharging the insurance, as this can be considered fraudulent billing. OFFICE OR OTHER OUTPATIENT SERVICES New patient, office, expanded problem focused history and exam, straightforward decision making. (Example: 16 year-old male with severe cystic acne.) ____________________. Established patient, office, detailed history and exam, decision making moderate complexity. (Example: 28 year-old female with regional enteritis, diarrhea and low grade fever. ____________________. An established patient presents in Dr. Seth OScopes office stating she needs emergency treatment because she cannot breathe. She is taken back to the treatment area and Dr. OScope makes several other patients who have appointments wait while he does an evaluation involving a detailed history and physical examination with low complexity medical decision-making. _________ and _________. When is time a factor in choosing the correct E&M code? When counseling and/or coordination of care is more than ___% of the total encounter time and when selecting P________Services, C________ Care Services, or Hospital _________ services. OBSERVATION SERVICES A pregnant patient (28 weeks gestation) with a long history of premature labor began having contractions and called Dr. Forceps, her obstetrician. The doctor recommended that she be placed in an observation unit in the hospital. His care included a comprehensive history and physical with low-level medical decision-making. The patient was discharged on the SAME day _________. Observation care on one day with discharge on a DIFFERENT day use codes 99218-99220 for the Observation and for the discharge day use code 99217. HOSPITAL SERVICES Initial hospital care, detailed comprehensive history & exam, low-level decision-making __________. Subsequent hospital care, detailed history and exam, high-complexity decision-making __________. Hospital discharge day management, more than 30 minutes ____________. CONSULTATIONS To qualify as a consultation, there must be a ________ doctor who is sent a ______. Medicare no longer accepts consultation codes, use new/established patient for Medicare. Dr. Dwight Coates calls Dr. Cleaver and asked Doctor Cleaver to perform a gastrointestinal inpatient consultation on Miss Hurt. The consultation involved detailed history and detailed physical exam and low complexity medical decision-making _________. Two days later Dr. Dwight Coates got results for Miss Hurts test results and called Dr. Cleaver to review the test results and see Miss Hurt again and write a report giving his recommendations for treatment. The visit involved a expanded problem-focused interval history and examination and moderate complexity decision making _________. A patient was sent for consultation to Dr. Pharmer C. Rexs office by the patients primary care physician, Dr. Seth OScope. The patient had a long history of urinary and kidney problems which required a comprehensive history and physical examination with moderate complexity medical decision-making _________. Dr. Fibula, an orthopedic surgeon, saw Dr. Dwight Coatess long-time patient in his office for a consultation regarding the patients amputated leg. The amputation was due to diabetic related gangrene some eight years previously. The patients below the knee prosthesis had fallen off of the patients right leg when the patient stepped off a curb on a busy downtown intersection, causing the patient to fall. There was a stress fracture in the tibial plateau. A cast was applied, but the fracture was not healing well due to the patients osteoporosis and diabetes. Surgery was inevitable, but the patients high deductible on their insurance and work obligations made them hesitant to set a surgery date, and the patient wanted to delay or avoid surgery if possible. Dr. Fibula sent the patient to Dr. Sawbones for a second opinion regarding the need for surgery and the best surgical procedure to perform. Dr. Sawbones took a comprehensive history, performed a comprehensive examination and high complexity medical decision making to evaluate the patient. He sent a report to Dr. Fibula recommending immediate surgical fixation with percutanious fracture reduction. Code Dr. Sawbones service _________. (This is a good exercise in extracting necessary information from long narratives containing confusing information not necessary for coding.) Initial inpatient consultation, detailed history and exam decision-making low. (Example: diagnosis/management of fever following abdominal surgery) __________. EMERGENCY ROOM How does the CPT book define emergency department? Code the following: Emergency department visit, comprehensive history and exam, high decision-making (Example: patient with new onset of rapid heart rate requiring IV drugs) _______. CRITICAL CARE Dr. Ron Call saw a critically ill patient in the intensive care unit of the hospital and provided constant bedside care for 45 minutes _________. Dr. Dwight Coates saw a critically ill new patient in the morning of January 8 in the cardiac care unit of the hospital. He provided constant bedside care for 1 hour 12 minutes. That afternoon, Dr. Dwight Coates returned to the hospital and spent an additional hour and ten minutes _______ x___ and _______ x___. NURSING FACILITY How does the CPT book define the types of facilities covered under nursing facility services codes?  1. 2. 3. and 4. A nursing facility provides medical services, but rest home, domiciliary, custodial care services have no ____________ care component at all. Code the following: Subsequent nursing facility care expanded problem focused exam and history, moderate complexity decision making (Example: skilled nursing facility patient who is six months post stroke and now has fever and mild cough) ____________. Dr. Dwight Coates went to the Holiday Hamlet Rest Home to see a patient of his who has chronic urinary problems and an occluded urostomy catheter. His visit included an extended problem-focused history, detailed physical and moderate-level medical decision-making _________. PROLONGED SERVICES Prolonged services are add-on codes and cannot be used by themselves. They are for additional time added to other Evaluation and Management service codes. Prolonged services can be face to face with the patient or not face to face. Refer to #4 above. The next day, without seeing the patient again, Dr. Coates spent an hour reviewing extensive patient records. Later that afternoon, Dr. Coates spent an additional 45 minutes giving instructions to the patients nurse about catheter use and problem prevention: _________ X___ and ___________ X___ (Note: there are TWO Prolonged Care sections, face to face and not face to face!) HOME SERVICES New patient home visit, expanded problem focused hx and px, moderate mdm _________. Established patient home visit expanded problem focused hx and px, low mdm _________. PHYSICIAN STANDYBY SERVICES Dr. Ferney Forceps spent 2 hours standing by for a high-risk cesarean delivery _______ Box 24 G (times:)x__. CARE PLAN OVERSIGHT Care plan oversight by physician of a patient referred by a home health agency, requiring complex care involving physician development of care plans 30 minutes within a one month period ___________. PREVENTIVE VISITS Preventive medicine services for a 5-year-old established patient _________. A 19-year-old established female patient presented in Dr. Dwight Coates office for a yearly physical examination. A comprehensive history and physical exam were performed and the doctor discussed sexually transmitted disease prevention and birth control _________. A 4-year-old new patient was brought to Dr. Dwight Coates office by his mother. He received a pre-kindergarten examination _________. New patient, age 14, initial preventive medicine exam and MMR vaccination? _________ and _________ COUNSELING RISK FACTOR SERVICES Mrs. Plumb was concerned about her 16-year-old daughter losing weight and constantly working out at the gym, and possibly being anorexic. The daughter refused to be examined by Dr. Coates, but she did consent to sit down for 45 minutes to talk with the doctor about diet and exercise _________. Mrs. Plumbs daughter agreed to return to a one-hour long group counseling session the following week. About eight young adults and teens discussed body image and eating disorders___________. SURGERY SERVICES (INVASIVE PROCEDURES) Global services and Bundled Services are services that are paid in a Combo Package. Evaluation and Management within 24 hours of surgery is usually packaged or bundled into the surgery code. Follow-up visits for the surgery are also bundled into the surgery code and shouldnt be billed separately. An analogy would be ordering a dinner combo (lets say the Big Mac #1 with drink and fries) and getting charged for each item separately a la carte. CPT code billing this way is sometimes called a la carte medicine, unbundling, or exploding charges, and it is considered fraud if intentionally billed that way on government claims. Where can you find the global surgery follow-up days listed? On the Medi____________ fee schedule websites or print-outs. A minor surgery that usually requires no return visits (for example, a small wart removal) generally has how many follow- days under the global surgery rules? ____. Same day decision for surgery visit modifier___. A major surgical procedure or a fracture reduction generally has 90 follow-up days under the global surgery rules? Same day decision for surgery visit modifier___. A minor surgery that usually has dressing changes or suture removals usually has 10 follow-up days under the global surgery rules? Same day decision for surgery visit is significant separately identifiable E/M service modifier___. Modifier -51 is for __________ surgery procedures on the same date, same session. It is not put on the ______st procedure (the most expensive one), nor is it put on _____-on procedures (marked with the + symbol) or on procedures marked with the  symbol. When multiple surgery procedures are billed with modifier -51, the first procedure (the most expensive) does not have modifier -51 and receives 100% fee schedule allowance, and second surgical procedure (with modifier -51) is paid at a reduced rate of 50% of the fee schedule allowance. The third procedure (with modifier -51) would usually receive only 25% of the fee schedule allowance and the fourth procedure (with modifier -51) would usually receive only 10% of the fee schedule allowance. On Medicare modifier -51 is not used. Medicare will automatically give a 100% fee schedule allowance to the most expensive procedure, and 50% of the fee schedule allowance to all covered subsequent procedures. ENDOSCOPIC PROCEDURES Endoscopy is the use of a scope or viewing instrument in a tube. The endoscopy can be simply for viewing (DIAGNOSTIC) or may be used to cut or take tissues out (SURGICAL). If a diagnostic endoscopy ends up taking a tissue for biopsy, code surgical endoscopy with biopsy only, do not code a diagnostic endoscopy, as the diagnostic endoscopy is assumed to be part of the surgical endoscopy. Many surgeries can either be done as open (incisional) or as endoscopic procedures. Multiple endoscopies are an exception to the percentage rules. You use a single endoscopy for the insertion of an endoscope from a point of entry to its farthest destination (think of airline tickets, you but from origin to destination, not from layover to layover). You do, however, bill an additional code if the endoscope is either removed and reinserted through another point of entry or if it is backed up and changes its course (example: bronchoscopy where the scope goes down the trachea into one lung, then backs up and goes into the other lung). Modifier -50 is for bilateral procedures, that is, they are done twice when there are a pair of organs. Identify which of the following will take a modifier -50: Cataract (Eye) surgery? Yes/No Nephrotomy (Kidney) surgery? Yes/No Uterine surgery such as hysterectomy with removal of ovaries? Yes/No A procedure with a description, multiple or bilateral. Yes/No Cochlear Implant (ear) surgery? Yes/No Lung surgery? Yes/No? A procedure with a description, separate procedure. Yes/No Integumentary is a fancy word for _______. A lesion is any discontinuity of the ________. A laceration is a __________. An avulsion is a _________. Always add up the total lengths of laceration repairs when the type of the repair and the __________ category are the same. A coder needs to code lesion excision measurements from which report? The Pathologist or Surgeon report? If a biopsy is performed and a surgical excision (removal) follows on the same date/surgery session, can you bill for a needle or excisional biopsy with an excision? Yes/No Can you bill for bandages or gauze used on a patient? Yes/No Can you bill for cast material such as plaster or fiberglass? Yes/No Modifier -58 is for __________ procedure. Use it when replacing a cast or in the rare situations where a surgery has to be done in more than one session. See the following example. Fracture Treatment Staged Procedure In this example we have several complicated CPT concepts: Application of additional code for after-hours service. Global surgery package items such as Decision for surgery visit payable on date of surgery Non-billable follow-up during global follow-up period (90 days for fractures) Radiology service with right or left modifier Surgical code with staged (phased) procedure modifier Supplies billed either with CPT or HCPCS code. CLAIM 1 A young patient comes into urgent care clearly in distress just before midnight. This is not an ER. She has not previously seen this doctor or been to this medical group. She is complaining of right wrist pain and swelling of the joint. Doctor Ron Call orders an x-ray film from the radiology center next-door, then looks at the film and determines that the patient has suffered a Smith fracture. The doctor performs a fracture manipulation and applies a long arm cast made of plaster. Evaluation/Management, new patient, level 3 with decision for surgery 99203-57 After-hours service call: 99053 Radiologic Exam, right wrist, AP and lateral views, reading+film: 73100-RT Closed treatment of distal radial fracture, smith type: 25605 Supplies (of plaster casting materials) CPT-Style: 99070 (with note or report) Or code HCPCS II plaster casting materials: Q4009 CLAIM 2 The patient returns in four weeks for follow-up care. There is a follow-up wrist x-ray (with the same particulars), the long-arm cast is removed and a short-arm cast is applied using fiberglass (Hexcelite) material. Follow-up visit related to surgical code: DONT BILL (bundled, but you can use 99024 for ledger) Radiologic Exam, right wrist, AP and lateral views, reading+film: 73100-RT Cast removal procedure: DONT BILL (still bundled, 99024 on ledger) Application of fiberglass short-arm cast as staged procedure: 29075-58 Supplies (of Hexcelite casting materials) CPT-Style: 99070 (with note or report) Or code HCPCS II Hexcelite casting material: Q4010 Add-On Codes and Lesion Removal A code with + next to it is an add-on code. These codes are in addition to another code and therefore cannot ever be billed by themselves. Alone they are unpayable, invalid orphan codes that need their parent! Code the following: Destruction of three premalignant lesions from the face using laser treatment: Line 1, Box 24 D__________X ____. Line 2, Box 24 D__________X____. Remember the first code is for a certain number of lesions, and the add-on code is for the remaining or additional lesions. NOTE: for all codes, read the special instructions for the section, and for the subsection and for the code itself. Repair of wounds/lacerations: Repair (suturing) can be: Simple (single, surface-layer) repair/closure or Intermediate (surface-layer plus the first layer below the surface) or Complex (closure of layers all the way through to the muscle tissue and/or including debridement or foreign-body removal). Code the following: Simple repair of superficial wound of the lip; 2.3 cm __________. Repair of complex wound of the scalp; 5 cm ___________. For surgical excisions (removal, cutting-out), a simple repair is included in the code and not billed separately. However, if the repair is intermediate or complex you would bill the additional repair code for the appropriate intermediate or complex repair done. Excision of benign lesion from the neck; 4 mm __________ (4 mm = 0.4 cm) Excision of malignant lesion from the ear (2.6 cm) requiring complex closure:___________ and ___________. What does a + next to a code mean? ______________ code. Code the Following: Excision, lesion right arm, benign 4.5 cm _________. Superficial wound dehiscence, simple wound closure ________. Repair layered closure of wound, hand, 12.8 cm _________. Five-year-old presents in the ED with following lacerations for simple repair with 4-0 vicryl sutures in upper layer of skin: 1.2 cm, right index finger and 0.8 cm right middle finger: ___________ F6 F7. What are the three methods that may be used to treat closed fractures? 1. 2. 3. NOTE: A closed fracture diagnosis may have open treatment CPT. The treatment method and the type of fracture are two different things not to be confused. VARIOUS SURGERIES AND ANESTHESIA Code the following: Incision/drainage of soft tissue abscess, cutaneous ___________. Treatment, closed nasal septal fracture __________. Closed reduction, fracture radius and ulna _________. Reconstruction, tendon pulley, hand __________. Surgical arthroscopy of elbow synovectomy, complete _________. Tonsillectomy, patient under 12 years _________. Diagnostic laparoscopy _________. Appendectomy, emergency due to rupture _________. Total OB care with Normal vaginal delivery of first baby __________. Cesarean delivery ONLY, first baby _________. NOTE: Prenatal and postnatal care are not billed with E/M codes. They are under delivery in surgery section. Bill OB care and delivery after delivery! Many surgical procedures have several possible components: Surgeon (no modifier), Assistant Surgeon (modifier -80), Two-surgeons (modifier -62 on both bills), Surgical Team (modifier -66) and Anesthesia (normally billed with an anesthesia section code, but sometimes billed as the surgery code with modifier -30 or modifier -36 on workers compensation). Code the following: Coronary artery bypass graft (CABG), vein only, 5 venous grafts ________. Another doctor was assisting the surgeon, and there was anesthesia administered with pump and oxygenator. Patient is 83 years old and has a mild systemic disease: Surgeon (Dr. Cutler): __________. Assistant Surgeon (Dr. Cleaver): ___________. Anesthesiologist (Dr. Zonk): _________-P__ and 99_____. NOTE: READ the introduction to the Anesthesia Section. There are modifiers to indicate the patients status and Qualifying Circumstance codes from the Medicine Section that often need to be added to anesthesia billing. Medicare has a completely different set of HCPCS modifiers to be used with anesthesia. RADIOLOGY PROCEDURES When a radiology code is billed without the modifiers 26 or TC, it means that the bill is for the technical and professional services together the technician/film and the reading/report. When a facility bills for the TECHNICAL COMPONENT of a radiology procedure, they are billing for the services of the technician and the film only. This is billed using the radiology code with the modifier TC added. When a doctor bills for the PROFESSIONAL COMPONENT of a radiology procedure (X-Ray, CT Scan, MRI, etc.), he is billing only for the reading or looking at the X-Ray and writing a report of his findings. This is billed using the radiology code with modifier 26 added. Modifiers RT and LT help identify and separate radiology procedures on hands, feet, etc. that might otherwise look like they are the same view being done twice. Code the following: Spiral CT scan of abdomen without contrast material and spiral scans of abdomen and pelvis using Isovue contrast injection. __________. Bundled Services are services that are paid in a Combo Package. X-Ray services also have the Bundled Services concept. One service: Radiological examination, chest, single view, (front) _________ One service: Radiological examination, chest, single view, (lateral) ________ BOTH views, same day: _________ ONLY!!!! Code the following: Chest X-Ray PA and lateral (2 views), technical component only _______ ___ X-Ray hand, 3 views, professional interpretation only _________ ___ X-Ray hand, 3 views (no split component) ____________ Diagnostic procedure is when there is a problem, such as a breast lump that needs to be diagnosed. Screening is a preventive service to make sure there is no lump or abnormality. Screening would have a V code ICD-9. Diagnostic would have 611.XX or some ICD-9 code indicating there was a mass or pain or some symptom or diagnosis. Unilateral Diagnostic Mammography ____________ Bilateral Screening Mammography ____________ PATHOLOGY AND LABORATORY SERVICES (Clinical Lab/Chemistry) Bundled Services are services that are paid in a Combo Package. Laboratory Panel services also have the Bundled Services concept. Code the following: One service: Cholesterol ___________ One service: Lipoprotein, direct measurement, high-density (HDL) __________ One service: Triglycerides ____________ ALL THREE tests, same day: bill __________ ONLY!!!! Remember that you need to have enough detailed information to select a correct code. A good example is that Hepatitis B can refer to testing for the disease by more than one method, or it can refer to giving a vaccination for the disease. Code the following: Hepatitis B (core antibody) __________. Hepatitis B (Virus antigen, direct probe) __________. Hepatitis B (vaccine, adult) _________ (not a lab service at all!). Under Clinical Laboratory Improvement Amendment (CLIA) rules, it is very important only to bill for laboratory services for which your office or laboratory is certified. For example, if you do not have a microscope or a technician capable of using the microscope, you would not bill codes involving microscope services. Code: UA (urinalysis), non-automated, without microscopy __________. PATHOLOGY (Anatomical Lab - Biopsies) Most laboratory services are not divisible into technical and professional components. However, Pathology Services (codes starting with 88) involve a physician taking a tissue sample (receiving biopsy sample) and looking at it through a microscope and writing a report of what he sees. The physicians pathology service is a professional service that may be billed with modifier 26. LAB-RELATED COLLECTION/VENIPUNCTURE (not Lab/Path codes) Many insurances pay for blood collection OR handling/conveyance, but not both. Code blood collection venipuncture (surgery section) ___________; Code handling of specimen for conveyance (medicine section)__________ MEDICINE SERVICES The Medicine Section of the CPT book is a jumble of services that do not fit into other sections. They may be diagnostic services, treatments, reports, or other special circumstances or services. Code the following: Therapeutic injection, subcutaneous _________. Hemodialysis, single physician evaluation ________. Esophageal motility study ___________ Electrocardiogram, 12 lead with interpretation and report ________. EKG 12 lead tracing only _________. EEG, extended monitoring, greater than one hour ________. Chemotherapy administration, subcutaneous _________. Service rendered on Sunday or Holiday __________. Medical Testimony _________. Ophthalmological service, new patient, medical examination with initiation of diagnostic and treatment program, comprehensive ___________. Individual psychotherapy, approximately 20-30 minutes with medical evaluation and management services ___________. Miss Zorba Tall was recently diagnosed with diabetes. Because of this, she attended a special instructional group session with noted diabetologist, Dr. Mel Saccharine. At the session, he explained insulin control measures such as use of glucose monitors and lancets, medications and adherence to a diabetic diet _________. Mechanical traction modality __________. Chiropractic manipulation, spinal, 4 regions __________. Post-operative follow-up visit that is part of the global surgery (no charge)_____. Acupuncture, 1 or more needles, without electrical stimulation ________. Allergy testing, percutaneous, with allergenic extracts, 10 tests _______24G x__. Supply of plaster cast material __________. Supply of wheelchair, heavy-duty, detachable arms, elevating leg rests _______ Supply of Vincristine sulfate, 4 mg, IV (chemotherapy drug) ___________ x__. Please review the HCPCS below and recode the 99070 services. Some Samples of HCPCS Medicare Alpha-Numeric Codes (bill to most insurers): Cast supplies, e.g, plaster = A4580 Special casting material, e.g., fiberglass = A4590 Wheelchair, heavy-duty, detachable arms, elevating leg rests = E1280 Vincristine sulfate 1 mg IV = J9370 Vincristine sulfate 2 mg IV = J9375 Vincristine sulfate 5 mg IV = J9380 California Medical Association AB 1455 Regulations: Unfair Payment Practices Summary Plans may not impose a deadline for claims submission that is less than 90 days for contracting physicians and less than 180 days for non-contracting physicians. An unfair payment pattern exists if a plan imposes a filing deadline that is inconsistent with the above in three (3) or more claims over the course of any three- month period. Plans are required to forward misdirected claims to the appropriate medical group/IPA and medical groups must forward misdirected claims to the appropriate health plan. An unfair payment pattern exists if a plan fails to forward at least 95% of misdirected claims over the course of any three-month period. Plans must accept a late claim if the physician files a formal physician dispute with the payor and demonstrates good cause for the claim filing delay. An unfair payment pattern exists if a plan does not accept late claims at least 95% of the time for the affected claims over the course of any three month period. Plans must appropriately request refunds for claims that have been overpaid. An unfair payment pattern exists if a plan fails to request reimbursement of an overpayment of a claim at least 95% of the time for the affected claims over the course of any three-month period. Plans must acknowledge receipt of all physician claims, whether or not complete, electronically, by post, phone or website. An unfair payment pattern exists if a plan fails to acknowledge the receipt of at least 95% of claims over the course of any three-month period. Plans must provide an accurate and clear written explanation of the specific reasons that each claim has been denied, adjusted or contested. An unfair payment pattern exists if a plan fails to provide specific reasons for denying, adjusting or contesting a claim at least 95% of the time for the affected claims over the course of any three-month period. Plans may not include a provision in a provider contract that requires a physician to submit medical records that are not reasonably relevant to the adjudication of a claim. An unfair payment pattern exists if a plan makes an unreasonable/unnecessary request for medical records on three or more occasions over the course of any three-month period. Plans must justify to DMHC that requests for medical records more frequently than in three-percent (3%) of the claims submitted over any 12-month period for non-emergency services and twenty percent (20%) of the claims submitted for emergency services were reasonably necessary. An unfair payment pattern exists if a plan fails to justify to the DMHC the reasonableness of its requests. Plans must reimburse claims with the correct payment including the automatic payment of all interest and penalties due. An unfair payment pattern exists if a plan fails to reimburse claims correctly at least 95% of the time during the course of any three-month period. Plans must contest or deny claims within 45 days (HMO) or 30 days (PPO) of receipt. An unfair payment pattern exists if a plan fails to contest or deny affected claims within the required time period at least 95% of the time over the course of any three-month period. Plans must contractually require its claims processing organizations and/or its capitated providers to comply with the requirements of these regulations. An unfair payment pattern exists if a plan fails to do so with three (3) or more of its contracts over the course of any three-month period. Plans must provide Information for Contracting Providers, the Fee Schedule and Other Required Information disclosures to all contracted providers on or before January 1, 2004, initially upon contracting and upon the contracted physicians request. Plans must fully disclose fee schedules and the payment rules used to adjudicate claims to physicians as well as a description of the plans provider dispute process. An unfair payment pattern exists if a plan fails to provide this information to three or more contracted providers over the course of any three-month period. Plans must provide contracted physicians with 45 days notice of any modifications to the Information for Contracting Physicians, to the Fee Schedule or Other Required Information. An unfair payment pattern exists if a plan fails to provide appropriate notice to 3 or more contracted physicians over the course of any three-month period. Plans may not require physicians to waive protections or assume any plan obligations pursuant to the Knox-Keene Act. An unfair payment pattern exists if a plan does so on 3 or more occasions over the course of any three-month period. Plans must provide physicians with a Notice to Provider of Dispute Mechanisms whenever a plan contests, adjusts or denies a claim. An unfair payment patterns exists if a plan fails to provide physicians with the appropriate notice at least 95% of the time for the affected claims over the course of any three-month period. Plans must acknowledge the receipt of a provider dispute within two (2) working days of the receipt of an electronic provider dispute and within fifteen (15) days of the date of receipt of a paper provider dispute. An unfair payment pattern exists if a plan fails to acknowledge at least 95% of the affected claims over the course of any three-month period. Plans may not impose a provider dispute filing deadline of less than 365 days from the date the plan denied the claim. An unfair payment pattern exists when a plan fails to comply with the Time Period for Resolution and Written Determination requirements at least 95% of the time over the course of any three-month period. Plans must resolve physician disputes within 45 days of receipt of the physician dispute. An unfair payment pattern exists if a plan fails to resolve at least 95% of the disputed claims during the specified time period over the course of any three-month period. Plans cannot rescind or modify an authorization for services after the physician renders the services pursuant to a prior authorization. An unfair payment pattern exists if a plan rescinds or modifies a prior authorization for services on three or more occasions over the course of any three-month period. For assistance with your reimbursement related problems, call CMAs Reimbursement Help Line at 1-888-401-5911 (AB 1455 applies to Health and Safely Code 1371.37.38.9) V. DATA FOR CMS 1500 FORM COMPLETION Claim AGLOBAL SURGERYClaim BCOB BILLINGSOLO PRACTICESOLO PRACTICEPatient Account NumberGATEGLOPatient Account NumberGATEGUIPatient NameGloria GatesPatient NameGuillermo GatesAddress2579 Los Angeles Avenue Simi Valley, CA 93065Address2579 Los Angeles Avenue Simi Valley, CA 93065Patient Home phone #(805) 555-1212Patient Home phone #(805) 555-1212Date of BirthJanuary 4, 1998Date of BirthAugust 12, 1930Relationship to InsuredChildRelationship to InsuredSelfMartial StatusSingleMartial StatusMarriedSexFemaleSexMaleInsured NameGuadalupe GatesInsured NameSelfInsured ID NumberVC155 45 5555Insured ID NumberBP764190Insured AddressSameInsured AddressSameInsured phone numberSameInsured phone numberSameInsured Date of BirthDecember 1, 1950Insured Date of BirthSelfInsured SexFemaleInsured SexMaleInsured Employer nameABC CorporationInsured Employer nameWalFed CorporationGroup NumberR7786Group NumberAE700Insurance CompanyBlue Cross of CaliforniaInsurance CompanyAETNA PPOInsurance Co. AddressP.O. BOX 60007 Los Angeles, CA 90060Insurance Co. AddressP.O. BOX 2700 El Quattro, CA 94106Rendering Provider Sally Sawbones, MD Rendering ProviderGeorge Weber, MDRendering Provider License NumberA4559Rendering Provider License NumberC65987Rendering Provider NPI1358432769Rendering Provider NPI4765413687Provider SSN556 66 7755Provider SSN443 22 4987Billing provider informationSally Sawbones, MD 2215 Gander Grove Simi Valley, CA 93065Billing provider information Weber Dermatology 4488 Brand Blvd Glendale, CA 91244Billing provider IDA4559Billing provider IDC65987Billing provider NPI 1358432769Billing provider NPI 2641534544Service facility location information AddressSanta Susana Medical Center 10 Boxwood Boulevard Santa Susana, CA 93063Service facility location information Address(No Facility)Service Facility NPI3667144551 Service Facility NPI(NONE)Date of ServiceSeptember 7, 2007, September 14, 2007Date of serviceOctober 1, 2007 Dr. Sawbones performed a problem-focused new-patient exam (CPT_99210-57) ($270.00) in the office (POS 11) on 9/07/2007. The doctor found the patient to have a cystic lesion of the left upper eyelid (ICD-9 _ 374.84) and found it necessary to perform outpatient surgery (excisional biopsy of lesion with flap reconstruction eyelid, CPT_67961-E1_) ($575.00) on the same day at Santa Susana Medical Center (POS 22) on 09/07/07. A follow-up visit with suture removal (**HINT: CPT_global_**) was done in the office (POS_11) on 9/14/2007. Authorization to Release Information is on file. Assignment of benefits on file.Dr. Weber performed a complex repair of 5.1 centimeter lesion (CPT 13132) ($950.00) in the office (POS 11). Diagnosis: Neck Lesion (ICD-9 739.1). Patient has *secondary* insurance through his spouse, Guadalupe Gates (see Insured/Insurance information on claim A or claim C). Authorization to Release Information is on file. Assignment of benefits on file. Claim CE/M ON SURG DAYClaim D (1 and 2)TOTAL OB CAREGROUP PRACTICE GROUP PRACTICEPatient Account NumberGATEGUIPatient Account Number68 9430Patient NameGuadalupe GatesPatient NameBarbara ButlerAddress2579 Los Angeles Avenue Simi Valley, CA 93065Address1111 E. Birmingham Bayport, CA 90020Patient Home phone #(805) 555-1212Patient Home phone #(999) 456-2233Date of Birth12/1/1950Date of BirthMay 15, 1985Relationship to InsuredSelfRelationship to InsuredSpouseMartial StatusMarriedMartial StatusMarriedSexFemaleSexFemaleLMP Date02/15/2007Insured NameSameInsured NameBranford ButlerInsured ID NumberVC155 45 5555Insured ID Number000 00 0000Insured AddressSameInsured AddressSameInsured phone numberSameInsured phone number(999) 456-2233Insured Date of Birth12/1/1950Insured Date of BirthMarch 12, 1980Insured SexFemaleInsured SexMaleInsured Employer nameABC CorporationInsured Employer nameXYZ CorporationGroup NumberR7786Group NumberGP002Insurance CompanyBlue Cross of CaliforniaInsurance CompanyBlue Cross of CaliforniaInsurance Co. AddressP.O. BOX 60007 Los Angeles, CA 90060Insurance Co. AddressP.O. Box 60007 Los Angeles, CA 90060Rendering Provider nameGeorge Gilroy, MDRendering Provider nameBrian Brown, MDRendering Provider License NumberA07854Rendering provider License NumberG45000Rendering Provider NPI 2347511764Rendering Provider NPI2275433176Employer ID number95-1442899Employer ID number33-1557669Service facility location (No Facility)Service Facility LocationBayport Hospital 4957 Nursery Lane Backdoor, CA 90120Service Facility NPI(NONE)Service Facility NPI0674156999Billing provider informationGavner Orthopedic 5900 Gathic Avenue Huntington park, CA 91311Billing provider informationBabies R US 4440 Bobsey Way Backdoor, CA 90120Billing provider IDW874534Billing provider IDW45689Billing provider NPI0684936649Billing Provider NPI0649378140Date of Service6/16/2007Patient Hospitalized October 21-23, 2007Date of First Visit6/16/2007Date of First VisitMay 15, 2007Dr. George Gilroy performed a new patient minimal visit of straightforward decision-making (CPT 99201-25) ($50.00) in the office (POS 11) on 6/16/2007. An injection of tendon sheath (CPT 20550-RT) ($70.00) was also performed on 6/16/07. On 7/15/2007 the patient came back to the office (POS 11) and Dr. Gilroy performed arthrocentesis on the right elbow (CPT 20605-RT) ($150.00) Diagnosis: Neuralgia/neuritis (ICD-9 729.2) A co-payment of $50.00 was made by patient. Authorization to Release Information is on file. Assignment of benefits in file.Patient complaint of abdominal pain (ICD-9 789.00) Detailed established patient office (POS 11) visit (CPT 99214) ($70.00) was performed, along with a urine pregnancy test (CPT 81025) (for $12.00) on 5/15/2007. Patient is found to be pregnant (ICD-9 V22.2). Prenatal visits on 6/16/07, 7/20/07, 8/15/07, 9/20/07. A UA dip with micro (CPT 81000) ($10.00) was performed on 9/20/07. SPLIT NEW FORM FACILITY POS: Patient vaginally delivered a baby girl on 10/21/07 (total OB care) (CPT 59400) ($2500.00) at Bayport Hospital (POS 21). Diagnosis: Vaginal Delivery, Single Life-born (ICD-9 650 and V27.0). Patient paid $200.00. Authorization to Release Information is on file. Assignment of benefits in file. Claim ENON-ASSIGNEDClaim FBILATERAL-UNILATERALUNRELATED TO SURGPatient Account Number88901Patient Account Number4356 098Patient NameBrielle ButlerPatient NameBranford ButlerAddress1111 E. Birmingham Bayport, CA 90020Address1111 E. Birmingham Bayport, CA 90020Patient Home phone #(999) 456-2233Patient Home phone #(999) 456-2233Date of BirthApril 2, 1997Date of BirthMarch 12, 1980Relationship to InsuredChildRelationship to InsuredSelfMartial StatusSingleMartial StatusMarriedSexFemaleSexMaleInsured NameBranford ButlerInsured NameBranford ButlerInsured ID Number000 00 0000Insured ID Number000 00 0000Insured AddressSameInsured AddressSameInsured phone number(999) 456-2233Insured phone number(999) 456-2233Insured Date of BirthMarch 12, 1980Insured Date of BirthMarch 12, 1980Insured SexMaleInsured SexMaleInsured Employer nameXYZ CorporationInsured Employer nameXYZ CorporationGroup NumberGP002Group NumberGP002Insurance CompanyBlue Cross of CaliforniaInsurance CompanyBlue Cross of CaliforniaInsurance Co. AddressP.O. BOX 60007 Los Angeles, CA 90060Insurance Co. AddressP.O. BOX 60007 Los Angeles, CA 90060Rendering Provider NameBenjamin Blood M. D. Rendering Provider NameBobby BrownRendering Provider License NumberA38877Rendering Provider License NumberG56782Rendering Provider NPI1140276510Rendering Provider NPI0919367415Employer ID number94-4446749Employer ID number95-4336712Service facility location information Address Out Patient ERMercy Medical Hospital 2400 Polar Avenue Brighton, CA 90129Service facility location information AddressMercy Medical ASC 2445 Polar Avenue Brighton, CA 90129Service facility NPI 0614422200Service facility NPI 212423770Billing provider informationEmergency Medical Group 1232 Boston Blvd. Brighton, CA 90129Billing provider informationSight for Sore Eyes 1501 Bass Drive Brighton, CA 90132Billing Provider ID W98723476Billing Provider IDW762533Billing provider NPI2655541367Billing Provider NPI3367410921Date of Service6/30/2007Date of Service4/30/07Authorization Number133374Patient was brought into the emergency room (POS 23). Patient fell from a horse today (ICD-9 E828.2). A problem-focused emergency room visit of moderate complexity (CPT 99283-57) ($250.00) and open treatment of distal radius with internal fixation (CPT 25620) ($2500.00) was performed by Dr. Benjamin Blood, MD. (NOTE: E CODES ALWAYS LAST!) Diagnosis: Fracture of distal radius, open (ICD-9 813.52). Patient returned to Emergency Room on 07/02/07 and a problem-focused ER visit of low complexity (CPT 99284-24) performed by Dr. Blood. Diagnosis: Acute asthma attack (ICD-9 493.92) Authorization to Release Information is on file. Benefits not assigned.Patient was scheduled for out patient surgery at Mercy Medical Ambulatory Surgical Center (ASC POS 24). On 4/30/07, Dr. Bobby Brown performed removal of lens, intracapsular for cataracts, bilaterally (CPT 66980-50) ($2500.00). On 7/10/07, Dr. Bobby Brown performed photo-coagulation scleral buckling for retinal detachment of the right eye (CPT 67107-RT) ($5500.00) at Mercy. Diagnosis: Cataract (ICD-9 366.9) Retinal Detachment (ICD-9 361.9) Authorization to Release Information is on file. Assignment of benefits in file. Claim GDECISION FOR SURGClaim HAUTHORIZATIONMULTIPLE SURGERYMULTI SURGERYPatient Account Number22222 7Patient Account Number66666-7Patient NameTony ThompsonPatient NameTerry ThompsonAddress222 Tamarack Lane Tomahawk, TN 37308Address222 Tamarack Lane Tomahawk, TN 37308Patient Home phone #(999) 444-4444Patient Home phone #(999) 444-4444Date of Birth7/10/50Date of Birth8/21/54Relationship to InsuredSelfRelationship to InsuredSpouseMartial StatusMarriedMartial StatusMarriedSexMaleSexFemaleInsured NameSameInsured NameTony ThompsonInsured ID Number999 99 9999Insured ID Number999 99 9999Insured AddressSameInsured AddressSameInsured phone numberSameInsured phone number(999) 444-4444Insured Date of Birth7/10/50Insured Date of Birth7/10/50Insured SexMaleInsured SexMaleInsured Employer nameXYZ CorporationInsured Employer nameXYZ CorporationGroup NumberGP003Group NumberGP003Insurance CompanyBlue Cross of CaliforniaInsurance CompanyBlue Cross of CaliforniaInsurance Co. AddressP.O. BOX 60007 Los Angeles, CA 90060Insurance Co. AddressP.O. BOX 60007 Los Angeles, CA 90060Rendering Provider NameTerrence Tew, MDRendering Provider NameTamara Teeson, MDRendering Provider License Number A8273Rendering Provider License Number C873332Rendering Provider NPI6631334759Rendering Provider NPI4498470012Employer ID number22-222222Employer ID number22-2222238Service facility location information Address Tomahawk Memorial Hospital 222 Hawk Street Tomahawk, TN 37308Service facility location information AddressTomahawk Women's Hospital 228 Hawk Street Tomahawk, TN 373708Service facility NPI 9974237419Service facility NPI 6740193320Billing Provider InformationTerrence Tew, MD 7643 Lakeview Ln Tomahawn, TN 37308Billing provider informationTamara Teeson, MD Tomahawk Women's Clinic 229 Indiana Street Tomahawk, TN 373708Billing Provider IDA8273Billing Provider IDW678823Billing Provider NPI6631334759Billing Provider NPI449847001Referring provider informationTamara Teeson, MD, UPIN OTH822Referring provider NPI4498470012*******Authorization********A2007170017Date of Service9/9/2007Date of Service7/21/07Date of First VisitHospitalized7/21-22/07A comprehensive consultation of moderate complexity (CPT 99244-57) ($200.00) was performed and it was it was determined the patient should have a bone cyst excised from the humerus (CPT 23150) ($1600.00) and excision of olecranon bursa (CPT 24105-51) ($500.00). These services were performed on 09/09/07 at Tomahawk Memorial Hospital Outpatient (POS 22). Patient was referred by Dr. Tamara Teeson. Diagnosis: Tennis Elbow (ICD-9 726.32) Authorization to Release Information is on file. Assignment of Benefits on file.While inpatient at Tomahawk Women's Hospital (POS 21), authorization was obtained (NOTE AUTH #!) and a laparoscopy for visualization of pelvis viscera (CPT 49320) ($600.00) was performed. A D&C was also performed (CPT 58120-51) $150.00) with laparoscopic lysis of adhesions (CPT 58660-51) ($200.00). Diagnosis: Menorrhagia (ICD-9 626.2) Pelvic Pain (ICD-9 625.9) Cyst Ovarian (ICD-9 620.2) Authorization to Release Information is on file. Assignment of Benefits on file. Claim IANESTHESIAClaim JANESTHESIAPatient Account NumberGH5246Patient Account Number485478Patient NameNed NortonPatient NameNancy NortonAddress34578 Navaho Lane Nampa, NV 80462Address34578 Navaho Lane Nampa, NV 80462Patient Home phone #(999) 334-4443Patient Home phone #(999) 334-4443Date of BirthMay 5, 1955Date of BirthJune 10, 1956Relationship to InsuredSelfRelationship to InsuredSpouseMartial StatusMarriedMartial StatusMarriedSexMaleSexFemaleInsured NameNed NortonInsured NameNed NortonInsured ID Number77-44-3333Insured ID Number77-44-3333Insured AddressSameInsured AddressSameInsured phone number(999) 334-4443Insured phone number(999) 334-4443Insuredl Date of BirthMay 5, 1955Insured Date of BirthMay 5, 1955Insured SexMaleInsured SexMaleInsured Employer nameABC CorporationInsured Employer nameABC CorporationGroup NumberGP004Group NumberGP004LMP Date04/01/2007Insurance CompanyBlue Cross of CaliforniaInsurance CompanyBlue Cross of CaliforniaInsurance Co. AddressP.O. BOX 60007 Los Angeles, CA 90060Insurance Co. AddressP.O. BOX 60007 Los Angeles, CA 90060Rendering Provider NameNathan Navarro, MDRendering Provider NameNorma Nelson, MDRendering Provider License NumberA87843Rendering Provider License NumberC2343Rendering Provider NPI0143755921Rendering Provider NPI8374659578Employer ID number88-8754449Employer ID number88-8778493Service facility location information Address Out Patient Nampa Medical Center 1226 Nampa Avenue Nampa, NV 89462Service facility location information AddressNampa Medical Center 1226 Nampa Avenue Nampa, NV 89462Service facility NPI 2224351420Service facility NPI 2224351420Billing provider informationNavarro Anesthesia Assoc 1234 Nampa Avenue Nampa, NV 89462Billing provider informationNorma Nelson, MD 475 Nancy Lane Nampa, NV 89462Billing Provider IDW6574Billing Provider IDC2343Billing Provider NPI6735295837Billing Provider NPI8374659578Referring Provider NameBart Simpson, MD, UPIN OTH765Referring Provider Name Maria Enceinte, MD, UPIN OTH245 Referring Provider NPI0143755921Referring Provider NPI6463211077Date of ServiceMay 5, 2007Date of ServiceDecember 28, 2006Time under AnesthesiaStart 20:20, Stop21:40Time under anesthesiaStart-10:30, Stop 17:56 7 Hours, 26 mins (actual time in attendance 2 hours, 4 mins)***Anesthesia Units***( _6_ ) UnitsHospitalizedDecember 28-31, 2006***Anesthesia Units***( _8_ ) UnitsDr. Nathan Navarro administered anesthesia for a colonoscopy with biopsy beyond splenic flexure (CPT00810-P1) ($350.00) at outpatient department of Nampa Medical Center (POS 22). Diagnosis: Excessive Gas (ICD-9 787.3) Authorization to Release Information is on file. Assignment of Benefits on file.Dr. Norma Nelson administered continuous epidural analgesia for labor and vaginal delivery (CPT 01967 -P1) ($1950.00) inpatient at Nampa Medical Center (POS 21). Diagnosis: Normal Vaginal Delivery without forceps or breech, single live born (ICD-9 650 and V27.0). Authorization to Release Information is on file. Assignment of Benefits on file.     PAGE  PAGE 19 Group Individual Policy Insured Subscriber Medicare Medi-Cal Provider Assignment of Benefits Premium Deductible Guarantor Eligibility Preauthorization Insurance To prevent spread of epidemics (or similar answer) Denied Fine Tabular (Numeric) Index doctor or documentation Code Book ICD-10 Mandatory Requirement Above or Below, Etc. Person Place Cause Signs/Symptoms Alphabetic Index Ill NO Index Main Tabular Proof Description 820.8 Fracture 918.1 Abrasion 682.3 Abscess 434.91 Accident 351.0 Bells or Paralysis 250.01 Diabetes 410.91 Infarction-Ischemia 381.10 Otitis 532.40 Ulcer 790.6 Abnormal or Blood 465.9 Infection 930.9 Foreign 197.0 Neoplasm; lung 599.0 Infection 401.1 Hypertension 414.00 Arteriosclerosis 173.3 Neoplasm; face 403.01 Hypertension 789.04 Pain 250.03 Diabetes 562.02 Diverticulosis 733.13 Fracture 116.0 Blastomycosis 996.85 Complication 881.21 Wound 719.81 Calcification 749.20 Cleft 038.3 Septicemia 286.1 Christmas 622.10 Dysplasia 782.3 Edema 537.4 Fistula 727.2 Nuns 726.32 Tennis 783.21 Abnormal 831.00 Dislocated 923.03 Contusion 823.20 Fracture 813.41 Fracture; Colles 723.0 Stenosis; Spinal Cervical (not 622.4 uterine) 410.52 Infarction-Ischemia 412 Infarction 042 Human Immunodeficiency.Illness V08 Human Immunodeficiency Infection 183.0 Neoplasm 250.00 Diabetes, V58.67 Long-term use 250.51 Diabetes; 365.44 Glaucoma 015.00 Tuberculosis; 737.41 kyphosis  086.0 Cardiomyopathy; 425.4 Chagas 650 Delivery, normal; V27.0  662.11 Deliver, prolonged; V27.9 if outcome not known. 042 HIV; 176.9 Kaposis 733.81 Malunion; 905.4 Late effects 716.16 Arthritis; 905.4 Late Effects 941.29; 944.20;942.30; 948.10 (Total 19%) V79.1 Screening V82.5 Screening V78.2 Screening V20.2 Screening V72.6 Routine V56.0 Encounter, dialysis E812.5 E list Accident E813.5 E list Accident E924.0 E list Burn E978 E list Legal E845.0 E list Accident The AMA CMS Medi-Cal Annually Current Procedural Terminology Evaluation/Management Anesthesia Surgery Radiology Pathology/Lab Medicine Specialty Three Established Established New Established Three Two Place 99202 99214 99214 99058 50 Prolonged Critical Discharge 99234 99221 99233 99239 Referring Report 99253 99232 99244 99245 99253 A 24-hour hospital-based facility for provision of unscheduled episodic services to patients who present for immediate attention. 99285 99291 99291 x1, 99292 x3 (142 minutes) SNF, ICF, LTCF, Psychiatric Residential Treatment Facility Medical 99308 99336 99358 x1 99359 x2 99342 99348 99360 x4 99375 99393 99395 99382 99384 90707 99403 99412 Medicare/CMS 0 -25 -57 -25 Multiple First NO NO NO Skin skin Cut tear Anatomic Surgeon for measurements, Pathologist only for diagnosis. No, its redundant NO Staged two-part 17000 x1 17003 x2 12011 13121 11420 11643 13152 Add-On 11406 12020 12045 12001 Total 2 cm Closed Open Percutaneous 10060 21337 25560 26500 29836 42825 49320 44960 59400 59514 33514 33514 33514 -80 00567 P2 99100 74178  71010 71035 71020 71020 -TC 73130 -26 73130 77055 77057 82465 83718 84478 80061 PANEL 86704 87515 90746 81002 36415 99000 96372 {90772, 90782} 90935 91010 93000 93005 note no TC or 26 95813 96401 99050 99075 92004 90805 99078 97012 98941 99024 97810 95004 x10 99070 or A4580 !#&; ! 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