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Flashcards in Coding/Billing Deck (18)
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1
Q

CPT-4

A
  • Current Procedural Terminology, versio 4

- published by AMA

2
Q

Most codes used by PTs/PTAs are in the ____ range

A
  • 97xxx

- no such thing as PT codes except for PT eval and PT re-eval

3
Q

Types of CPT Codes

A
  • time codes

- untimed codes

4
Q

Timed Codes

A
  • usually 15 min (can be billed in multiples)

- must supervise pt to be billable

5
Q

Time:

A

-face to face tie with patient

if you’re not supervising the care, then you can’t bill for it

6
Q

unit of time is attained when:

A
  • when mid-point is passed

- for example: our obtained when 31 min have elapsed, 2nd hour when 91 min have elapsed

7
Q

Billing for untimed codes

A

-always bill, no matter what

eval, hot pack, e-stim

8
Q

1 unit=
2 units=
3 units=
4 units=

A

1=8+ min
2=23+ min
3=38+ min
4=53+ min

9
Q

NCCI

A

-National Correct Coding Initiative

10
Q

NCCI Edit Pairs

A
  • created by private company on contract to CMS
  • Identify codes that can’t be billed on same day (n) or can’t be billed simultaneously (m)– ‘m’ must be done sequentially
11
Q

untimed codes _____ apply to the 8-23 minute rule

A
  • do NOT

- just bill no matte what

12
Q

all timed codes added up ______ to the ____ min rule

A
  • DO APPLY

- 8-23 min rule

13
Q

timed codes do not ______ in the 8-23 min

A

stand on their own

14
Q

in the CPT rule each code _____ & has to be at least ____ min each

A
  • stands alone

- 8 min each

15
Q

What to bill for?

CPT

A

-timed codes are for face-to-face time

16
Q

What to bill for?

Medicare

A
  • only for active treatment time
  • can’t include pt bathroom time (unless training)
  • can’t include rest time (unless doing something during rest)
17
Q

use group charge when

A

-performing TIMED codes on 2 or more pts at SAME time and supervising them SIMULTANEOUSLY

18
Q

don’t use group charge when

A
  • performing a timed code with 1 pt and an untimed code with another
  • when working with 2+ pts and you’re not providing simultaneous supervision