MOA115_WK3_Week 3 Online Lab_CSanson_12.1.23
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Fortis Institute, Port Saint Lucie *
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MAS115
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History
Date
Feb 20, 2024
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3
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MOA115 Medical Records and Insurance Week 3 Online Lab –
CPT & HCPCS Coding Part 1: CPT Coding Chapter 14 Procedural Coding Essentials A. Introduction to the CPT Manual 1.
The CPT was developed and is maintained by the _______________________. 2.
The CPT manual is updated every year on _______________________. 3.
The CPT code is a five-digit code also known as a(n) _______________________ code. 4.
Category II codes are primarily used for _______________________ and are optional. 5.
Category _______________________ codes are for new experimental procedures or emerging technology. 6.
The CPT coding manual organizes codes into the Alphabetic Index and the _______________________. 7.
The six sections of the CPT manual include: a.
_________________________________________________________________ b.
_________________________________________________________________ c.
_________________________________________________________________ d.
_________________________________________________________________ e.
_________________________________________________________________ f.
_________________________________________________________________ 8.
When using an unlisted procedure code, a(n) _______________________ must be sent with the insurance claim. 9.
_______________________ are found at the beginning of each of the six sections of the CPT coding manual, and the medical assistant refers to them often when coding procedures. 10.
Code additions that explain circumstances that alter a provided service or provide additional clarification or detail are called _______________________. 11.
Define upcoding
and discuss the effects. ________________________________________________________________________
________________________________________________________________________ 12.
Define downcoding
and discuss the effects. ________________________________________________________________________
________________________________________________________________________ 13.
Define medical necessity
as it applies to procedural coding. ________________________________________________________________________
________________________________________________________________________ 14.
Describe how to use the most current procedural coding system. ________________________________________________________________________
________________________________________________________________________ 15.
Describe the four primary classifications of main and modifying terms.
MOA115 Medical Records and Insurance Week 3 Online Lab –
CPT & HCPCS Coding ________________________________________________________________________
________________________________________________________________________ 16.
Explain the difference between “see” and “see also”. ________________________________________________________________________
________________________________________________________________________ 17.
_______________________ codes provide information on the healthcare facility where services were rendered. 18.
Codes in which the components of a procedure are separated and reported separately are called _______________________ codes. Part 2: Coding Charges using an Encounter Form Background: •
Medical assistants often have a list of CPT codes that they use when entering provider orders. Directions: 1.
For this assignment, use the Figure 14.3 Encounter Form from Chapter 14 of The Medical Assistant Textbook. 2.
Read each scenario and identify all items that need to have a CPT code. 3.
Use the encounter form to identify the code. 4.
Type the code with the description in the space provided. You may have several codes per scenario. Notes: •
Well visits are considered preventative medicine •
Handling fee for lab studies is for when the specimen needs to be sent to an outside lab Scenarios: 1.
Lizzy came in for her 2-month-old well child (preventative) check. She is a new patient to the clinic. She received a Hepatitis B –
HIB vaccine. ________________________________________________________________________ ________________________________________________________________________ 2.
Betsy, a 63-year-old established patient, came in for her yearly preventative checkup. The provider ordered a lipid profile and a chemistry profile, which requires a venipuncture. The lab work is done in the clinic lab. She also had an Adult TD vaccine. ________________________________________________________________________
MOA115 Medical Records and Insurance Week 3 Online Lab –
CPT & HCPCS Coding ________________________________________________________________________ 3.
Thomas is a 45-year-old new patient. The provider stated it was a complex exam. He had venipuncture done and a CBC with diff, Cholesterol, and a glucose were done. He had a pulse oximetry and spirometry test done during his visit. ________________________________________________________________________ ________________________________________________________________________ 4.
Henry is a 32-year-old patient with sinus pressure and pain. He is an established patient of the clinic. The visit is a focused exam. The provider ordered an x-ray of his sinuses. ________________________________________________________________________ ________________________________________________________________________
Part 3: CPT versus HCPCS Directions: Answer the following questions based on the information found on the CMS website. 1.
Explain the differences between CPT coding and HCPCS coding. ________________________________________________________________________ ________________________________________________________________________ 2.
Explain when CPT coding would be used. ________________________________________________________________________ ________________________________________________________________________ 3.
Explain when HCPCS coding would be used. ________________________________________________________________________ ________________________________________________________________________ 4.
Describe two things you learned about CPT codes based on your research. ________________________________________________________________________ ________________________________________________________________________ 5.
Describe two things you learned about HCPCS codes based on your research. ________________________________________________________________________ ________________________________________________________________________
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