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Rheumatology Coding Corner Question: Coding & Billing Basics

From the College  |  Issue: April 2016  |  April 15, 2016

  1. When reporting E/M service levels, if time spent counseling and/or coordinating care dominates the session, which of the following is true?
    • Total time must be documented
    • Greater than 50% of the time must be for face-to-face counseling and/or coordinating care
    • The extent of the counseling and/or coordinating care must be documented
    • All of the above
  2. Which of the following is true when applying modifier -25?
    • This modifier can always be used when the diagnoses are different
    • Never use this modifier when the diagnoses are the same
    • It should only be appended to an E/M service code
    • Always use this modifier for a new patient
  3. Which formula would you use to calculate the unadjusted RVUs for a procedure performed in the office setting?
    • Work RVUs + Facility Practice Expense RVUs + Malpractice RVUs
    • Work RVUs + Facility Practice Expense RVUs + GPCI
    • Work RVUs + Non-Facility Practice Expense RVUs + Malpractice RVUs
    • Work RVUs + Non-Facility Practice Expense RVUs + GPCI
  4. You may append modifier XS for a secondary procedure within the same anatomic site (for example, when reporting two arthrocentesis procedures in the same knee).
    • True
    • False
  5. When determining an E/M service level, which is the single most important factor to be determined from the documentation?
    • Medical necessity
    • Medical decision making
    • History
    • Exam
  6. Using the General Equivalent Mappings (GEMs) is an acceptable method to implement ICD-10-CM in a small practice.
    • True
    • False

Click here for the answers.

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