1. The three goals of the Physicians Payment Reform are to decrease Medicare expenditures. As well as redistribute physician’s payments more equitably. Also to ensure quality health care at a reasonable rate.
2. I would use modifier -57, decision for surgery with the E/M code for this case. Due to the E/M service and the decision for surgery were made earlier that same day.
3. There are three components of the relative value unit the first component is work, which is the amount of time, the intensity of effort and the technical expertise required for the physician to provide the service. The second would be the overhead component also known as the practice expense, it is identified as the allocation of cost associated with the physicians practice (ex. Staffing) that must be expended in order to provide a service. The third component is malpractice and is identified as the cost of the medical malpractice insurance coverage/ risk associated with providing the service.
4. People age 65 and older, along with patients who are experiencing end-stage renal disease are both eligible for Medicare. As well as people who are eligible for disability benefits from social security, they are too covered by the Medicare program.
5. To find the main terms in the index of the CPT you must use these basic location methods, you must search by the service or the procedure, the anatomic site, condition or disease. You also could use synonyms, eponym’s or abbreviations to find main terms in the index.
6. The E/M code 99253 would be used to report an initial impatient consultation. With a detailed history and exam along with a MDM of low complexity.
7. There are many elements when considering the correct E/M code. There are four elements of history which include chief complaint, history of present illness, as well as review of symptoms and past, family, and/or social history.
8. The complexity of medical decision making is base doff of three elements which are the number of diagnosis or management options. These options can be minimal, limited, multiple or extensive. The nest element is the amount and/or the complexity of data to review. The data can be minimal or none, limited, moderate or extensive. The last element of medical decision making is the risk of complication or death if the condition goes untreated. This risk can be minimal, low, moderate or high.
9. The correct CPT code is 99214 due to the detailed history. As well as the detailed exam and a MDM of moderate complexity.
10. There are three key components present in every patient’s case except counseling encounters and/or time based codes. The three components are the history, the level of examination, the level of medical decision making. These components allow us coders to choose the appropriate level of service.