Physician Payment Reform

Custom Student Mr. Teacher ENG 1001-04 24 September 2016

Physician Payment Reform

1. The three goals of the Physician Payment Reform is to decrease medicare expenditures by promoting preventative care and preventing unnecessary hospital stays. The next goal is to Re-distribute physicians payments more equitably by ensuring that physicians receive a fair payment for services rendered. The last goal is to ensure quality health care at a reasonable rate. 2. Modifier -25 would be the appropriate choice, it is a separately indentifiable service that was provided by the same physician on the same day. 3. Medicare pays physicians for services based on three basic compnents called relative value units. The first is Physician work which is the time, skill, and training it takes to provide a particular service. The next is practice expense which is everything that goes into running a practice, like equipment, rent, supplies, etc. The last of these is malpractice, which covers the cost of professional liability expenses.

4. The three types of persons eligible for medicare are the elderly who are age 65 and older. The second are people who are disabled and drawing by social security disability The third are people who are in the stage of renal failure (ESRD). 5. The six basic location methods to find main terms in the index of CPT are; procedure/service, synonym, eponymous, anatomic site, condition of disease, and abbreviations. 6. 99253 is the appropriate E/M code of the initial impatient consultation. The consultation was with a detailed history, a detailed exam, and MDM of low complexity 7. The four elements of history are the chief complaint, the second is the history of present illness. The third is the review of systems, and the final is past, family, and/or social history. 8. The complexity of medical decision making is based off of the number of diagnoses, risk or morbidity (complication or death), and the amount of data (complexity). 9. The appropriate CPT code for this scenario is 99214. There is a detailed history, a detailed exam, and a MDM of moderate complexity.

10. The three key components that are present in every patient case, (except counseling encounters or time-based codes) are history, examination and medical decision making. 11. The correct CPT code for this clinic note is 99396. It is a 42-year-old female who is going for a routine physical exam, which is a preventative measure to ensure her health. 12. The appropriate CPT code would be 99341. This case is for a home visit with a problem focused history, a problem focused exam, as well as a straight forward MDM. 13. The four levels of history type are problem focused, expanded problem focused, detailed and comprehensive. 14. The appropriate CPT code is 99281, and the ICD-9 code is 918.1. 15. This scenario has a problem focused history, a problem focused exam and a straight forward MDM (or of low complexity.) Therefore the correct CPT code is 99231. 16. If a patient were discharged from the hospital with a diagnosis of probable myocardial infarction without a history of MI in the past, the coder would use the ICD-9 diagnosis code 410 for this stay.

17. The correct CPT code is 13160, and the correct ICD-9 code is 998.32. 18. The difference between outpatient and inpatient measures of time is that outpatient care is when a patient comes in and receives a medical procedure or treatment and goes home immediately. As where with inpatient care they will receive a medical procedure and stay at the hospital. 19. In this scenario the patient has a fracture of the distal radius, the appropriate CPT code for this is 25600. 20. Four of the five graft types in the musculoskeletal system are bone graft, tissue, fascia, and cartilage. 21. The procedure that was performed in this scenario is on the placement of a halo. The correct CPT code for this scenario is 20661. 22. Since the procedure in this scenario is a left heath catherterization with coronary angiography and left ventriculogra, the correct CPT code for this is 93452. 23. The correct CPT code for the placement only of a dual-chamber pacemaker is 33208. 24. In this scenario the procedure is for the replacement of a pulse generator in an old pacemaker, the correct CPT code is 33228.

25. The correct CPT diagnosis code is 58558, and the correct ICD-9 code is 621.0. 26. This outpatient clinic scenario is for a bilateral screening mammogram, the correct CPT code is 77057. 27. The correct CPT code for this scenario, an MRI of the brain, is 70552. 28. This scenario is for a dialysis progress note, the correct CPT code is 90947. 29. The correct CPT code for a pulmonary walking stress test is 94620. 30. Physical status modifier P3 indicates a patient with severe systemic disease. 31. The correct CPT code for a patient who receives anesthesia for revision of total hip arthroplasty is 01215. The physical status modifier would be P2, because the patient has mild systemic disease. 32. The main term in the diagnosis of fractured clavicle is fractured. 33. The main term in the diagnosis of globe adhesions is adhesions.

34. The main term in the diagnosis of urinary retention is retention. 35. The main term in the diagnosis of acute pneumonia is pneumonia. 36. The correct code for personal history of peptic ulcer is V12.71. 37. The correct code for family history of breast cancer (for a), female is V16.3. 38. The correct code for the preoperative evaluation is V72.83, the code for COPD is 496. 39. In this scenario it is for a simple repair of a superficial wound of the nose measuring 5.2cm, the correct CPT code for this is 12014. 40. To correctly code a lesion excision you must first know the size, location, and number of lesions. You must also know if it is malignant or benign to properly code. 41. The appropriate CPT code for an unlisted procedure of the neck or thorax is 21899.


  • Subject:

  • University/College: University of California

  • Type of paper: Thesis/Dissertation Chapter

  • Date: 24 September 2016

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