Aapc

Is reporting 14000 with 11401 unbundling? - Yes according to CPT guidelines the excision of a benign lesion or malignant lesion is not separately reportable. Commercial and Government carriers audit medical records. Select the statement that is TRUE regarding commercial and government carriers. - Commercial carriers and Government carriers both use claims data to identify providers and services to audit. A comprehensive audit is: - sometimes referred to as a focused review, is an audit of...

A family physician requests a post payment audit on claims from a particular commercial payer from which he is receiving denials. Whenever the provider performs a minor procedure with an E/M service, the minor surgery is reimbursed but the E/M service is denied. You review 10 charts and all cases are documented and coded correctly. What could be the reason for the denial? - The payer contract may bundle the E/M service when performed on the same day as the minor surgery Which type of case ...

A patient with esophageal cancer is brought to the OR for subtotal esophagectomy. A thoracotomy incision is made & the esophagus is identified. The tumor is carefully dissected free of the surrounding structures. No invasion of the aorta or IVC is identified. The cervical esophagus is controlled with pursestring sutures & then transected above the sternal notch. The esophagus is then dissected free of the stomach & the entire specimen is removed from the chest cavity & sent to pathology. T...

Patient is seen in the hospital's outpatient surgical area witha diagnosis of a displaced comminluted closed fracture of the lateral condyle, right elbow. An ORIF procedure was performed, which included the following techniques: An incision was made in the area of the lateral epicondyle. This was carried through subcutaneous tissue, and the fracture site was easily exposed. Inspection revealed the fragment to be rotated in two places, about 90 degrees. It was possible to manually reduce ...

The word describing the presence of blood in the pleural cavity is: Angioplasty Cytopenia Endocardium Hemothorax - Hemothorax In the ICD-10-CM Alphabetic Index what is the code next to the main term called? "Unspecified" codes "Other" codes Combination Code Default Code - Default Code A 6-year-old patient is seen in the office for acute otitis media, coded as H66.90. This is an example of what ICD-10-CM convention? NOS NEC 7th Character "and" - NOS

Q: A 30-year-old female is having 15 sq cm debridement performed on an infected ulcer with eschar on the right foot. Using sharp dissection, the ulcer was debrided all the way to down to the bone of the foot. The bone had to be minimally trimmed because of a sharp point at the end of the metatarsal. After debriding the area, there was minimal bleeding because of very poor circulation of the foot. It seems that the toes next to the ulcer may have some involvement and cultures were t...

Q: Local Coverage Determinations are administered by whom? a. State Law b. NCDs c. Each regional MAC d. LMRPs Ans: c. Each regional MAC Q: ABN stands for _____. a. Advanced Benefits Notification b. Advisory Beneficial Notice c. Admitting Beneficiary Notice d. Advance Beneficiary Notice Ans: d. Advance Beneficiary Notice Q: What type of health insurance provides coverage for low income families? a. Commercial HMO Sunday, 02 March 2025 b. Medicaid c...

Q: INDICATION: Patient has a hypertrophic scar on the posterior side of the left leg, at the level of the knee. This has begun to restrict his mobility. His physical therapy trial was unsuccessful. PROCEDURE: After the proper induction of anesthesia, the subcutaneous tissue of the patient's left leg beneath the scar was infiltrated with crystalloid solution containing epinephrine to minimize blood loss. The scar was then excised down to viable dermis. Hemostasis was obtained wit...

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Quiz: which medicare part is reimbursed based on the risk adjustment models Ans: part c Quiz: who typically employs risk adjustment coders Ans: health plans Quiz: is a health plan required to follow the minimum necessary rule Ans: yes, health plans are covered entities and are therefore required to follow the minimum necessary rule Quiz: what is an example of fraud Ans: reporting a diagnosis or co-morbidity that does not exist to obtain higher reimburseme...