Chapter 6 Questions | EssayIvy.com

1) Understand the history of CPT.

CPT was first developed by the American Medical Association in 1966. The first

edition basically contained surgical procedure and less of medicine, radiology and

laboratory procedures.However, the second edition, produced in 1970, was expanded

to contain terms and codes for diagnostic and therapeutic procedures in medicine,

surgery, and specialties, In the mid-1970s, the 3

and 4

edition were produced. And

in 1983, CPT nomenclature was adopted for the use by the Center for Medicare and

Medicaid Services (CMS) (130)

2) Understand evaluation and management (E/M) services.

The extent of history documented

The extent of examination documented

The complexity of the medical decision making documented

Counseling

Coordination of care with other providers

Time

Nature of the presenting problem (pg.139)

3) Explain the three types of CPT categories.

The first category describes a procedure or service. They comprise of five-digit codes

that correspond to a procedure or service. These Codes run between 00100 – 99499

(pg.131)

Category II is a set of optional tracking codes, which are mainly developed to track

performance

While the category III are temporary codes for emerging technologies, procedures

and services (pg.132)

4) Distinguish the need for modifiers.

Modifiers help service providers to respond to payment policy requirements needed

by third-party payers effectively.

The two digit code helps indicate that the service or procedure has been altered due to

specific circumstances but not changed in its code or definition.

5) Distinguish between a new and established patient.

A new patient is one who, in the last three years, has not received any professional

medical services from a physician or another of the same specialty who belongs to

the same group

practice.

On the other hand, an established patient has received professional medical services in

the last three years from a physician or another of the same specialty who belongs to

the same group (pg.138)

practice.

6)Know the three key elements in choosing an E/M code.

The extent of the patient’s history obtained

The extent of the examination documented

The complexity of the medical decision making. (pg.139)

7) Determine the correct E/M code.

The patient's medical record must contain, the clinical data to support it, The history,

examination, and medical decision making must be sufficiently documented. (134)

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