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TRAINING & EDUCATION

SELF ASSESSMENT TEST

  • 4)
     I. OAS  V. 2 yrs
     II. IRO  VI. 3 yrs
     III. OIG  VII. 5 yrs
     IV. CMS  VIII. 7 years
  • 8)
    I. Take her proper coding references (CPT, ICD-9, HCPCS books)
    II. Take a copy of '97 guidelines since this is a specialty practice
    III. Ask that PAR contracts be made available for reference during the audit
    IV. Request a copy of their fee schedule
  • 9) The auditor is reviewing records for an intensivist. The following was found in a record:
    • Patient presented with respiratory failure to the ER via ambulance
    • Patient has chronic COPD
    • ER physician stabilizes patient upon arrival and places the patient on a ventilator
    • Patient is sent to the ICU for admission and is seen by the intensivist
    • The intensivist does not feel that the patient's vent settings are appropriate and makes modifications based on the findings of his exam and review of ER services
    • The intensivist documents his services were performed from 1:15 - 2:40 and positively documents that the patient was critical due to vent status caused by respiratory failure.
  • 14) When scoring an E&M encounter, the HPI is noted as:

    The patient presents with a history of 2-day rash to the right forearm. She thought it may be poison ivy since she tried using Calamine lotion with no relief. The itching is noted to be worsening.

    The ROS is documented as:

    The patient reports ROS as no fevers, no weight loss/gain, no other rashes or lesions to the exposed skin, and no ENT or respiratory complaints.

    Answer the following regarding this documentation:
  • 15) When scoring an E&M encounter, the HPI is noted as:

    The patient presents with a history of 2-day rash to the right forearm. She thought it may be poison ivy since she tried using Calamine lotion with no relief. The itching is noted to be worsening.

    The ROS is documented as:

    The patient reports ROS as no fevers, no weight loss/gain, no other rashes or lesions to the exposed skin, and no ENT or respiratory complaints.

    Answer the following regarding this documentation:
  • 16) When scoring an E&M encounter, the HPI is noted as:

    The patient presents with a history of 2-day rash to the right forearm. She thought it may be poison ivy since she tried using Calamine lotion with no relief. The itching is noted to be worsening.

    The ROS is documented as:

    The patient reports ROS as no fevers, no weight loss/gain, no other rashes or lesions to the exposed skin, and no ENT or respiratory complaints.

    Answer the following regarding this documentation:
  • 18) Audit the following physical therapy services:

    Ms. Jones returns for her bi-weekly session for chronic low back pain. We are now in week 2 of her therapy and she is progressing nicely. Today's therapy:

    • Manual Therapy X 22 minutes
    • Electric Stimulation X 9 minutes
    • Ice Pack X 17 minutes

    Ms. Jones should return next week for her next therapy appointment.
    Shannon Robinson, PT
    Spencer White, PTA

    The codes and units billed are:
    -97140 GP X 2 units:
    -97032 GP X 1 unit:
    -97010 GP X 2 units

    I. All CPT Codes are correctly billed
    II. The modifier used is inappropriate for services performed by a physical therapist
    III. The ice pack services do not represent 2 units
    IV. Manual therapy time is not enough to support 2 units

  • 19) Audit the following physical therapy services:

    Ms. Jones returns for her bi-weekly session for chronic low back pain. We are now in week 2 of her therapy and she is progressing nicely. Today's therapy:

    • Manual Therapy X 22 minutes
    • Electric Stimulation X 9 minutes
    • Ice Pack X 17 minutes

    Ms. Jones should return next week for her next therapy appointment.
    Shannon Robinson, PT
    Spencer White, PTA

    The codes and units billed are:
    -97140 GP X 2 units:
    -97032 GP X 1 unit:
    -97010 GP X 2 units

    Answer the following:
  • 20) Audit the following physical therapy services:

    Ms. Jones returns for her bi-weekly session for chronic low back pain. We are now in week 2 of her therapy and she is progressing nicely. Today's therapy:

    • Manual Therapy X 22 minutes
    • Electric Stimulation X 9 minutes
    • Ice Pack X 17 minutes

    Ms. Jones should return next week for her next therapy appointment.
    Shannon Robinson, PT
    Spencer White, PTA

    The codes and units billed are:
    -97140 GP X 2 units:
    -97032 GP X 1 unit:
    -97010 GP X 2 units

    Answer the following:
  • 21)
    Drug Dose Route Start Stop
    Trexall 150 mg IV 10:14 10:49
    Normal Saline 1000 cc IV 10:14 11:10
    Phenergan 50 mg IV Push N/A N/A

  • Use the following table to answer questions 23 - 30

    CPT Code Medicare LOS Medicare Distribution Practice LOS Practice Distribution Practice $ Distribution Medicare Distribution on Practice Distribution Difference Medicare $ Distribution on Practice Distribution Difference in $'S
    99211 51,567 4% 192 4% $3,648.00 196.44 0% $3,732.34 ($84.34)
    99212 261,329 24% 1,012 22% $35,420.00 1077.9 1% $37,726.38 ($2,306.38)
    99213 502,014 52% 3,067 67% $147,216.00 2399.4 -15% $115,171.01 $32,044.99
    99214 380,275 17% 198 4% $15,048.00 796.29 13% $60,517.90 ($45,469.90)
    99215 106,138 2% 110 2% $12,210.00 108.98 0% $12,096.80 $113.20
    Totals 1,301,323 100% 4,579 100% $213,542.00 4579 0 $229,244.43 ($15,702.43)
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