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Coding Scenarios

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1. Decrease Medicare Expenditures and Re-Distribute Physicians payments more equitibly are two of the three goals of Physician Payment Reform. The third goal of the Physicians Payment Reform is to Ensure quality healthcare at a responsible rate. 2. Mr. Jones was admitted to the hospital for severe hip pain. During the ortho surgeon's initial visit, it was determined that Mr. Jone's had a fractured hip and stated a required surgical intervention. The modifier that would be used for the hospital visit is modifier -57 3. Work and overhead are two of the three components of the relative value unit. The third component of the relative value unit is malpractice. 4. Elderly - Disabled by Social Security and Renal Failure Patients (ESRD) are two types of people eligible for Medicare. Administration is the other people eligible for Medicare. 5. Five of the six basic location methods to locate terms in the index of the CPT are: Service or Procedure, Anatomic Site, Condition or Disease, Synonym and Eponym. The last location method to locate the terms in the index of the CPT is the Abbreviations. 6. An initial inpatient consultation occured. The consultation consisted of a detailed history, detailed exam, and a MDM of low complexity. The E/M code will be 99253. 7. Three of the four elements of history are: Chief Complaint (CC), History or Present Illness (HPI) and Review of Symptoms (ROS). The final of the four elements of history is Past, Present Family and/or Social History (PFSH). 8. The complexity of medical decisions are based on three elements. The three elements are: Number of Diagnoses, Risk of Morbidity (complication or death) and the Amount of Data Complexity. 9. A 7-year-old female established patient was presented to the pediatrician complaining of ear pain for three days. The pediatrician performed a detailed exam. After the examination, the pediatrician diagnosed the patient with otitis media and an upper respiratory infection. The CPT Code would be 99214....