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Some Basic question also be asked from general guidlines as Follow

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1.What are Modifiers ?

Modifiers are the code's that are the way of altering the procedure or service without changing the defination of procedure. Suppose we use 22 modifier in any surgical procedure then the procedure is considered as more  time taking and complicated, because of applying 22 modifier.

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2.What are the difference between Modifier 51 and Modifier 59 ? Imp

Modifier 59 is distinct procedural service that indicate the other procedure performed is separate and distinct from another procedure on the same date of service.

Modifer 51 is multiple procedure and its indicate that more than one procedure was performed during the same session by the same physician.

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3.What is XU,XS,XP, XE modifier ? Imp

Since 59 modifier is distinct procdure but it does not give more detail so we use X modifers.

These are the distinct procedural service that indicate that the procedure is separate and distinct from another procedure, performed on the same date of service by more specific reason such as

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XP: “Separate Practitioner, a service that is distinct because it was performed by a different
practitioner.”

XE: “Separate Encounter, a service that is distinct because it occurred during a separate encounter.”

XS : “Separate Structure, a service that is distinct because it was performed on a separate organ/
structure.”

XU: “Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap
usual components of the main service.”

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4. What is NCCI edits ?

NCCI stand for National correct coding initiative. It is a system that helps ensure correct coding and prevent improper payment for medicare Part B claims. The NCCI has two type of edits

1. Procedure to procedure (PTP) edits

2. Medically Unlikely Edits (MUEs)

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5.What is PTP edits of NCCI ?

This prevent providers from reporting certain pairs of CPT/HCPCS together - Same patient - Same day.

Each edits has two Column :

Column 1 Primary procedure : Payable 

Column 2 Additional proceudre : Denied if you dont put appropriate Modifier.

Edit Type 1 : Secondary procedure is codable with appropriate modifier

Edit Type 2 : Secondary procedure is not codable you need to remove it.

Example 1: 43235 is not codable with 43239, you need to delete 43235.

Example 2 : 43239 is codable along with 43251 if polyps is different by appending XU/59 modifier.

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6.What is MUE ?

An MUE for a HCPCS/CPT code is the maximum units of service (UOS) that a provider would report under most circumstances for a single beneficiary on a single date of service. Not all HCPCS/CPT codes have an MUE.

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7.What are HCPCS level 2 codes and there usage ?

HCPCS Level 2 code are the code for Drugs, supplies, equipment, non-physician services, and services not represented in CPT.These are 5 characters, beginning with a letter and followed by 4 numbers.

For example: J7298 is the code for Mirena Intrauterine Contraceptive device (IUD).

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8.What are HCPCS level 1 codes and there usage ?

All CPT codes are the part of HCPCS level 1 codes. It includes Procedures and services provided by physicians and other allied healthcare professionals. Example : 43235 is HCPCS Level 1 code.

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9.What you will code if any procedure is performed first through endoscoppy approach and after that through open approach ?

As per coding guideline, we will not code for the same procedure performed through two different approach we will code for extensive procedure that is open procedure.

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10.How you will code if the biospy is performed for a lesion and then lesion is completely excised ?

As per coding guideline, we will not code for the biopsy and excision for same lesion , we will code more extensive procedure and that is excision only.

11.What are scout procedure, give example of scout procedure in Hysterectomy ?

Scout procedure are the procedure that is inclusive on primary procedure and is performed to verify the completion of proedure. For example after hysterectomy , the provider perform cystoscopy to ensure the successful completion of hysterectomy and no any abnormality is found.'

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12.What is Separate Procedure ? Imp

A separate procedure designation identifies a procedure that may be performed independently or as part of a more extensive procedure, depending on the circumstances.

In other words:

1. If a separate procedure is performed during a more extensive procedure in which it typically is included, it is not separately reported.

2. If a separate procedure is performed alone, or with another procedure of which it typically is not a part, it may be separately reported.

For example, 29830 may be reported by itself to describe a diagnostic scope of the elbow, but is not separately reported (or reimbursed) with another arthroscopic procedure in the same elbow (e.g., 29834 Arthroscopy, elbow, surgical; with removal of loose body or foreign body).

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10. What is Global period ? Imp

Medicare defines the global period as that period of time during which a physician may not bill for related office visits.

The global period may be 90, 10, or 0 days.

According to Medicare, a major surgery has a global period of 90 days, and a minor surgery has a global period of either 10 or 0 days. Thus, the time frame of, not the complexity of, the surgery determines whether a surgery is major or minor.

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10. What is surgical package? Imp

These are the services that is included in the surgery as follow :

• Evaluation and Management (E/M) service(s) subsequent to the decision for surgery on the day before and/or day of surgery (including history and physical)​

• Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia

• Immediate postoperative care, including dictating operative notes, talking with the family and other physicians or other qualified health care professionals

• Evaluating the patient in the postanesthesia recovery area

• Typical postoperative follow-up care

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