CASCC flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

HIPAA covered entities

Health plans, health care clearinghouses, and health care providers who transmit health information electronically in connection with covered transactions.

False Claims Act

Federal law imposing liability on persons who knowingly submit false or fraudulent claims to the government, including deliberate ignorance or reckless disregard.

Anti-Kickback Statute

Prohibits offering, paying, soliciting, or receiving remuneration to induce referrals of items or services covered by federal health care programs.

Stark Law

Prohibits physician referrals of designated health services to entities with which the physician or immediate family has a financial relationship, unless an exception applies.

Advance Beneficiary Notice

A form used when Medicare may deny a service as not reasonable and necessary; if properly executed, it shifts financial liability to the patient.

Wound repair coding

Codes 12001-13160 are selected by length, complexity (simple, intermediate, complex), and site; multiple wounds are summed by complexity group.

Lesion excision margins

Excision codes include margins and simple closure; intermediate or complex closures are separately reportable with modifier 59 or XS if distinct.

Surgical package

Includes the procedure, local anesthesia, and typical postoperative care; E/M on the same day may require modifier 24 or 57.

Arthroscopic surgery bundling

Arthroscopic codes are site-specific and include limited debridement; meniscectomy and chondroplasty in the same compartment may be bundled.

Fracture care global

Fracture care codes include application of cast or splint and follow-up; casting for initial treatment is not separately billed.

Anesthesia time units

Anesthesia is billed as base units plus time units; one time unit is typically 15 minutes, and physical status modifiers P1-P6 may apply.

MAC anesthesia

Monitored anesthesia care is reported with the same anesthesia codes as general anesthesia, often with modifier QS when appropriate.

Pain injection guidance

Spinal and peripheral pain injections include fluoroscopy or CT guidance when performed; do not separately bill guidance unless distinct.

Implantable pump refill

Refill of an implantable drug delivery system (62368) includes access and drug; programming (62369-62370) is a distinct service.

Radiology global vs component

Global services include technical and professional components; append modifier 26 for professional only or TC for technical only.

CT/MRI contrast coding

Select the code that matches contrast use (without, with, or without and with); do not separately bill contrast unless the descriptor allows.

Radiology guidance bundling

Guidance codes (e.g., 77001-77022) are separately reported only when not included in the primary procedure; check NCCI edits.

Interventional radiology components

Interventional radiology codes include access, catheter placement, and injection; additional selective catheterization may be separately coded.

Surgical pathology coding

Codes 88300-88309 are selected by specimen type and complexity; multiple specimens may be billed separately with modifier 59 if distinct.

Lab panel unbundling

Clinical laboratory panels (e.g., 80053) should not be unbundled unless medically necessary and documented; otherwise bill the panel code.

Immunohistochemistry billing

IHC codes (88342-88343) are billed per antibody; multiple antibodies may be separately reported with modifier 59 if distinct.

Molecular pathology codes

Codes 81161-81479 are specific to gene or mutation; use the most specific code and document the method used.

E/M level selection

E/M codes are selected by site, patient type (new/established), and either medical decision making or time; documentation must support the level.

Vaccine administration coding

Vaccination product codes (90460-90474) may include counseling for children; administration codes (90471-90474) are separate and depend on route and components.

Dialysis coding

Dialysis codes (90935-90999) include physician supervision; monthly capitation codes (90951-90970) apply for outpatient dialysis.

Chemotherapy administration

Chemotherapy administration codes (96401-96549) are distinct from the drugs; select by method (infusion, injection) and duration.

Modifier 25

Indicates a significant, separately identifiable E/M service by the same physician on the same day as a procedure; documentation must support the E/M.

Modifier 59

Used to indicate distinct procedural services; it should not be used to bypass bundling edits when services are integral to each other.

Modifier 26 and TC

Split professional (26) and technical (TC) components; use only when the provider furnishes one component of a global service.

Modifier 24

Indicates an unrelated E/M service during a postoperative period; documentation must show the service is unrelated to the surgery.

ASC payment system

ASCs are paid based on the ASC-covered surgical procedure list; not all CPT codes are payable, and multiple procedure reduction applies.

ASC facility fee

Includes nursing, supplies, and equipment; physician professional fees are billed separately. Implants may be separately reimbursed if on the device list.