Module 10 – Quality Review of Coded Data

Fill in the blank:

1. What is the government’s audit plan called? ______________________________

Instructions: Following are excerpts from three CMS-1500 billing forms. In each problem, compare the visit note to the CMS-1500 to detect the CPT coding error(s) and supply the correct coding assignment. (The ICD-9-CM codes are provided for reference only.)

2. CMS-1500 Question #1—Visit Note

CC—Eye pain

S—This new patient comes in with his right eye red and mattering for the last day. He wears contacts and has them in at this time. He has no sore throat, no stuffy nose, and no temperature, earaches, or coughing. He is currently on no medication and is not allergic to any medication. He also is concerned about a wart on his hand.

O—He is in no acute distress. Vital signs are normal. TMs look okay. Pharynx was good. Pupils equal, round, react to light and accommodation. No evidence of any iritis. Bulbar conjunctivae of the right eye is red. Some mattering is noted on the right side; left eye looks okay. Right hand shows a wart at the base of thumb.

A—Right eye conjunctivitis, wart on right hand

P—Liquid nitrogen was applied to the wart. Retreat in about seven to ten days, if necessary. Will treat the conjunctivitis by removing contacts and wearing only regular eyeglasses for at least one week. Started on Gentamycin Ophthalmic, one to two drops in the eye, four times a day, warm compresses to the eye. Be careful not to infect the left eye. Sterilize the contacts before putting them back into the eyes. He will return for retreatment of the wart or sooner if he has any further problem with his eye. He will schedule a baseline physical exam within the next month.

CMS-1500 #1:

Correct codes:  _____________________

3. CMS-1500 Question #2—Visit Note

CC—Sore throat

S—This 15-year-old male is brought in with a sore throat and sinus congestion. He has been running a slight fever since yesterday and has had severe ear pain since last night. He has had a nonproductive cough for three days, and today he woke up feeling nauseous and then he vomited. He vomited here at the office today.

O—He is alert, in no acute distress. Temperature is 97.2, pulse is 74, respirations are 18, blood pressure is 102/72. His right ear is clear. Left ear has loss of light reflex, and is erythematous and bulging. Both TMs show evidence of otosclerosis, which is old. Nose is congested. Pharynx shows some erythema on the left side. Neck is supple. Lungs are clear. Heart regular rate and rhythm. Abdomen is soft, nontender. Rapid strep test is negative, but a throat culture was obtained for verification.

A—Otitis media and pharyngitis

P—Patient was put on Septra DS one, po b.i.d. He is to use Tylenol as needed for pain and fever. He is to follow up if he does not have complete resolution but should be followed up in any case for reAssessment of the ear after completion of the medication. Otherwise, he will be seen as needed.

CMS-1500 #2:

Correct codes:  _____________________

4. CMS-1500 Question #3—Outpatient Procedure  Note

CC—Sebaceous cyst

Indication:  The patient has had a few infectious processes of cysts on the neck. He is a patient of Dr. Johnson, who sends him for excision of the most recent cyst today.

Pleasant male in no distress. A 0.5 cm sebaceous cyst is evident on the neck. No drainage. No inflammation at this time. The area is washed with iodine and alcohol. Injected with 2% Lidocaine plain. An ellipse of skin was taken overlying the area of the cyst. The cyst was taken intact. Good hemostasis was provided with electrocautery. The skin was then approximated with 3-0 Vicryl in a vertical mattress form. Three stitches were placed. The area was washed with peroxide and water, dried, dressed with Telfa and Tegaderm, and a 2×2 gauze was added for pressure effect.

Procedure Performed:  Excision of sebaceous cyst from the neck

The patient was given written and verbal wound instructions. Treat with ice and pressure at home today. Call with any difficulties with bleeding. Otherwise, follow back in two weeks for suture removal.

CMS-1500 #3:

Correct codes:  _____________________