Wiki Coding Interview Questions

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Mtee

Mtee

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I recently had my first medical coding interview. This was arranged through a recruiting agency. The company is pursuing other candidates and they gave the recruiter feedback, but they said the interview went well and didn't specify how I can become more eligible for coding opportunities in the future. My best guess is that I didn't answer the coding questions confidently or thoroughly enough.

The questions are listed below with my answers.
Please share your expertise with me on how I can best answer coding questions like these!
THANK YOU!!!

Q. Describe to me the difference between inpatient and outpatient coding guidelines
A. Inpatient and outpatient services are coded according to the guidelines regarding the place of service and duration.
Inpatient - Hospitals (24 hr +)
Outpatient - Clinics, Offices, Ambulatory Surgery Centers (Same day)

Q. How would you describe the difference between facility and profee coding?
A. Facility is for Nurses' services (employees of the hospital directly) and supplies
Profee is for the physician's services (E/M, surgical procedures, consultations) (The physician is not hospital employee, but is providing services at that location)

Q. What is a modifier to you?
A. A modifier describes circumstances applicable to a code, but not changing the code's definition

Q. When do you use modifiers?
A. With CPT and HCPCS codes
 
Q. Describe to me the difference between inpatient and outpatient coding guidelines
A. Inpatient and outpatient services are coded according to the guidelines regarding the place of service and duration.
Inpatient - Hospitals (24 hr +)
Outpatient - Clinics, Offices, Ambulatory Surgery Centers (Same day)

Inpatient (facility) is coded based on the entire patient chart to determine a final diagnosis, present-on-admission factors and CCs or MCCs...as opposed to the clinics, which are coded based on encounter (reason for visit). IP facility coding allows for 'rule out' diagnosis, where OP and Pro-fee require a symptom or final diagnosis that has been confirmed by the physician. IP procedures are coded with ICD-10-PCS and OP/Pro fee with CPT.....These are just a few of many differences.

Q. How would you describe the difference between facility and profee coding?
A. Facility is for Nurses' services (employees of the hospital directly) and supplies
Profee is for the physician's services (E/M, surgical procedures, consultations) (The physician is not hospital employee, but is providing services at that location) What they're looking for is whether or not you understand the process differences between facility and professional fee coding. In this case, IP Facility coding provides the calculation of the DRG....basically the facility gets paid based on the severity of patient's condition, which requires more resources to treat, Correct diagnosis and procedural coding is the catalyst for the correct DRG, so it's important to be accurate. Also see above with regards to ICD-10-PCS, vs. CPT for physicians. Physician's services are calculated based on a fee schedule, so care needs to be made to use modifiers appropriately, which impacts payment in some cases. Additionally, pro-fee coding is based on a fee-for-service model, meaning each encounter typically stands on it's own.

Q. What is a modifier to you?
A. A modifier describes circumstances applicable to a code, but not changing the code's definition. It would have been helpful to give examples here. A modifier changes how a procedure is considered for payment (such as a return to the OR during an otherwise un-payable global period), who provided the procedure (as in Assistant Surgeon), where on the body the procedure was performed (as in which cardiac vessel), and in some cases with HCPCS modifiers, the reason for the procedure (such as the EA modifier for the administration of Aranesp for anemia due to anticancer chemotherapy.)

Q. When do you use modifiers?
A. With CPT and HCPCS codes[/QUOTE] The question was "when" not "where". When there has been an extenuating circumstance that is described in the medical record that changes how or if the payer would need to consider that procedure for payment. For example, the -50 modifier indicates a bilateral service; requiring payment at 150% of the fee schedule. The -GA modifier indicates that the patient is aware that the service may not be covered and that they may have financial responsibility.

Hope these answers are helpful. Always give examples when you can, this shows you know what you are talking about and can think outside the box. Good luck!
 
here is another coding opportunity....

“The CSI Companies is looking to hire 100 plus, experienced, certified coders over the next 2 months. If you have 3 or more years of coding experience as well as some HCC experience, please send your resume to LGrace@thecsicompanies.com
 
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