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CEMC practice exam from the AAPC

  1. #21
    Location
    North Carolina
    Posts
    3,126
    Default
    Medical Coding Books
    Interesting. So...Let's say you had not detected these errors and the errors weren't reported......If the individual taking the exam based their answer on the provided answer (incorrect answer), who is held accountable and how does this become rectified?
    Rebecca CPC, CPMA, CEMC




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  2. #22
    Location
    Milwaukee WI
    Posts
    4,466
    Default I stand by my answer and CPT
    Quote Originally Posted by FTessaBartels View Post
    If you look in 2009 CPT Professional Edition, page 19 there is a table with times and appropriate codes.

    75-104 minutes is coded as 99291 x1 AND 99292 x1

    You have to have at least 15 minutes over the first hour (i.e. 75 minutes). That is why 74 minutes is still considered the first hour.

    F Tessa Bartels, CPC, CEMC
    The CPT book is very clear and specific in the table referenced in my earlier response.

    Go back some years to previous editions of CPT and you'll find that the original description of 99291 was for the "first hour" ... then they started in with the at "last 15 minutes" criteria and began to really muddy the waters. Every time they try to clarify they just cause more confusion.

    In fact, CPT is full of inconsistencies and conflicting information because it has never been written (or edited) by an English major! (Check out all the references to age for the new pediatric critical care codes and you'll see what I mean.)

    If you look at the guidelines and explanation for prolonged service codes, which have a similar time-frame requirement, you'll see an explanation (page 26 of 2009 CPT Professional Edition) that includes a phrase "30 minutes beyond the first hour" ... and you'll see a table that is virtually identical to the one for critical care (but with the prolonged service codes).

    If AAPC is changing the exam that is a poor reflection on AAPC.

    F Tessa Bartels, CPC, CEMC

  3. #23
    Default
    I agree with Tessa - I also was reminded of the prolonged service codes as this discussed unfolded.
    Karolina, CPC, CPMA, CEMC

  4. #24
    Default
    http://www.cms.hhs.gov/Transmittals/...ds/R1530CP.pdf

    Top of page 18. Per CMS, less than 15 minutes beyond the first 74 minutes is not separately payable.

    Laura, CPC

  5. #25
    Location
    Milwaukee WI
    Posts
    4,466
    Default Same reference - look at the table
    Quote Originally Posted by katmryn78 View Post
    http://www.cms.hhs.gov/Transmittals/...ds/R1530CP.pdf

    Top of page 18. Per CMS, less than 15 minutes beyond the first 74 minutes is not separately payable.

    Laura, CPC
    Same exact reference as Laura cited ... look at the bottom of that same page ... the table clearly shows the same thing that CPT shows.

    75-104 minutes is 99291x1 PLUS 99292x1

    F Tessa Bartels, CPC, CEMC

  6. #26
    Default
    So your position is that even though medicare clearly states less than 15 minutes over 74 is not separately payable, that since the chart says 75 minutes it is ok to bill it anyway?

    Sorry, but I'm going with Medicare on this one, I don't want to pay back all that money plus penalties when they have clearly defined what is payable and what is not.

    Because they will pay it if you submit it, then if they audit they will take it back plus a lot more than they paid in the first place.

    Laura, CPC

  7. #27
    Default
    After looking at this page I think what they (Medicare) are saying is that 99292 is billed for each block of up to 30 minutes. If the last block is less than 15 minutes, this cannot be billed. So when they say in the table 75 - 104 minutes they really mean 75 - 104 minutes if at least 89 minutes were spent.
    Karolina, CPC, CPMA, CEMC

  8. #28
    Default I agree with Tessa
    The verbage Medicare has in their manual you are referring to is redundant and confusing. Basically what they are saying is in order to use both codes.... 99291 is for the first hour, you need to have a fraction of 15 in order to use 99292 for the final time. So for example, 75 minutes is 15 minutes above the first hour, you would code 99291 and 99292.

    A simple formula for correct critical care coding as follows:

    Total minutes: 197 minus 60 (99291) divided by 30 (determines units of 99292)

    Subtract the first hour from your total, you have a 99291 and 137 minutes remaining. 137 / 30 is 4. Your remaining minutes is 17. Therefore, it would be appropriate to code 99291 and 99292 x 5.

    Hope that helps.
    Last edited by ARCPC9491; 06-11-2009 at 02:23 PM.

  9. Default
    I would like to thank everyone for their discussion on this topic and providing their sources. Our expert advisors are split on the proper code selection. Below is a summary of information from CMS, CPT Assistant and the CPT manual.

    According to 100-04 Medicare Claims Processing Manual Chapter 12 - Physicians/Nonphysician Practitioners 30.6.12 - Critical Care Visits and Neonatal Intensive Care (Codes 99291 - 99292)

    Page 66

    “The CPT code 99291 is used to report the first 30 - 74 minutes of critical care on a given calendar date of service. It should only be used once per calendar date per patient by the same physician or physician group of the same specialty. CPT code 99292 is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes of critical care (See table below-the same as in CPT®). Critical care of less than 30 minutes total duration on a given calendar date is not reported separately using the critical care codes. This service should be reported using another appropriate E/M code such as subsequent hospital care.

    http://www.cms.hhs.gov/manuals/downloads/clm104c12.pdf

    The same information is also provided in the revised transmittal which notes an error provided in the 1530 Transmittal regarding critical care time.

    http://www.cms.hhs.gov/Transmittals/...ds/R1548CP.pdf

    The most recent information provided by CMS supports using 99291, 99292 for 75 minutes of critical care time.

    The information provided in CPT Assistant is as follows:

    November 1999 CPT 2000 Code and Guideline Changes: A Comprehensive Review

    “Code 99292 is used to report each additional 30 minutes beyond the first 74 minutes. It also may be used to report the final 15-30 minutes of critical care on a given date. Critical care of less than 15 minutes beyond the first 74 minutes or less than 15 minutes beyond the final 30 minutes is not reported separately.”

    December 1998 Critical Care Services

    “CPT code 99292 is used to report each additional 30 minutes beyond the first hour. It also may be used to report the final 15-30 minutes of critical care on a given date. Critical care of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately.”

    The most recent information provided in CPT Assistant supports coding 99291 for 75 minutes of critical care. This is not reflected in the table provided in CPT.

    The coding guidelines in CPT® state “Code 99292 is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes.” This would support coding 99291, 99292 for 75 minutes of critical care time since the clarification for 15 minutes is not provided.

    We will request clarification from CMS and AMA.

    Thanks,
    Rae

    Raemarie Jimenez, CPC, CPC-I, CANPC, CRHC
    Director of Exam Content
    American Academy of Professional Coders
    Phone 877-642-9909
    Fax 801-236-2258

  10. Default CEMC practice exam
    I just purchase the CEMC online practicum, but haven't received a confirmation. Is the online information email to you on how to download the practicum on to a computer or is it shipped to you?

    Thanks,

    Michelle CPC

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