posted by kristina .
I have done my cms 1500 form but I want to make sure that I did it correctly.
Here it goes:
i tried to post it but it will not allow
If you tried to copy and paste something (especially if it’s a numbered or bulleted list), it did not work. You’ll need to type it in by hand.
is there an email that I can post an attachment?
No, you will need to type it, as I said above.
The only way we can see it is if you type it here.
Also -- it's doubtful if any of our Jiskha tutors will be able help you with the "cms 1500 form."
This is a cms 1500 form.
Resources: Appendix A, Appendix C, and Table 8.3 on pp. 258–259 of Medical Insurance
Refer to Table 8.3 on pp. 258–259 of your text to complete the CMS-1500 form, located in Appendix C, according to the following case study:
A 67-year-old Medicare patient presents to the office, exhibiting symptoms of HIV infection. After detailed examination, symptoms are determined to be advanced AIDS with manifestation of Kaposi’s sarcoma and other opportunistic infections.
Name: James Brown
Account Number: 080811
Policy Number: 1098765
ID number: 12345678910
Insured: James Brown
Address: 1600 Pennsylvania Ave.
Wash. D.C. 60000
Marital Status: Widowed
Patient’s Employer: Retired
Nature of Condition: HIV, AIDS, Kaposi’s sarcoma
Date of Illness: 06/01/2007
Referring Physician: Thomas Glassman, M.D.
Physician ID: 1080808080
Federal Tax ID: 5551116679
Dates of Service: 06/01/2007, 06/15/2007, 07/07/2007, 08/01/2007
Procedure: Detailed examination, screening blood panel, pathology services
Include ICD (categories only), CPT, HCPCS, and insurance information.
If you believe there is insufficient information provided to fill a required field with data, indicate this by typing N/A.
The answers that I need to make sure I have correct are 21. 1. V08 2. O42 3. 176.9
24. The part D. 1. 99214 2. 80050 3. 80502 and the last one is N/A I just wanted to make sure that I had these correct.