Home Page Math Information Theory American Hospital Association Chapter 5 Review Questions : Diagnostic Coding 5-1 - Flashcards

Chapter 5 Review Questions : Diagnostic Coding 5-1 – Flashcards

Henry Lowe

7 July 2022

question

Insurance carriers keep ___, which are a compilation of statistics regarding services and payments made to the physician over a period of time

answer

physicians fee schedule

question

When submitting insurance claims for patients seen in a physician's office or in an outpatient hospital setting, the ___diagnosis is listed first, but in the inpatient hospital setting, the ___diagnosis is used

answer

primary,principal

question

Claims to insurance carriers often are denied because of lack of ___which indicates that the procedure provided was not payable for the diagnosis submitted

answer

medical necessity

question

Diagnosis coding for services provided by a physician are reported using ICD-10-CM effective with dates of service___

answer

october 1 2014

question

The abbreviation ICD-10-CM means___

answer

International Classification of Diseases,Tenth Revision, Clinical Modification

question

The official version of the International Classification of Disease was developed by the ___

answer

world health organization

question

ICD-10-CM requires ___documentation in the medical record than the preview coding system, ICD-9-CM

answer

greater

question

ICD-10-CM is the coding system for reporting inpatient services by hospitals and replaces ___of the ICD-9-CM coding system

answer

volume 3

question

ICD-10-CM is the standard code set required under ___legislation and must be used by covered entities when assigning diagnostic codes

answer

HIPAA

question

Volume 2, Diseases, is a/an ___index or listing of code numbers

answer

alphabetic

question

Volume 1, Diseases, is a/an ___listing of code numbers

answer

tabular

question

When using the ICD-10-cM coding system, the ___ is used as a placeholder to save space for future code expansion

answer

question

Conventions are ___ used in the diagnostic code books to assist in the selection of correct codes for the diagnosis encountered

answer

rules or principles

question

The abbreviation NEC appearing in the ICD-10-CM code book means___

answer

not elsewhere classifiable

question

___are used to enclose synonyms in the Tabular List

answer

brackets

question

If a condition is documented in the medical record, but it is not specified as to whether the condition is acute or chronic, then the ___ code should be assigned

answer

default

question

When selecting a code that corresponds with the condition stated in the medical record, the coder should first locate the term in the ___and then confirm the code in the ___

answer

alphabetic index tabular list

question

The instructional note ___ listed in the Tabular List assists the coder as to when it is appropriate to report a secondary code

answer

dash

question

A condition that is produced after the acute phase of an illness is listed as the main term ___ in the Alphabetic Index

answer

sequela

question

When reporting a condition that affects the left side of the patient, the character ___ is reported to indicate laterality

answer

question

The neoplasm table has column headings for ___, ___, ___, and ___

answer

malignant,benign,uncertain behavior,unspecified

question

In juvenile diabetes, the patient's ___ does not function and produce enough insulin

answer

pancreas

question

When coding for diabetes in pregnancy, a code from category ___ is assigned as the primary diagnosis

answer

O24

question

___ hypertension is indicative of a life-threatening condition

answer

malignant

question

Full-term uncomplicated ___ deliveries are always reported with the code O80

answer

vaginal

question

When reporting accidents and injuries, a seventh character of "A" identifies that the encounter is ___

answer

initial encounter

question

Additional external cause codes are ___ when reporting poisonings using combination codes from T36 through T65

answer

adverse effects

question

If documentation states that the incident related to a poisoning was a suspected suicide attempt, the code would be reported from the column titled ___

answer

undetermined

question

If a patient falls and fractures his or her wrist, the fracture code is the primary code, followed by a/an ___code to explain how the accident occured

answer

external cause

question

When a person encounters health services to receive a vaccination, the diagnosis is reported with a ___

answer

Z code

question

GEMS is a common translation tool used to a. convert ICD-9-CM codes to ICD-10-CM codes b. convert ICD-10-CM codes to ICD-10-PCS codes c. convert ICD-10-CM codes to ICD-9-CM codes d. a and c e. all of the above

answer

d. a and c

question

Annual updates to ICD-10-CM are published a. by the AMA and AHA b. by the AHA and AHIMA c. by the AHA, AHIMA, and U.S. Printing Office d. by the AMA, AHA, AHIMA, and U.S. Printing Office

answer

c. by the AHA, AHIMA, and U.S. Printing Office

question

The Alphabetic Index to Diseases and Injuries is placed a. after Volume 1, the Tabular Index b. first in the coding manual c. after the Table of Drugs and Chemicals d. after the Index to External Causes

answer

b. first in the coding manual

question

How many chapters does the Tabular List contain? a. 17 b. 17 with two supplementary classifications c. 19 d. 21

answer

d. 21

question

When two diagnoses are classified with a single code, it is referred to as a. a combination code b. a manifestation c. an external cause code d. a Z code

answer

a. a combination code

question

An essential modifier is also referred to as a a. main term b. nonessential modifier c. subterm d. convention

answer

c. subterm

question

The equivalent of unspecified is a. NEC b. NOS c. nonessential d. secondary

answer

a. NEC

question

Signs and symptoms are acceptable for reporting purposes a. in all situations b. in addition to the definitive diagnosis c. when a definitive diagnosis has not been determined d. under no circumstances

answer

c. when a definitive diagnosis has not been determined

question

When conditions documented as "threatened" are referenced in the Alphabetic Index and there is no entry for the threatened condition, report a. with signs and symptoms b. as if the patient has the condition c. the existing underlying condition d. all of the above

answer

c. the existing underlying condition

question

When reporting laterality, the final character " 3" is reported to indicate a. right side b. left side c. bilateral d. unspecified

answer

c. bilateral

question

When reporting an encounter for testing of HIV, the code should be assigned as a. B20 b. R75 c. Z11.4 d. Z21

answer

c. Z11.4

question

When fractures are documented, but there is no indication of whether the fracture is open or closed, a. report as closed b. report as open c. it does not matter if it is reported as open or closed d. report as unspecified

answer

a. report as closed

question

When identifying the total body surface area of a burn, the front torso is considered as a. 1% b. 9% c. 18% d. 36%

answer

c. 18%

question

External cause codes are used to a. generate additional revenue b. establish injury prevention programs c. a and b d. none of the above

answer

d. none of the above

question

Diagnoses that relate to the patient's previous medical problem must always be reported

answer

False

question

The concept of "principal diagnosis" is applicable to outpatient and inpatient cases

answer

False

question

The diagnosis coding system is designed to provide statistical mortality rate data that include information about causes of diseases

answer

False

question

The process for looking up a diagnosis code in the ICD-9-CM coding system is the same as in the ICD-10-CM coding system

answer

True

question

ICD-10-CM was published by the WHO and clinically modified by CMS

answer

True

question

The Alphabetic Index contains the Table of Drugs and Chemicals

answer

True

question

ICD-10-CM codes can contain up to seven characters

answer

True

question

Signs and symptoms that are not typically associated with a disease process should be reported when documented

answer

False

question

When a person who is not currently sick encounters health services for some specific purpose, such as to receive a vaccination, then a Z code is used

answer

True

question

Code conventions are rules or principles for determining a diagnostic code when using a diagnostic code book

answer

True

question

Because there are annual ICD-10-CM code revisions, there is a 3-month grace period to implement these changes and revisions

answer

False

question

An external cause code may never be sequenced as the primary diagnosis in the first position

answer

True

question

adverse effect

answer

An unfavorable , detrimental, or pathologic reaction to a drug that occurs when appropriate doses are given to humans for prophylaxis (prevention of disease), diagnosis, and therapy

question

benign tumor

answer

An abnormal growth that does not have the properties of invasion and metastasis and is usually surrounded by a fibrous capsule, also called a neoplasm.

question

chief complaint (CC)

answer

A patient's statement describing symptoms, problems, or conditions as the reason for seeking health care services from a physician.

question

combination code

answer

A combination code is: - a situation in which a single code is used to classify two diagnoses or - a diagnosis with an associated secondary process (manifestation) or - a diagnosis with an associated complication. Identify a combination code by referring to subterm entries in the Alphabetic Index and by reading the inclusion and exclusion notes in the Tabular List. If the combination code does not specifically describe the manifestation or complications, then use a secondary code

question

computer-assisted coding

answer

Use of computer software that automatically generates a set of medical codes for review, validation, and use based on clinical documentation provided by health care.

question

conventions

answer

Rules or principles for determining a diagnostic code when using diagnostic code books such as each space, typefaces, indentations, punctuation marks, instructional notes, abbreviations, cross-reference notes, and specific usage of the words "and", "with", and "due to". These rules assist in the selection of correct codes for the diagnoses encountered.

question

eponym

answer

a disease, structure, operation, or procedure named for the person who discovered or described it first

question

essential modifiers

answer

Terms indented two spaces to the right below the main term called subterms. Are essential modifiers b/c they have bearing on the right selection of the code.

question

etiology

answer

The cause of a disease; the study of the cause of a disease.

question

excludes 1

answer

Means not coded here; the two conditions cannot occur together and therefore cannot be used together

question

excludes 2

answer

A type 2 excludes note represents "Not included here". An excludes 2 note indicates that the condition excluded is not part of the condition represented y the code but a patient may have both conditions at the same time. It is acceptable to use both the code and the excluded code together, when appropriate.

question

external causes of morbidity

answer

Secondary codes intended to provide data for injury research and evaluation of injury prevention strategies

question

in situ

answer

A description applied to a malignant growth confined to the site of origin without invasion of neighboring tissues.

question

International Classification of Diseases, 9th Revision, Clinical Modification

answer

A diagnostic code book that uses a system for classifying diseases and operations to assist collection of uniform and comparable health information. A code system to replace this is ICD-10 which is being modified for use in the United States.

question

International Classification of Diseases, 10th Revision, Clinical Modification

answer

Diagnostic code book that uses a system for classifying diseases and operations to assist collection of uniform and comparable health information. It has been modified, will be implemented on October 1, 2014, and will replace ICD-9-CM volumes 1 and 2 when submitting insurance claims for billing hospital and physician office medical services.

question

International Classification of Diseases, 10th Revision, Procedural Coding System

answer

Procedural code system developed by 3M Health Information Systems (HIS) under contract with the Centers for Medicare and Medicaid Services (CMS). When implemented on October 1, 2014, it will replace ICD-9-CM Volume 3 for hospital inpatient procedure reporting in the United States.

question

Intoxication

answer

A diagnostic coding term that relates to an adverse effect rather than a poisoning when drugs such as digitalis, steroid agents, and so on are involved.

question

late effect

answer

An inactive residual effect or condition produced after the acute phase of an illness or injury has ended.

question

malignant tumor

answer

An abnormal growth that has the properties of invasion and metastasis (e.g., transfer of diseases from one organ to another). The word carcinoma (CA) refers to a cancerous or malignant tumor

question

metastasis

answer

Process in which tumor cells spread and transfer from one organ to another side.

question

neoplasm

answer

benign or malignant tumor

question

nonessential modifier

answer

supplementary words located in parentheses after an ICD-10-CM main term that do not have to be included in the diagnostic statement for the code number to be assigned.

question

not elsewhere classifiable

answer

NEC, This term is used in the ICD-9-CM numeric code system when the code lacks the information necessary to code the term in a more specific category.

question

not otherwise specified

answer

NOS Unspecified. Used in ICD-9-CM numeric code system for coding diagnoses.

question

official icd-9-cm guidelines for coding and reporting

answer

set of rules developed to accompany and complement the official conventions and instructions provided within the icd 9 coding manual

question

physician's fee profile

answer

A compilation of each physician's charges and the payments made to him or her over a given period of time for each specific professional service rendered to a patient.

question

placeholder

answer

last or 7th character that composes an icd 10 cm diagnostic code indicated with a X that is used to allow space for future code expansion and/or to meet the requirement of coding to the highest level of specificity

question

poisoning

answer

A condition resulting from an overdose of drugs or chemical substances or from the wrong drug or agent given, or taken in error.

question

primary diagnosis

answer

Initial identification of the condition or chief complaint for which the patient is treated for outpatient medical care.

question

principal diagnosis

answer

CONDITION RESPONSIBLE FOR HOSPITAL ADMISSION L-A condition established after study that is chiefly responsible for the admission of the patient to the hospital.

question

secondary diagnosis

answer

SUBSEQUENT CONDITION THAT MAY CONTRIBUTE TO NEED FOR HIGHER LEVEL OF CARE BUT IS NOT THE UNDERLYING CAUSE. A reason subsequent to the primary diagnosis for an office or hospital encounter that may contribute to the condition or define the need for a higher level of care but is not the underlying cause. There may be more than one secondary diagnosis.

question

sequela

answer

a disorder or condition usually resulting from a previous disease or injury

question

syndrome

answer

Another name for a symptom complex (a set of complex signs, symptoms, or other manifestations resulting from a common cause or appearing in combination, presenting a distinct clinical picture of a disease or inherited abnormality).

question

Z codes

answer

Abbreviation for ICD-10-CM codes that identify factors that influence health status and encounters that are not due to illness or injury. Chapter 21 contains Z codes that are used to report encounters for circumstances other than a disease or injury, such as factors influencing health status, and to describe the nature of a patient's contact with health services. There are two main types: (1) reporting visits with healthy (or ill) patients who receive services other than treatments, such as annual checkups, immunizations, and normal childbirth. This use is coded by a Z code that identifies the service, such as Z00.01 Encounter for general adult medical examination with abnormal findings; and (2) Reporting encounters in which a problem not currently affecting the patient's health status needs to be noted, such as personal and family history. For example, a person with a family history of breast cancer is at higher risk for the disease, and a Z code is assigned as an additional code for screening codes to explain the need for a test or procedure such as Z80.3 Family history of malignant neoplasm of breast.

question

AHA

answer

American Hospital Association

question

AHIMA

answer

American Health Information Management

question

CAC

answer

computer-assisted coding

question

answer

chief complaint

question

answer

clinical modification

question

CPT

answer

Current Procedural Terminology

question

answer

diabetes mellitus

question

DRG

answer

diagnosis related group

question

ICD-9-CM

answer

International Classification of Diseases 9th Revision (Clinical Modification)

question

ICD-10-CM

answer

International Classification of Diseases 10th Revision (Clinical Modification)

question

ICD-10-PCS

answer

International Classification of Disease 10th Revision (Procedural Coding System)

question

MRI

answer

Magnetic resonance imaging

question

NCHS

answer

National Center for Health Standards.

question

NEC

answer

Not elsewhere classifiable

question

NOS

answer

Not otherwise specified

1 of

Unlock all answers in this set

Unlock answers

question

Insurance carriers keep ___, which are a compilation of statistics regarding services and payments made to the physician over a period of time

answer

physicians fee schedule

question

answer

primary,principal

question

Claims to insurance carriers often are denied because of lack of ___which indicates that the procedure provided was not payable for the diagnosis submitted

answer

medical necessity

question

Diagnosis coding for services provided by a physician are reported using ICD-10-CM effective with dates of service___

answer

october 1 2014

question

The abbreviation ICD-10-CM means___

answer

International Classification of Diseases,Tenth Revision, Clinical Modification

question

The official version of the International Classification of Disease was developed by the ___

answer

world health organization

question

ICD-10-CM requires ___documentation in the medical record than the preview coding system, ICD-9-CM

answer

greater

question

ICD-10-CM is the coding system for reporting inpatient services by hospitals and replaces ___of the ICD-9-CM coding system

answer

volume 3

question

ICD-10-CM is the standard code set required under ___legislation and must be used by covered entities when assigning diagnostic codes

answer

HIPAA

question

Volume 2, Diseases, is a/an ___index or listing of code numbers

answer

alphabetic

question

Volume 1, Diseases, is a/an ___listing of code numbers

answer

tabular

question

When using the ICD-10-cM coding system, the ___ is used as a placeholder to save space for future code expansion

answer

question

Conventions are ___ used in the diagnostic code books to assist in the selection of correct codes for the diagnosis encountered

answer

rules or principles

question

The abbreviation NEC appearing in the ICD-10-CM code book means___

answer

not elsewhere classifiable

question

___are used to enclose synonyms in the Tabular List

answer

brackets

question

If a condition is documented in the medical record, but it is not specified as to whether the condition is acute or chronic, then the ___ code should be assigned

answer

default

question

When selecting a code that corresponds with the condition stated in the medical record, the coder should first locate the term in the ___and then confirm the code in the ___

answer

alphabetic index tabular list

question

The instructional note ___ listed in the Tabular List assists the coder as to when it is appropriate to report a secondary code

answer

dash

question

A condition that is produced after the acute phase of an illness is listed as the main term ___ in the Alphabetic Index

answer

sequela

question

When reporting a condition that affects the left side of the patient, the character ___ is reported to indicate laterality

answer

question

The neoplasm table has column headings for ___, ___, ___, and ___

answer

malignant,benign,uncertain behavior,unspecified

question

In juvenile diabetes, the patient's ___ does not function and produce enough insulin

answer

pancreas

question

When coding for diabetes in pregnancy, a code from category ___ is assigned as the primary diagnosis

answer

O24

question

___ hypertension is indicative of a life-threatening condition

answer

malignant

question

Full-term uncomplicated ___ deliveries are always reported with the code O80

answer

vaginal

question

When reporting accidents and injuries, a seventh character of "A" identifies that the encounter is ___

answer

initial encounter

question

Additional external cause codes are ___ when reporting poisonings using combination codes from T36 through T65

answer

adverse effects

question

If documentation states that the incident related to a poisoning was a suspected suicide attempt, the code would be reported from the column titled ___

answer

undetermined

question

If a patient falls and fractures his or her wrist, the fracture code is the primary code, followed by a/an ___code to explain how the accident occured

answer

external cause

question

When a person encounters health services to receive a vaccination, the diagnosis is reported with a ___

answer

Z code

question

answer

d. a and c

question

Annual updates to ICD-10-CM are published a. by the AMA and AHA b. by the AHA and AHIMA c. by the AHA, AHIMA, and U.S. Printing Office d. by the AMA, AHA, AHIMA, and U.S. Printing Office

answer

c. by the AHA, AHIMA, and U.S. Printing Office

question

answer

b. first in the coding manual

question

How many chapters does the Tabular List contain? a. 17 b. 17 with two supplementary classifications c. 19 d. 21

answer

d. 21

question

When two diagnoses are classified with a single code, it is referred to as a. a combination code b. a manifestation c. an external cause code d. a Z code

answer

a. a combination code

question

An essential modifier is also referred to as a a. main term b. nonessential modifier c. subterm d. convention

answer

c. subterm

question

The equivalent of unspecified is a. NEC b. NOS c. nonessential d. secondary

answer

a. NEC

question

answer

c. when a definitive diagnosis has not been determined

question

answer

c. the existing underlying condition

question

When reporting laterality, the final character " 3" is reported to indicate a. right side b. left side c. bilateral d. unspecified

answer

c. bilateral

question

When reporting an encounter for testing of HIV, the code should be assigned as a. B20 b. R75 c. Z11.4 d. Z21

answer

c. Z11.4

question

answer

a. report as closed

question

When identifying the total body surface area of a burn, the front torso is considered as a. 1% b. 9% c. 18% d. 36%

answer

c. 18%

question

External cause codes are used to a. generate additional revenue b. establish injury prevention programs c. a and b d. none of the above

answer

d. none of the above

question

Diagnoses that relate to the patient's previous medical problem must always be reported

answer

False

question

The concept of "principal diagnosis" is applicable to outpatient and inpatient cases

answer

False

question

The diagnosis coding system is designed to provide statistical mortality rate data that include information about causes of diseases

answer

False

question

The process for looking up a diagnosis code in the ICD-9-CM coding system is the same as in the ICD-10-CM coding system

answer

True

question

ICD-10-CM was published by the WHO and clinically modified by CMS

answer

True

question

The Alphabetic Index contains the Table of Drugs and Chemicals

answer

True

question

ICD-10-CM codes can contain up to seven characters

answer

True

question

Signs and symptoms that are not typically associated with a disease process should be reported when documented

answer

False

question

When a person who is not currently sick encounters health services for some specific purpose, such as to receive a vaccination, then a Z code is used

answer

True

question

Code conventions are rules or principles for determining a diagnostic code when using a diagnostic code book

answer

True

question

Because there are annual ICD-10-CM code revisions, there is a 3-month grace period to implement these changes and revisions

answer

False

question

An external cause code may never be sequenced as the primary diagnosis in the first position

answer

True

question

adverse effect

answer

An unfavorable , detrimental, or pathologic reaction to a drug that occurs when appropriate doses are given to humans for prophylaxis (prevention of disease), diagnosis, and therapy

question

benign tumor

answer

An abnormal growth that does not have the properties of invasion and metastasis and is usually surrounded by a fibrous capsule, also called a neoplasm.

question

chief complaint (CC)

answer

A patient's statement describing symptoms, problems, or conditions as the reason for seeking health care services from a physician.

question

combination code

answer

question

computer-assisted coding

answer

Use of computer software that automatically generates a set of medical codes for review, validation, and use based on clinical documentation provided by health care.

question

conventions

answer

question

eponym

answer

a disease, structure, operation, or procedure named for the person who discovered or described it first

question

essential modifiers

answer

Terms indented two spaces to the right below the main term called subterms. Are essential modifiers b/c they have bearing on the right selection of the code.

question

etiology

answer

The cause of a disease; the study of the cause of a disease.

question

excludes 1

answer

Means not coded here; the two conditions cannot occur together and therefore cannot be used together

question

excludes 2

answer

question

external causes of morbidity

answer

Secondary codes intended to provide data for injury research and evaluation of injury prevention strategies

question

in situ

answer

A description applied to a malignant growth confined to the site of origin without invasion of neighboring tissues.

question

International Classification of Diseases, 9th Revision, Clinical Modification

answer

question

International Classification of Diseases, 10th Revision, Clinical Modification

answer

question

International Classification of Diseases, 10th Revision, Procedural Coding System

answer

question

Intoxication

answer

A diagnostic coding term that relates to an adverse effect rather than a poisoning when drugs such as digitalis, steroid agents, and so on are involved.

question

late effect

answer

An inactive residual effect or condition produced after the acute phase of an illness or injury has ended.

question

malignant tumor

answer

An abnormal growth that has the properties of invasion and metastasis (e.g., transfer of diseases from one organ to another). The word carcinoma (CA) refers to a cancerous or malignant tumor

question

metastasis

answer

Process in which tumor cells spread and transfer from one organ to another side.

question

neoplasm

answer

benign or malignant tumor

question

nonessential modifier

answer

supplementary words located in parentheses after an ICD-10-CM main term that do not have to be included in the diagnostic statement for the code number to be assigned.

question

not elsewhere classifiable

answer

NEC, This term is used in the ICD-9-CM numeric code system when the code lacks the information necessary to code the term in a more specific category.

question

not otherwise specified

answer

NOS Unspecified. Used in ICD-9-CM numeric code system for coding diagnoses.

question

official icd-9-cm guidelines for coding and reporting

answer

set of rules developed to accompany and complement the official conventions and instructions provided within the icd 9 coding manual

question

physician's fee profile

answer

A compilation of each physician's charges and the payments made to him or her over a given period of time for each specific professional service rendered to a patient.

question

placeholder

answer

question

poisoning

answer

A condition resulting from an overdose of drugs or chemical substances or from the wrong drug or agent given, or taken in error.

question

primary diagnosis

answer

Initial identification of the condition or chief complaint for which the patient is treated for outpatient medical care.

question

principal diagnosis

answer

CONDITION RESPONSIBLE FOR HOSPITAL ADMISSION L-A condition established after study that is chiefly responsible for the admission of the patient to the hospital.

question

secondary diagnosis

answer

question

sequela

answer

a disorder or condition usually resulting from a previous disease or injury

question

syndrome

answer

question

Z codes

answer

question

AHA

answer

American Hospital Association

question

AHIMA

answer

American Health Information Management

question

CAC

answer

computer-assisted coding

question

answer

chief complaint

question

answer

clinical modification

question

CPT

answer

Current Procedural Terminology

question

answer

diabetes mellitus

question

DRG

answer

diagnosis related group

question

ICD-9-CM

answer

International Classification of Diseases 9th Revision (Clinical Modification)

question

ICD-10-CM

answer

International Classification of Diseases 10th Revision (Clinical Modification)

question

ICD-10-PCS

answer

International Classification of Disease 10th Revision (Procedural Coding System)

question

MRI

answer

Magnetic resonance imaging

question

NCHS

answer

National Center for Health Standards.

question

NEC

answer

Not elsewhere classifiable

question

NOS

answer

Not otherwise specified

Chapter 5 Review Questions : Diagnostic Coding 5-1 – Flashcards

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