question

What are the two main organization components

answer

Alphabetic Index and Tabular List

question

One difference between ICD-9 and ICD-10 is that ICD-10 describes a patient's disease or condition with much greater specificity.

answer

True

question

ICD-10 CM must be used for diagnostic coding in the United States starting October 1, 2014

answer

True

question

In diagnostic coding, the coexisting conditions are coded first; followed by any other conditions that are being treated in that encounter.

answer

False

question

This is the main reason a patient is presenting to the doctor and provides the main term to be coded first.

answer

primary diagnosis

question

In the term, "Complete paralysis", what is the main term

answer

paralysis

question

The first Coding Step says to Review Complete Medical Documentation. This is where you will find the primary diagnosis.

answer

true

question

According to the Steps of Diagnosis Coding, you should verify the code in the Tabular List and then check it in the Alphabetic Index.

answer

False

question

The very last step before submitting a diagnosis code is to

answer

Check compliance with any applicable Official Guidelines and list codes in appropriate order

question

ICD-10 is the _____ version of the diagnostic code set.

answer

10th

question

Which is the correct process for selecting CPT codes

answer

determine the procedures and services to report, identify the correct codes and determine the need for modifiers

question

Upon selecting an Evaluation and Management code, three components are considered: the type of history, the physical examination and the

answer

medical decision making

question

In CPT, E/M is the abbreviation for Evaluation and

answer

management

question

Under CPT's definition, after a referral, who takes responsibility for the patient's care

answer

the physician to whom the patient is referred

question

Codes in CPT's anesthesia section generally cover

answer

preoperative evaluation and planning care during the procedure routine postoperative care "All of the above"

question

Which section of CPT codes is the physical status modifier, such as P1 for normal, healthy patient, exclusively used with

answer

anesthesia

question

Under CPT guidelines, all services related to a surgical procedure are not additionally reimbursed

answer

during the global period

question

What was set up to give healthcare providers a coding system that describes specific products, supplies, and services that patients receive

answer

HCPCS

question

Durable medical equipment (DME) such as wheelchairs covered by the Medicare program are reported using?

answer

HCPCS codes

question

In CPT, what do Category II codes report

answer

services to track performance measurement

question

In CPT, what do Category III codes report

answer

emerging technology, services and procedures

question

In CPT, a plus sign (+) next to code indicates a

answer

add-on code

question

In CPT, a bullet (a solid circle) next to a code indicates a

answer

new code

question

The division of CPT, such as anesthesia and radiology are referred to as

answer

sections

question

In CPT, a lightning bolt symbol next to a code indicates a

answer

code pending FDA approval

question

In CPT, a triangle next to a code indicates a

answer

revised code descriptor

question

in CPT, what do facing triangles that appear in front of a code indicate

answer

new/revised test other than a code descriptor

question

In CPT, what type of code is described by the following entry? + each additional 24 hours (list separately in addition to code for primary procedure)

answer

add-on code

question

The CPT code that is listed first for an encounter is the procedure that

answer

is the most resource-intensive

question

What is required of the physician in order to report the professional component of a CPT code from the Radiology section

answer

reading the radiological examination and writing a report of interpretation

question

In CPT, some codes have both a technical component and another component representing the physician's skill, time and expertise. What is the name of this other component

answer

professional

question

In CPT, a single code grouping laboratory tests is called a

answer

panel

question

The use of CPT Category II codes does not affect reimbursement and is

answer

optional

question

CPT is a publication of the

answer

American Medical Association

question

Which of the following is not a main term in the CPT index

answer

anatomical site of the procedure abbreviations eponyms "None of the above"

question

Which of the following is a cross-reference that might be seen in CPT

answer

both "see" and "see also" are seen

question

CPT was first published in what year

answer

1966

question

The E/M coding method came from

answer

joint effort of CMS and AMA

question

The last step in the coding process is

answer

determine the need for modifiers

question

How many key components are there when evaluating an E/M code

answer

three

question

Which is not a key component in E/M coding

answer

treatment

question

What is the abbreviation HPI used for

answer

history of present illness

question

ROS is the abbreviation for

answer

review of systems

question

In CPT, the term_____ describes services that a provider performs at the request of another provider after which the patient is returned to the requesting provider's care

answer

consultation

question

Most of the surgery section is organized by

answer

body system

question

Which member of the medical practice is ultimately responsible for proper documentation and correct coding

answer

physician

question

Some possible consequences of inaccurate coding and incorrect billing in a medical practice are

answer

denied claims and reduced payments prison sentences fines "All of the above"

question

The Correct Coding Initiative (CCI) is a program of

answer

Medicare

question

If a payer judges that too high a code level has been assigned by a practice for a reported service, the usual action is to

answer

downcode the reported procedure code

question

What type of coding uses diagnoses that are not as specific as possible

answer

truncated coding

question

What type of coding uses a procedure code that provides a higher reimbursement rate than the correct code

answer

upcoding

question

What type of coding uses a lower level code

answer

downcoding

question

Professional courtesy refers to

answer

discounted charges made for other providers and their families

question

Routinely waiving deductibles and copayments is

answer

illegal

question

What type of audit is performed internally before claims are reported

answer

prospective audit

question

What type of audit is performed internally after claims are submitted

answer

retrospective audit

question

What type of external audit is performed by payers before claims are processed

answer

prepayment

question

What type of audit do payers routinely conduct to ensure that claims are compliant

answer

post-payment

question

The CMS/AMA Documentation Guidelines set up the rules for the selection of

answer

Evaluation and Management codes

question

What type of fees are defined as those that physicians charge to most of their patients most of the time under typical conditions?

answer

usual fees

question

Under RBRVs, the nationally uniform relative value is based on

answer

the provider's work, practice cost, and malpractice insurance costs

question

What are the main methods payers use to pay providers

answer

allowed charges, contracted fee schedule, and capitation

question

What is the fixed prepayment for each plan member in a capitation contract called

answer

capitation rate

question

Medical insurance specialists help ensure maximum appropriate reimbursement for services by

answer

submitting claims that are correct and compliant

question

When regulations seem contradictory or unclear, the OIG issues

answer

advisory opinions

question

CCI is an abbreviation for

answer

Correct Coding Initiative

question

The _______ lists the types of medical billing and reporting practices that the Office of Inspector General intends to investigate in the coming year

answer

OIG Work Plan

question

Medical necessity is based on

answer

the relationship between the diagnosis and the treatment provided

question

Which of the following is NOT a medically necessary procedure

answer

Cosmetic nasal surgery

question

What does the term "assumption coding" mean

answer

That the medical coder coded and reported services that were not documented in the patient's medical record

question

Which of the following is not fraudulent

answer

Using a non-specific diagnosis code

question

________ refers to a coding method in which lower-level codes are selected to avoid government investigation

answer

Downcoding

question

____________ refers to a coding problem in which a procedure code is used that provides a higher reimbursement than the correct code

answer

Upcoding

question

Only the codes that ______ should be reported

answer

are supported by the documentation

question

Global periods for a minor procedure have which of the following postoperative periods

answer

10 days

question

Global periods for a major procedure have which of the following postoperative periods

answer

90 days

question

What is a way that upcoding is being monitored by payers

answer

benchmarking practices' E/M codes with national averages

question

Which of the following is considered a formal examination

answer

audit

question

Which of the following means that a physician has chosen to waive the charges for services to other physicians

answer

professional courtesy

question

An audit involves reviewing

answer

every claim a sample 10% of the claim "All of the above"

question

RACs requests for information must be answered in _____ days

answer

45

question

If a RAC's request is not answered in the appropriate amount of time, which of the following might occur

answer

an error is declared and penalties may result

question

Which of the following is not an element of HPI

answer

location timing context "None of the above"

question

_________ is a normal fee charged by a provider

answer

usual fee

question

Most practices set their fees

answer

slightly above those paid by the highest reimbursing plan

Billing & Insurance, Coding Chap 4,5,6 – Flashcards

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