ICD-10-CM/PCS Ch 1-5 – Flashcards
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_______ services include laboratory, radiology, or physical therapy.
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Ancillary
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The _______ physician oversees and coordinates all aspects of the patient's care.
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attending
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A _______ is the progression of jobs and responsibilities throughout one's working life.
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career path
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The _______ plan may include medication, surgery, lifestyle changes, or therapy.
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treatment
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When the documentation is unclear, coders _______ the physician for clarification.
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query
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Most coders are expected meet a case _______ standard to code a specific number of cases each day, while maintaining high ________.
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production, accuracy
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The replacement code set used for diagnosis coding is__________.
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ICD-10-CM
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_______ is the replacement code set that is used for hospital inpatient procedure coding.
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ICD-10-PCS
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Which of the following is NOT a HIPAA-mandated code set?
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DSM-IV
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A specific interaction between a patient and healthcare provider is an ___________.
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Encounter
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Which of the following is NOT an example of an outpatient encounter?
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Hospital admission
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Coders do which of the following tasks?
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Assign diagnostic and procedure codes for patient encounters after an encounter is completed.
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Which statement about certification is NOT true?
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All states legally mandate coder certification.
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Most coders look for a (an) _______ job upon graduation in order to gain basic skills, become familiar with the healthcare field, and establish excellent work habits.
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Entry-level
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_______ is an example of an entry-level job.
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Data Entry Clerk
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Many organizations post their job openings _______, available only to current employees, for a period of time before they are advertised to the public.
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Internally
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_______ is hospital insurance that covers a specific list of services for inpatient hospital care, skilled nursing facilities, hospice, and home healthcare.
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Part A (Medicare)
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_______ is a Medicare supplement insurance policy sold by private insurance companies to fill gaps in Part A and Part B coverage.
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Medigap
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_______ is health insurance coverage for family members of active duty personnel and for retired military personnel and their families.
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TC (Tricare)
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_______ is the health status of immediate family members, causes of death (if known), and diseases common in the family.
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Family history
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Each patient encounter is coded based on _______ for that visit.
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progress notes
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The _______ is a statement that lists all the services the provider billed, which ones were accepted for payment, how much the insurance company will pay, how much the patient owes, and how much will not be paid.
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EOB (explanation of benefits)
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_______ is knowingly billing for services that were never given or billing for a service that as a higher reimbursement than the service provided.
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Fraud
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_______ is mistakenly accepting payment for items or services that should not be paid for by Medicare.
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Abuse
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_______ investigates fraud, abuse, and other noncompliance matters in the Medicare and Medicaid programs.
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OIG (Office of the Inspector General
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The OIG issued sample _______ programs, which include seven major characteristics.
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compliance
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Med pay or personal injury protection from automobile insurance policies is regulated by
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Each state's Department of Insurance
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_______ is funded two-thirds by the federal government and one-third by state governments.
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Medicaid
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An example of the medical necessity criterion evidence-based practice is
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Medications proven to benefit patients based on scientific studies.
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The provider verifies eligibility with the insurance company
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before the encounter
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The chart is given to the coding department where a coder reviews the progess note, assigns diagnosis and procedure codes, and enters the codes into the computer
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after the encounter
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The computer system first performs a front-end edit check
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at the insurance company
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Which of the following is NOT a coding problem that causes rejected or denied claims?
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The patient's insurance has expired.
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Knowingly submitting a bill to a government healthcare program, such as Medicare, that contains incorrect codes is considered to be presenting a
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false claim
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The Patient Protection and Affordable Care Act (PPACA), passed in 2010, mandates _______ for providers who contract with Medicare, Medicaid, and SCHIP.
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compliance programs
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The RAC program uses _______ to identify Medicare overpayments and underpayments to healthcare providers and suppliers.
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independent contractors
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ICD-10-CM codes contain _______ to _______ characters.
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three, seven
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ICD-10-PCS codes contain _______ characters.
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seven
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______ is causes of disease and illness.
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morbidity
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Version 5010 is mandatory on the date _______.
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January 1, 2012
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The United States version of ICD-10 diagnosis codes is much more _______ than it is in other nations.
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granular
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The code set _______ was developed by WHO for worldwide use.
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ICD-10
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The code set _______ is used only by inpatient hospitals.
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ICD-10-PCS
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Coders already certified through _______ for ICD-9-CM/PCS must complete a specified amount of continuing education, based on their specialty and coding credential, beginning in 2011.
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AHIMA
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_______ uses more combination codes than ICD-9-CM.
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ICD-10-CM
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Researchers use _______ to analyze large volumes of data, but coders should not use them for code assignment.
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GEMs
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Which of the following is NOT a benefit of ICD-10-CM?
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The structure of the new code set allows physicians to create new codes whenever they need to, if an appropriate code is not already available.
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Which of the following conditions does NOT require updated terminology in ICD-10-CM?
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Influenza
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Who is required to use ICD-10-CM?
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HIPAA-covered entities
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Which of the following is NOT a requirement that impacts health information systems?
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Create separate fields for ICD-9-CM and ICD-10-CM codes.
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Which of the following is NOT an example of provider documentation changes under ICD-10-CM/PCS?
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Acute vs chronic
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Changes in procedure abstracting under ICD-10-PCS include all of the following EXCEPT
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External causes
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Coding professionals recommend that full training of all staff take place approximately _______ months prior to the compliance date.
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three to six
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GEMs do not provide an exact one-to-one match between ICD-9-CM and ICD-10-CM because
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There are more ICD-10-CM codes than ICD-9-CM codes.
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Which of the following areas will impact coders?
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Learning new software, Enhanced data entry skills, Expanded medical terminology
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Which is the most accurate description of GEMs?
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An authoritative source for comparing codes between ICD-10-CM/PCS and ICD-9-CM.
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The convention _______ identifies nonessential modifiers that describe the default variations of a term.
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( )
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The convention _______ identifies mutually exclusive codes that should not be used together.
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Excludes1
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The convention _______ tells the coder that additional characters should be assigned to a code.
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-
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A code that appears in ______ in the Index should be sequenced second.
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[ ]
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The convention _______ appears in front of a four-digit code to indicate that a fifth digit is required.
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5th
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The convention _______ is a placeholder in codes with less than six characters that require a seventh character extension.
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X
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The convention _______ indicates that the condition excluded is not part of the condition represented by the code, but the patient may have both conditions at the same time.
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Excludes2
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The convention _______ instructs the coder to sequence the etiology first.
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code first
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The convention _______ instructs the coder to sequence the manifestation second.
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use additional code
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The convention _______ instructs the coder to reference another Main Term or condition to locate the correct code.
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see
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_______ are the seventh characters of codes that must appear in that position, regardless of the length of the code.
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Extensions
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In the outpatient setting, the ______ diagnosis is the diagnosis, condition, problem, or other reason for the encounter visit shown in the mdeical record to be chiefly responsible for the services provided.
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First-listed
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_______ diagnoses are preceded by the words probable, possible, suspected, questionable, rule out, working diagnosis, or similar word.
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Uncertain
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In an inpatient setting, the _______ diagnosis is the condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.
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principal
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_______ are rules that complement the conventions and instructional notes to provide additional information and direction in identifying the diagnoses to be reported.
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OGCR
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_______ are the use of symbols, typeface, and layout features to succinctly convey interpretive information.
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Conventions
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_______ means to read the medical record and determine which elements of the encounter require codes.
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Abstracting
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A _______ is a contiguous range of codes within a chapter in ICD-10-CM.
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block
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_______ is a new OGCR that defines separate codes for the right and left sides of the body.
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Laterality
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Do not code signs or symptoms that are a/an _______ part of the disease process when the diagnosis has been established.
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integral
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_________ describes the anatomical site where the neoplasm begins.
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primary
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_________ describes the tissue type.
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histology
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_________ describes a neoplasm that has spread to other sites.
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metastasis
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__________ is the process of determining how far the cancer has spread.
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Staging
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Chemotherapy, radiotherapy, and immunotherapy are examples of _________ therapy.
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adjuvant
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________ uses drugs to kill cancer cells.
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Chemotherapy
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_______ occurs only in epithelial cells.
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Carcinoma
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_______ tumors are contiguous sites where the neoplasm continues from one site to the adjacent one without interruption.
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overlapping
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_________ describes how closely the cancer cell looks like a normal cell when viewed microscopically.
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grading
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___________ means life threatening.
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malignant
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Which of the following is NOT a characteristic of malignant neoplasms?
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Produce no cachexia
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Malignant neoplasms metastasize through
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the bloodstream and lymphatic system
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Personal history of malignant neoplasm is
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a condition the patient had in the past, was removed, and is no longer being treated, but has the potential for recurrence
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Which of the following is NOT a column on the Table of Neoplasms?
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Personal History
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Which of the following statements about the Table of Neoplasms is TRUE?
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Codes in the Table of Neoplasms must always be verified in the Tabular List
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When a patient is seen for evaluation or treatment of metastasis, which code should be sequenced first?
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Secondary neoplasm
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When a patient is seen for dehydration due to colon cancer that has metastasized to multiple sites, which code should be sequenced first?
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Dehydration
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When a patient is admitted for surgery to remove a tumor from the breast, then receives chemotherapy while still in the hospital, which code should be sequenced first?
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Breast cancer
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When a patient receives a colonoscopy more frequently than normal, due to a family history of colon cancer, which code should be sequenced first?
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Screening
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When a patient who previously had surgery to remove a malignant neoplasm of the lung has an encounter only for radiotherapy, which code(s) should be assigned?
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Encounter for radiotherapy first and malignant neoplasm second
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