question

___________codes describe patient illnesses, diseases, conditions, injuries, or other reasons for seeking healthcare services.

answer

Diagnosis

question

The three skills of an "ace" coder are to _______ information from the medical record; _______ the accurate code number; and _______ the codes in proper order.

answer

abstract, assign, arrange

question

_______ encounters are physician interactions with patients who have not been formally admitted to a healthcare institution, such as an acute care hospital, long-term care facility, or rehabilitation facility.

answer

Outpatient

question

_______ encounters are physician interactions with patients who have been formally admitted to a healthcare facility, such as an acute care hospital, long-term care facility, or rehabilitation facility.

answer

Inpatient

question

_______ services include laboratory, radiology, or physical therapy.

answer

Ancillary

question

The _______ physician oversees and coordinates all aspects of the patient's care.

answer

attending

question

A _______ is the progression of jobs and responsibilities throughout one's working life.

answer

career path

question

The _______ plan may include medication, surgery, lifestyle changes, or therapy.

answer

treatment

question

When the documentation is unclear, coders _______ the physician for clarification.

answer

query

question

Most coders are expected meet a case _______ standard to code a specific number of cases each day, while maintaining high ________.

answer

production, accuracy

question

The replacement code set used for diagnosis coding is__________.

answer

ICD-10-CM

question

_______ is the replacement code set that is used for hospital inpatient procedure coding.

answer

ICD-10-PCS

question

Which of the following is NOT a HIPAA-mandated code set?

answer

DSM-IV

question

A specific interaction between a patient and healthcare provider is an ___________.

answer

Encounter

question

Which of the following is NOT an example of an outpatient encounter?

answer

Hospital admission

question

Coders do which of the following tasks?

answer

Assign diagnostic and procedure codes for patient encounters after an encounter is completed.

question

Which statement about certification is NOT true?

answer

All states legally mandate coder certification.

question

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.

answer

Entry-level

question

_______ is an example of an entry-level job.

answer

Data Entry Clerk

question

Many organizations post their job openings _______, available only to current employees, for a period of time before they are advertised to the public.

answer

Internally

question

_______ is hospital insurance that covers a specific list of services for inpatient hospital care, skilled nursing facilities, hospice, and home healthcare.

answer

Part A (Medicare)

question

_______ is a Medicare supplement insurance policy sold by private insurance companies to fill gaps in Part A and Part B coverage.

answer

Medigap

question

_______ is health insurance coverage for family members of active duty personnel and for retired military personnel and their families.

answer

TC (Tricare)

question

_______ is the health status of immediate family members, causes of death (if known), and diseases common in the family.

answer

Family history

question

Each patient encounter is coded based on _______ for that visit.

answer

progress notes

question

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.

answer

EOB (explanation of benefits)

question

_______ is knowingly billing for services that were never given or billing for a service that as a higher reimbursement than the service provided.

answer

Fraud

question

_______ is mistakenly accepting payment for items or services that should not be paid for by Medicare.

answer

Abuse

question

_______ investigates fraud, abuse, and other noncompliance matters in the Medicare and Medicaid programs.

answer

OIG (Office of the Inspector General

question

The OIG issued sample _______ programs, which include seven major characteristics.

answer

compliance

question

Med pay or personal injury protection from automobile insurance policies is regulated by

answer

Each state's Department of Insurance

question

_______ is funded two-thirds by the federal government and one-third by state governments.

answer

Medicaid

question

An example of the medical necessity criterion evidence-based practice is

answer

Medications proven to benefit patients based on scientific studies.

question

The provider verifies eligibility with the insurance company

answer

before the encounter

question

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

answer

after the encounter

question

The computer system first performs a front-end edit check

answer

at the insurance company

question

Which of the following is NOT a coding problem that causes rejected or denied claims?

answer

The patient's insurance has expired.

question

Knowingly submitting a bill to a government healthcare program, such as Medicare, that contains incorrect codes is considered to be presenting a

answer

false claim

question

The Patient Protection and Affordable Care Act (PPACA), passed in 2010, mandates _______ for providers who contract with Medicare, Medicaid, and SCHIP.

answer

compliance programs

question

The RAC program uses _______ to identify Medicare overpayments and underpayments to healthcare providers and suppliers.

answer

independent contractors

question

ICD-10-CM codes contain _______ to _______ characters.

answer

three, seven

question

ICD-10-PCS codes contain _______ characters.

answer

seven

question

______ is causes of disease and illness.

answer

morbidity

question

Version 5010 is mandatory on the date _______.

answer

January 1, 2012

question

The United States version of ICD-10 diagnosis codes is much more _______ than it is in other nations.

answer

granular

question

The code set _______ was developed by WHO for worldwide use.

answer

ICD-10

question

The code set _______ is used only by inpatient hospitals.

answer

ICD-10-PCS

question

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.

answer

AHIMA

question

_______ uses more combination codes than ICD-9-CM.

answer

ICD-10-CM

question

Researchers use _______ to analyze large volumes of data, but coders should not use them for code assignment.

answer

GEMs

question

Which of the following is NOT a benefit of ICD-10-CM?

answer

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.

question

Which of the following conditions does NOT require updated terminology in ICD-10-CM?

answer

Influenza

question

Who is required to use ICD-10-CM?

answer

HIPAA-covered entities

question

Which of the following is NOT a requirement that impacts health information systems?

answer

Create separate fields for ICD-9-CM and ICD-10-CM codes.

question

Which of the following is NOT an example of provider documentation changes under ICD-10-CM/PCS?

answer

Acute vs chronic

question

Changes in procedure abstracting under ICD-10-PCS include all of the following EXCEPT

answer

External causes

question

Coding professionals recommend that full training of all staff take place approximately _______ months prior to the compliance date.

answer

three to six

question

GEMs do not provide an exact one-to-one match between ICD-9-CM and ICD-10-CM because

answer

There are more ICD-10-CM codes than ICD-9-CM codes.

question

Which of the following areas will impact coders?

answer

Learning new software, Enhanced data entry skills, Expanded medical terminology

question

Which is the most accurate description of GEMs?

answer

An authoritative source for comparing codes between ICD-10-CM/PCS and ICD-9-CM.

question

The convention _______ identifies nonessential modifiers that describe the default variations of a term.

answer

( )

question

The convention _______ identifies mutually exclusive codes that should not be used together.

answer

Excludes1

question

The convention _______ tells the coder that additional characters should be assigned to a code.

answer

-

question

A code that appears in ______ in the Index should be sequenced second.

answer

[ ]

question

The convention _______ appears in front of a four-digit code to indicate that a fifth digit is required.

answer

5th

question

The convention _______ is a placeholder in codes with less than six characters that require a seventh character extension.

answer

X

question

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.

answer

Excludes2

question

The convention _______ instructs the coder to sequence the etiology first.

answer

code first

question

The convention _______ instructs the coder to sequence the manifestation second.

answer

use additional code

question

The convention _______ instructs the coder to reference another Main Term or condition to locate the correct code.

answer

see

question

_______ are the seventh characters of codes that must appear in that position, regardless of the length of the code.

answer

Extensions

question

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.

answer

First-listed

question

_______ diagnoses are preceded by the words probable, possible, suspected, questionable, rule out, working diagnosis, or similar word.

answer

Uncertain

question

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.

answer

principal

question

_______ are rules that complement the conventions and instructional notes to provide additional information and direction in identifying the diagnoses to be reported.

answer

OGCR

question

_______ are the use of symbols, typeface, and layout features to succinctly convey interpretive information.

answer

Conventions

question

_______ means to read the medical record and determine which elements of the encounter require codes.

answer

Abstracting

question

A _______ is a contiguous range of codes within a chapter in ICD-10-CM.

answer

block

question

_______ is a new OGCR that defines separate codes for the right and left sides of the body.

answer

Laterality

question

Do not code signs or symptoms that are a/an _______ part of the disease process when the diagnosis has been established.

answer

integral

question

_________ describes the anatomical site where the neoplasm begins.

answer

primary

question

_________ describes the tissue type.

answer

histology

question

_________ describes a neoplasm that has spread to other sites.

answer

metastasis

question

__________ is the process of determining how far the cancer has spread.

answer

Staging

question

Chemotherapy, radiotherapy, and immunotherapy are examples of _________ therapy.

answer

adjuvant

question

________ uses drugs to kill cancer cells.

answer

Chemotherapy

question

_______ occurs only in epithelial cells.

answer

Carcinoma

question

_______ tumors are contiguous sites where the neoplasm continues from one site to the adjacent one without interruption.

answer

overlapping

question

_________ describes how closely the cancer cell looks like a normal cell when viewed microscopically.

answer

grading

question

___________ means life threatening.

answer

malignant

question

Which of the following is NOT a characteristic of malignant neoplasms?

answer

Produce no cachexia

question

Malignant neoplasms metastasize through

answer

the bloodstream and lymphatic system

question

Personal history of malignant neoplasm is

answer

a condition the patient had in the past, was removed, and is no longer being treated, but has the potential for recurrence

question

Which of the following is NOT a column on the Table of Neoplasms?

answer

Personal History

question

Which of the following statements about the Table of Neoplasms is TRUE?

answer

Codes in the Table of Neoplasms must always be verified in the Tabular List

question

When a patient is seen for evaluation or treatment of metastasis, which code should be sequenced first?

answer

Secondary neoplasm

question

When a patient is seen for dehydration due to colon cancer that has metastasized to multiple sites, which code should be sequenced first?

answer

Dehydration

question

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?

answer

Breast cancer

question

When a patient receives a colonoscopy more frequently than normal, due to a family history of colon cancer, which code should be sequenced first?

answer

Screening

question

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?

answer

Encounter for radiotherapy first and malignant neoplasm second

ICD-10-CM/PCS Ch 1-5 – Flashcards

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