Question 1

Centers for Medicare & Medicaid Services (CMS)

Accepted Answer

An administrative agency within the Department of Health and Human Services (DHHS) that oversees Medicare, Medicaid, and other government programs. Formerly known as the Health Care Financing Administration (HCFA)

Question 2

American Academy of Professional Coders (AAPC)

Accepted Answer

The professional association for medical coders providing ongoing education, certification, networking and recognition, with certifications for coders in physicians\' offices and hospital outpatient facilities

Question 3

American Health Information Management Association (AHIMA)

Accepted Answer

One of the four co-operationg parties for ICD-9-CM. Professional association for over 38,000 Health Information Management Professionals throughout the country

Question 4

Board of Advanced Medical Coding (BAMC)

Accepted Answer

An organization of coders, clinicians, and compliance professionals dedicated to the evaluation, recognition, and career advancement of professional medical coders within physician practices, facility and post-acute settings

Question 5

Board of Advanced Medical Coding (BMAC)

Accepted Answer

provides specialty certification for::  Anesthesia/Pain Management, Cardiology, Dermatology,  Facility Outpatient/ Ambulatory Surgical Center, Family Practice/Pediatrics, Gastroenterology, General Surgery, Obstetrics/Gynecology, Ophthalmology, Orthopedics, Radiology, Urology

Question 6

Health Insurance Portability and Accountability Act (HIPAA)

Accepted Answer

Mandates regulations that govern privacy, security, and electronic transactions standards for health care information

Question 7

insurance fraud

Accepted Answer

intentional, deliberate misrepresentation of information for profit or to gain some unfair or dishonest advantage

Question 8

Health Insurance Association of America (HIAA)

Accepted Answer

An agency providing statistics and resources for public health information which includes diseases, pregnancies, aging, and mortality.

Question 9

insurance abuse

Accepted Answer

inconsistent activities considered unacceptable business practice

Question 10

Omnibus Budget Reconciliation Act (OBRA)

Accepted Answer

A federal law outlining numerous areas of healthcare, establishing guidelines and penalties

Question 11

tools of the trade for coders

Accepted Answer

current: ICD-9-CM manual issued every October, CPT manual issued every January, HCPCS manual issued every January, medical dictionary w/ supplement for medical abbreviations and acronyms, carrier bulletins, newsletters, and websites

Question 12

Healthcare Common Procedure Coding System (HCPCS)

Accepted Answer

coding system that consists of CPT and national codes (level II), used to identify procedures, supplies, medications (except vaccines), and equipment. pronounced hick picks.

Question 13

Healthcare Common Procedure Coding (HCPCS)

Accepted Answer

a three-level coding system:  Level I - CPT,  Level II - National Codes,  Level III- Local codes deleted 12/31/03

Question 14

HCPCS codes

Accepted Answer

Codes are required when reporting services and procedures provided to medicare and Medicaid beneficiaries

Question 15

Physicians\' Current Procedure Terminology (CPT)

Accepted Answer

numeric codes and descriptors for services and procedures performed by providers, published by American Medical Association

Question 16

CPT

Accepted Answer

provides uniformity in accurately describing medical , surgical, and diagnostic services for effective communication among physicians, patients, and third-party payers.

Question 17

CPT

Accepted Answer

introduced in 1966, greatest change was 1992 when Evaluation and Management services were created

Question 18

CPT Evaluation and Management

Accepted Answer

CPT section requires practitioners to make decisions as to level of service for offices, hospitals, nursing home services

Question 19

CPT Appendix B

Accepted Answer

summarizes the changes since the previous edition, including additions and deletions essential for updating computer programs and or encounter forms used in the facilty

Question 20

CPT Level I Modifers

Accepted Answer

Appendix A, is a two -digit code added to the main CPT code indicating the procedure has been altered by a specific circumstance. Ex.: 19100-50

Question 21

CPT Level II National Codes (HCPCS)

Accepted Answer

alphanumeric \"national codes\" supplied by the federal government, these codes supplement CPT codes enabling providers to report non physician services such as durable medical equipment, ambulance services, supplies and medications, particularly injectable drugs

Question 22

Level II HCPCS Modifers

Accepted Answer

are either alphanumeric or letters that can be used with all levels of HCPCS codes. Ex. -LT used to identify procedures performed ton the left side of the body

Question 23

CPT Level III

Accepted Answer

called local codes, deleted 12/31/03 under HIPAA regulations, many local code concepts were moved to Level II

Question 24

International Classification of Diseases, 9th Revision, Clinical Modifications (ICD-9-CM)

Accepted Answer

coding system used to report diagnoses, diseases, and symptoms and reasons for encounters for insurance claims

Question 25

ICD-9-CM

Accepted Answer

created by the World Health Organization (WHO) based in Geneva, Switzerland

Question 26

ICD-9-CM

Accepted Answer

provides a diagnostic coding system for the compilation and reporting of morbidity and mortality statistics for reimbursement purposed in the US

Question 27

ICD-9-CM

Accepted Answer

allows for the reporting of conditions, injuries, and traumas along with complications and circumstances occurring with the illness or injury, also provides the reason for patient care

Question 28

ICD-9-CM

Accepted Answer

contains three volumes

Question 29

ICD-9-CM Volume 1

Accepted Answer

Tabular List of Diseases, used by all health care facilities , used to report diagnoses

Question 30

ICD-9-CM Volume 2

Accepted Answer

Alphabetic Index to Diseases, used by all health care facilities, used to report diagnoses

Question 31

ICD-9-CM Volume 3

Accepted Answer

Used by by hospitals, used to report inpatient procedures (CPT is used to report procedures performed in physician offices, ambulatory care centers, and hospital outpatient departments)

Question 32

ICD-9-CM three major functions for insurance purposes

Accepted Answer

1. justifies procedures and services rendered by the physician.  2. It assists in establishing medical necessity for services and procedures performed by the physician.  3. It serves as an indicator in measuring the quality of health care delivered by the physician provider.

Question 33

ICD-10-CM

Accepted Answer

replacement for ICD-9-CM

Question 34

ICD-10-CM

Accepted Answer

anatomy is the foundation, criteria to select and assign a diagnostic code will be based on etiology, site, or morphology

Question 35

ICD-10-CM

Accepted Answer

three volumes Volume 1 - Tabular List Volume 2 - Instruction Manual Volume 3 - Alphabetic List

Question 36

ICD-9-CM

Accepted Answer

is used for coding and classifying diagnoses and procedures by numerical system

Question 37

DRG

Accepted Answer

Diagnosis Related Groups, method of prospective payment used by Medicare and other third party payers for hospital inpatients

Question 38

ICD-9-CM

Accepted Answer

is updated every year with changes every October 1

Question 39

four agencies that are responsible for maintaining and updating ICD-9-CM

Accepted Answer

American Hospital Association (AHA) National Center for Health Statistics (NCHS) Centers for Medicare and Medicaid Services (CMS) American Health Information Management Association (AHIMA)

Question 40

cooperating agencies

Accepted Answer

four agencies who share responsibility for maintaining and updating ICD-9-CM

Question 41

ICD-9-CM Coordination and Maintenance Committee

Accepted Answer

various federal ICD-9-CM users, serve as an advisory committee to the cooperating parties

Question 42

The Coding Clinic for ICD-9-CM

Accepted Answer

a quarterly publication published by the AHA. Considered to be the official publication for the ICD-9-CM coding guidelines and advice from the four cooperating parties

Question 43

The Coding Clinic for ICD-9-CM

Accepted Answer

advice given is to be followed by coders in all settings, including physician office, clinic, outpatient, and hospital inpatient coding

Question 44

sequencing

Accepted Answer

arranging codes in the proper order according to the definitions of principal or primary diagnosis

Question 45

NCHS

Accepted Answer

maintains and updates the diagnosis portion of ICD-9-CM

Question 46

CMS

Accepted Answer

maintains and updates the procedure portion (Volume 3)

Question 47

AHA

Accepted Answer

maintains the Central Office on ICD-9-CM to answer questions from coders and produces the Coding Clinic for ICD-9-CM, the official guidelines for ICD-9-CM usage

Question 48

AHIMA

Accepted Answer

provides training and certification for coding professionals

Question 49

principal diagnosis

Accepted Answer

the reason, after study, which caused the patient to be admitted to the hospital, inpatient

Question 50

first-listed diagnosis

Accepted Answer

in the outpatient setting, the primary diagnosis is the main reason for the visit. it is usually the diagnosis taking the majority of resources for the visit

Question 51

How to look up a ICD-9-CM term

Accepted Answer

Step 1- locate the main term Step 2- identify subterms

Question 52

ICD-9-CM Step 1 locating the main term

Accepted Answer

look in the alphabetic index of Volume Two under the main term.

Question 53

main term

Accepted Answer

the patients illness or disease, in the ICD-9-CM the main term is the primary way to locate the disease in the alphabetic index. are printed in boldface, even with the left margin on each page

Question 54

main terms examples

Accepted Answer

fracture, pneumonia, disease, injury, and enlarged

Question 55

not main terms examples

Accepted Answer

anatomic terms : kidney, shoulder

Question 56

alphabetic index

Accepted Answer

Volume 2 of the ICD-9-CM, the alphabetic listing of diagnoses

Question 57

alphabetic index

Accepted Answer

cross-refrenced extremely well to allow the coder to locate the correct code using several different terms. Ex. \"congestive heart failure\" can be found under the main term \" failure\" and/or \"congestive\"

Question 58

ICD-9-CM three alphanumeric classifications

Accepted Answer

V codes, E codes, M codes

Question 59

V codes (ICD-9-CM)

Accepted Answer

used to describe the main reason for the patient\'s visit in cases where the patient is not sick. used as a secondary diagnosis to provide further information about the patient\'s medical condition.

Question 60

E codes (ICD-9-CM)

Accepted Answer

are external causes of injury and poisoning. are optional by some carriers, many state statues require the assignment of an E code to a claim form. E codes are secondary diagnosis to show the cause of injury, such as a fall or automobile accident, if it is known.

Question 61

M codes, Morphology Codes (ICD-9-CM)

Accepted Answer

located in the alphabetic index, used to further identify the behavior and cell type of a neoplasm and are used in conjunction with neoplasm codes from the main classification

Question 62

M codes (ICD-9-CM)

Accepted Answer

used primarily by cancer registries and are not assigned when submitting a claim to a carrier by the physician office

Question 63

Medical Coding – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards