question

The first step in the reimbursement process of healthcare claims is:

answer

reading & understanding the physician's documentation.

question

Diagnosis codes submitted on insurance claim forms are generally used to:

answer

.determine benefit coverage.

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ICD-9 codes are used by outside agencies to:

answer

conduct studies of trends in diseases, review cost. forecast healthcare needs.

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The London Bills of Mortality were first introduced mainly to:

answer

warn about the plague epidemics.

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The first form of medical diagnostics coding date back to :

answer

16th century-England

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In 1948 the ICD came under the direction of the:

answer

World Health Organazation (WHO)

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ICD information was used by the WHO for all of the following:

answer

make statistical assessments of the international health, track morbidity, assist in tracking mortality.

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As of 1948, the ICD became known as the:

answer

International Classification of Diseases

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The clinical modification of the ICD-9 was developed by the:

answer

National center for Health Statistics

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As part of the Medicare Catastrophic Coverage Act of 1988, providers were required to:

answer

use ICD-9-CM codes to document conditions.

question

ICD-9-Cm coding serves the following purposes:

answer

It establishes medical necessity, it translates written terminology into unerversal, common language, it provides data for statistical analysis.

question

The clinical modificationof the ICD-9 allowed data to be used for all of the following.

answer

conducting epidemiological, and clinical research, compling & conparing healthcare data, assisting in the planning healthcare delivery system.

question

Diagnostic coding changes for Volumes 1 & 2 of the ICD-9-Cm are made:

answer

Annually on October 1

question

Revisions to Volume 3 are made by:

answer

the centers for medicare & medicaid services

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Updates to Volume 1 & 2 of the ICD-9-CM may include:

answer

additions of new codes, deletion of old codes, revisions to the descriptors.

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The ICD-10-CM uses codes that are:

answer

alphanumeric

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Improvements in the ICD-10-Cm include:

answer

the addition of information relevant to managed care encounters, a reduction in the # of codes needed to be fully describe a condition.

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The # of chaacters in a code from the ICD-10-CM is:

answer

6 characters

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Volume 1 of the ICD-9-CM is known as the:

answer

Tabular & numeric list of Diseases.

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Volume 2 of the ICD-9-CM is known as the:

answer

alphabetic Index of diseases.

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Volume 3 Of the ICD-9-CM is known as the:

answer

Tabular & alphabetic Index of procedures

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Volume 3 of the ICD-9-CM is used by the:

answer

hospitals to code procedures

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The chapters in the tabular list diseases are grouped by:

answer

body system affected by condition

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To report external causes of injury & poisoning, a coder should use:

answer

E codes

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Appendices included in the tabular list diseases include all of the following:

answer

morphology of neoplasms, list of 3 digit categories, classification of the industrial accidents according to agency.

question

Tables found in volume 2 of the ICD-9-Cm include all of the following:

answer

hypertension, drugs & chemicals, & neoplasms

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External causes of poisoning include all of the following categories:

answer

assault, suicide attempt, & therapeutic use.

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When the physician determines the patients main reason for the encounter, the impression is reffered to as the:

answer

primary diagnosis

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Subterms in an ICD-9-Cm entry may show:

answer

the cause or orgin of the disease.

question

All of the following are ture of supplementary terms in an ICD-9-CM entry: due to the fact that they are essential to the selection of the correct code:

answer

aid the coder in finding the correct term, can be in parentheses, & brackets.

question

The folowing are true carryover lines in an ICD-9-Cm entry:

answer

they list anorther name for the condition or disease.

question

An example of a eponym

answer

Hodgkin's disease

question

When coding acute serous otitis media using Volume 2 of the ICD-9-CM, the main term a coder would look up is:

answer

serous

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When coding a pregancy test with a positive results using volume 2 of ICD-9-CM, the main term you would look up is:

answer

positive

question

When coding narrowing of the vertebral artery with cerebral infarction using volume 2 of the ICD-9-CM, the main term you would look up is:

answer

narrowing

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Not elsewhere classified (NEC) is used when the:

answer

coder lacks the information necessary to code the term more specifically.

question

Volume 1 should be referred to by a coder:

answer

after the condition has been located in volume 2

question

Square brackets are used in volume 1 of the ICD-9-CM to enclose:

answer

synonyms

question

Instructional notes are used in volume 1 of the ICD-9-CM to:

answer

provide 5th digits information, define terms, & provide coding instructions.

question

The first step that should be followed in order to obtain the accurate, most-specific code is:

answer

determine the reason for the encounter.

question

KEy coding guidelines that apply to ICD-9-CM coding are:

answer

coding to the hoghest level of certainty & specificity.

question

If the physician cannot determine the diagnosis at the time of the encounter, the medical office specialist should:

answer

code the symptoms, signs, or reason for the encounter.

question

If a patient presents with no complaints of illness or injury, the medical office specilist should:

answer

use V code

question

In coding residual effects, amedical office specialist should:

answer

code the late effect followed by the cause of the late effect.

question

Major categories of E codes include all of the following:

answer

accidential falls, assaults or purposely inflicted injury, & late effects of accidents or self injury.

question

Malignant neoplasms are classified as:

answer

primary, secondary, or carcinoma in situ.

question

Hypertension is classified in the hypertension table as:

answer

benign, malignant, or unspecified only.

question

Coding burns are based on:

answer

the degree of severity of the burn, the location of the burn, the precentage of the total body burned.

question

Type 1 diabetes mellitus indicates that the:

answer

patient is insulin-dependent

question

The rule of nine is used by the medical office specialist in coding to:

answer

estimate the body surface are involved in a burn.

question

The Current Procedural Terminology (CPT) is published by:

answer

American Medical Association(AMA)

question

The current CPT system uses codes with:

answer

five digits

question

CPT codes are implemented each year on:

answer

January 1

question

The codes that describe a procedure or service with a five digit numeric code & descriptor are:

answer

Category 1 CPT codes

question

The temporary codes used for emerging technology, services, or procedures are:

answer

Category 111 CPT codes

question

The Health Portability & Accountability Act(HIPPA) supports the:

answer

elimination of Category lll CPT codes

question

CPT Category ll codes are used principally:

answer

for measuring performance

question

How are the 8 sections of the CPT code book divided?

answer

6 sections Category l, 1 section Category ll, & 1 section Category lll.

question

All of the following are sections of the Category l CPT codes:

answer

Evaluation & Management, Surgery, & Medicine.

question

The first section of the CPT code book is:

answer

Evaluation & Management(99201-99499)

question

The symbol + used with a CPT code indicates:

answer

add-on code

question

The symbol a solid triangle used with a CPT code indicates:

answer

a revised code

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In order to report that a description of a service or procedure has been altered in someway, the medical office specialist should use:

answer

a modifier

question

The modifier 21 is used to indicate:

answer

prolonged evaluation and management(E/M) service

question

The modifier 52 is used to indicate:

answer

reduced services

question

The modifier 25 is used to indicate:

answer

significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service.

question

The modifier 57 is used to indicate:

answer

a decision for surgery

question

If a physician began an initial gynecological exam on a patient, but, due to the patient's extreme discomfort, discontinued it, the modifier would be:

answer

modifier 52

question

The most often reported evaluation & management services are:

answer

office & other out patient services.

question

A new patient is considered one who has not received professional services from the physician or another physician of the same specialty in the same group within the past:

answer

3 years

question

The transferof the total care of a patient from one physician to another is called:

answer

a referral

question

When a second physician examines a patient and renders an opinion, the service is referred to as a:

answer

consultation

question

Componets that define the level of evaluation& management service include all of the following:

answer

the complexity of the medical decision making documented, time, & the extent of the history documented.

question

In order to code for an evaluation & management service, the following are elements that must be documented:

answer

History, Exam, & medical decision making.

question

Counseling with a patient or family can be considered in coding an evaluation & management service if it pertains to:

answer

prognosis, risks & benefits of treatment options, & diagnosis results

question

The review of systems(ROS) is considered part of:

answer

The history of the patient.

question

A presenting problem that may not require the presence of a physician, but if service is provided under the physician's supervision, it is considered:

answer

minimal in nature

question

The classes of main entries found in the CPT index include all of the following:

answer

organs, or other anatomic site, synonyms, eponyms, abbreviations, & conditions.

question

If only one code for a procedure or service occurs in the index, the user should:

answer

Verify the code in the main text of the CPT book.

question

Example of procedures or services include all of the following

answer

osteopathic manipulation, evaluation & management, & arthroscopy

question

In the CPT index, all topics referring to CPT code sections or Chapter headings are listed in:

answer

bold uppercase letters

question

If 2 codes apply to an entry in the CPT index, the codes are seperated by a:

answer

Comma

question

The first code that appears left justified in a series of codes is called the:

answer

parnet code

question

The proper use of CPT modifiers can result in:

answer

increased reimbursement

question

The modifier used to report a bilateral procedure is:

answer

modifier 50

question

Modifier-47 is used to report:

answer

anesthesia by a surgeon

question

A special Report submitted with a claim can be used to;

answer

detail the reason for the variable procedure

question

Modifier -51 can be used in the following applications:

answer

A combination of medical & operative procedures performed at the same session by the same providers, multiple, related operative proceduresperformed at the same session by the same provider, & multiple medical proceduresperformed at the same session by the same provider.

question

The modifier used to identify a procedure that is discontinued is:

answer

modifier -53

question

When one physician provides surgical care only & does not provide the preoperative and/or postoperative management, the coder should use modifier:

answer

modifier -54

question

When 2 or more modifiersare necessary to completely define a service, the medical office assistant should:

answer

use modifier -99

question

All services or procedures coded must be:

answer

preformed by the physician who is billing the patient, & documented in the patients chart.

question

Codes to be reported for each day's services are ranked in the order of:

answer

highest to lowest reimbursment rate.

question

The anesthesia section of the code book can be found direstly before the:

answer

surgery section

question

Anesthesia is reimbursed according to the:

answer

time under anesthesia

question

a bundled code refers to a:

answer

group of related procedures covered by a single code.

question

THe usual services of an anesthesiologist include the following:

answer

monitoring the patient post surgery recovery from anesthesia,routine preoperative visits to evaluate the patient for planned anesthesia, & administration of fluids during the period of the anesthesia care.

question

The subsections under anesthesia in the CPt coding book are organized by:

answer

types of surgery or procedure.

question

The physical status modifier P1 refers to a:

answer

normal, healthy person

question

THe add on code used to identify that a patient is younger than 1 year old & is receiving anesthesia is:

answer

+99100

question

The largest section of the CPT coding book is:

answer

surgery

question

The subsection of the surgery section of the CPT code book is broken down by:

answer

body system

question

The body systems listed as subsections under surgery in the CPT code book include:

answer

intergumentary system, male genital system, & maternity care & delivery.

question

Types of surgical procedures can be described as:

answer

excisions, removal, & incisions

question

a closed manipulation or repair of a fraction is considered:

answer

surgery

question

Add-on codes describe procedures/services that are preformed:

answer

in addition to the primary procedure.

question

Procedures that represent the total procedure that was preformed are reported by using a(n)

answer

stand alone code

question

Examples of when add-on codes would be used:

answer

complicated closure of a second wound, anesthesia of a patient more than 70 years of age, & a biopsy of a second or third lesion.

question

Codes identified by the symbol of a circle with a back slash through it are:

answer

exeempt from modifier -51

question

A surgicial package would include:

answer

one evaluation & management encounter on thew date immediately prior to the date of the procedure.

question

The Globial surgicial period is typically between:

answer

0-90 days

question

Globial surgical packages are determined by:

answer

each individual third party payer.

question

A service not included in the surgical package code would be:

answer

complications or the presence of other diseases requiring additional services.

question

With respest to the global surgical package guidelines, surgical supplies are:

answer

billed seperately only if they are over & above those usually included.

question

In coding radiology services, the part of the procedure that reflects the technologist & the equipment is the:

answer

technical compenet

question

The term Sepervision & interpretation(S&I) mean that the radiology code is only for the:

answer

professional componet

question

The collection of specimens via venipuncture is coded as a:

answer

surgical procedure

question

Under pathology & laboratory codes, a panel is coded when:

answer

all of the listed test are preformed without substitution

question

If a physician's office collects blood sample & sends it to an outside lab, the physician:

answer

can bill for obtaining the sample.

question

To bill for the services of a physical therapist, CPT codes would be found in the:

answer

Medicine section

question

To code for immunizations, the medical office assistant should use:

answer

one code for for the administration & one code for the vaccine

question

To bill for an audiologist, CPT codes would be found in the :

answer

Medicine section

question

CPT codes for administering vaccines or immunization can be found in the:

answer

Medicine section

question

The CPT code 99024 used to identify a postoperative follow up visit included in the surgical package would be found in the :

answer

medicine section

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