The first step in the reimbursement process of healthcare claims is:
reading & understanding the physician's documentation.
Diagnosis codes submitted on insurance claim forms are generally used to:
.determine benefit coverage.
ICD-9 codes are used by outside agencies to:
conduct studies of trends in diseases, review cost. forecast healthcare needs.
The London Bills of Mortality were first introduced mainly to:
warn about the plague epidemics.
The first form of medical diagnostics coding date back to :
In 1948 the ICD came under the direction of the:
World Health Organazation (WHO)
ICD information was used by the WHO for all of the following:
make statistical assessments of the international health, track morbidity, assist in tracking mortality.
As of 1948, the ICD became known as the:
International Classification of Diseases
The clinical modification of the ICD-9 was developed by the:
National center for Health Statistics
As part of the Medicare Catastrophic Coverage Act of 1988, providers were required to:
use ICD-9-CM codes to document conditions.
ICD-9-Cm coding serves the following purposes:
It establishes medical necessity, it translates written terminology into unerversal, common language, it provides data for statistical analysis.
The clinical modificationof the ICD-9 allowed data to be used for all of the following.
conducting epidemiological, and clinical research, compling & conparing healthcare data, assisting in the planning healthcare delivery system.
Diagnostic coding changes for Volumes 1 & 2 of the ICD-9-Cm are made:
Annually on October 1
Revisions to Volume 3 are made by:
the centers for medicare & medicaid services
Updates to Volume 1 & 2 of the ICD-9-CM may include:
additions of new codes, deletion of old codes, revisions to the descriptors.
The ICD-10-CM uses codes that are:
Improvements in the ICD-10-Cm include:
the addition of information relevant to managed care encounters, a reduction in the # of codes needed to be fully describe a condition.
The # of chaacters in a code from the ICD-10-CM is:
Volume 1 of the ICD-9-CM is known as the:
Tabular & numeric list of Diseases.
Volume 2 of the ICD-9-CM is known as the:
alphabetic Index of diseases.
Volume 3 Of the ICD-9-CM is known as the:
Tabular & alphabetic Index of procedures
Volume 3 of the ICD-9-CM is used by the:
hospitals to code procedures
The chapters in the tabular list diseases are grouped by:
body system affected by condition
To report external causes of injury & poisoning, a coder should use:
Appendices included in the tabular list diseases include all of the following:
morphology of neoplasms, list of 3 digit categories, classification of the industrial accidents according to agency.
Tables found in volume 2 of the ICD-9-Cm include all of the following:
hypertension, drugs & chemicals, & neoplasms
External causes of poisoning include all of the following categories:
assault, suicide attempt, & therapeutic use.
When the physician determines the patients main reason for the encounter, the impression is reffered to as the:
Subterms in an ICD-9-Cm entry may show:
the cause or orgin of the disease.
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:
aid the coder in finding the correct term, can be in parentheses, & brackets.
The folowing are true carryover lines in an ICD-9-Cm entry:
they list anorther name for the condition or disease.
An example of a eponym
When coding acute serous otitis media using Volume 2 of the ICD-9-CM, the main term a coder would look up is:
When coding a pregancy test with a positive results using volume 2 of ICD-9-CM, the main term you would look up is:
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:
Not elsewhere classified (NEC) is used when the:
coder lacks the information necessary to code the term more specifically.
Volume 1 should be referred to by a coder:
after the condition has been located in volume 2
Square brackets are used in volume 1 of the ICD-9-CM to enclose:
Instructional notes are used in volume 1 of the ICD-9-CM to:
provide 5th digits information, define terms, & provide coding instructions.
The first step that should be followed in order to obtain the accurate, most-specific code is:
determine the reason for the encounter.
KEy coding guidelines that apply to ICD-9-CM coding are:
coding to the hoghest level of certainty & specificity.
If the physician cannot determine the diagnosis at the time of the encounter, the medical office specialist should:
code the symptoms, signs, or reason for the encounter.
If a patient presents with no complaints of illness or injury, the medical office specilist should:
use V code
In coding residual effects, amedical office specialist should:
code the late effect followed by the cause of the late effect.
Major categories of E codes include all of the following:
accidential falls, assaults or purposely inflicted injury, & late effects of accidents or self injury.
Malignant neoplasms are classified as:
primary, secondary, or carcinoma in situ.
Hypertension is classified in the hypertension table as:
benign, malignant, or unspecified only.
Coding burns are based on:
the degree of severity of the burn, the location of the burn, the precentage of the total body burned.
Type 1 diabetes mellitus indicates that the:
patient is insulin-dependent
The rule of nine is used by the medical office specialist in coding to:
estimate the body surface are involved in a burn.
The Current Procedural Terminology (CPT) is published by:
American Medical Association(AMA)
The current CPT system uses codes with:
CPT codes are implemented each year on:
The codes that describe a procedure or service with a five digit numeric code & descriptor are:
Category 1 CPT codes
The temporary codes used for emerging technology, services, or procedures are:
Category 111 CPT codes
The Health Portability & Accountability Act(HIPPA) supports the:
elimination of Category lll CPT codes
CPT Category ll codes are used principally:
for measuring performance
How are the 8 sections of the CPT code book divided?
6 sections Category l, 1 section Category ll, & 1 section Category lll.
All of the following are sections of the Category l CPT codes:
Evaluation & Management, Surgery, & Medicine.
The first section of the CPT code book is:
Evaluation & Management(99201-99499)
The symbol + used with a CPT code indicates:
The symbol a solid triangle used with a CPT code indicates:
a revised code
In order to report that a description of a service or procedure has been altered in someway, the medical office specialist should use:
The modifier 21 is used to indicate:
prolonged evaluation and management(E/M) service
The modifier 52 is used to indicate:
The modifier 25 is used to indicate:
significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service.
The modifier 57 is used to indicate:
a decision for surgery
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:
The most often reported evaluation & management services are:
office & other out patient services.
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:
The transferof the total care of a patient from one physician to another is called:
When a second physician examines a patient and renders an opinion, the service is referred to as a:
Componets that define the level of evaluation& management service include all of the following:
the complexity of the medical decision making documented, time, & the extent of the history documented.
In order to code for an evaluation & management service, the following are elements that must be documented:
History, Exam, & medical decision making.
Counseling with a patient or family can be considered in coding an evaluation & management service if it pertains to:
prognosis, risks & benefits of treatment options, & diagnosis results
The review of systems(ROS) is considered part of:
The history of the patient.
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:
minimal in nature
The classes of main entries found in the CPT index include all of the following:
organs, or other anatomic site, synonyms, eponyms, abbreviations, & conditions.
If only one code for a procedure or service occurs in the index, the user should:
Verify the code in the main text of the CPT book.
Example of procedures or services include all of the following
osteopathic manipulation, evaluation & management, & arthroscopy
In the CPT index, all topics referring to CPT code sections or Chapter headings are listed in:
bold uppercase letters
If 2 codes apply to an entry in the CPT index, the codes are seperated by a:
The first code that appears left justified in a series of codes is called the:
The proper use of CPT modifiers can result in:
The modifier used to report a bilateral procedure is:
Modifier-47 is used to report:
anesthesia by a surgeon
A special Report submitted with a claim can be used to;
detail the reason for the variable procedure
Modifier -51 can be used in the following applications:
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.
The modifier used to identify a procedure that is discontinued is:
When one physician provides surgical care only & does not provide the preoperative and/or postoperative management, the coder should use modifier:
When 2 or more modifiersare necessary to completely define a service, the medical office assistant should:
use modifier -99
All services or procedures coded must be:
preformed by the physician who is billing the patient, & documented in the patients chart.
Codes to be reported for each day's services are ranked in the order of:
highest to lowest reimbursment rate.
The anesthesia section of the code book can be found direstly before the:
Anesthesia is reimbursed according to the:
time under anesthesia
a bundled code refers to a:
group of related procedures covered by a single code.
THe usual services of an anesthesiologist include the following:
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.
The subsections under anesthesia in the CPt coding book are organized by:
types of surgery or procedure.
The physical status modifier P1 refers to a:
normal, healthy person
THe add on code used to identify that a patient is younger than 1 year old & is receiving anesthesia is:
The largest section of the CPT coding book is:
The subsection of the surgery section of the CPT code book is broken down by:
The body systems listed as subsections under surgery in the CPT code book include:
intergumentary system, male genital system, & maternity care & delivery.
Types of surgical procedures can be described as:
excisions, removal, & incisions
a closed manipulation or repair of a fraction is considered:
Add-on codes describe procedures/services that are preformed:
in addition to the primary procedure.
Procedures that represent the total procedure that was preformed are reported by using a(n)
stand alone code
Examples of when add-on codes would be used:
complicated closure of a second wound, anesthesia of a patient more than 70 years of age, & a biopsy of a second or third lesion.
Codes identified by the symbol of a circle with a back slash through it are:
exeempt from modifier -51
A surgicial package would include:
one evaluation & management encounter on thew date immediately prior to the date of the procedure.
The Globial surgicial period is typically between:
Globial surgical packages are determined by:
each individual third party payer.
A service not included in the surgical package code would be:
complications or the presence of other diseases requiring additional services.
With respest to the global surgical package guidelines, surgical supplies are:
billed seperately only if they are over & above those usually included.
In coding radiology services, the part of the procedure that reflects the technologist & the equipment is the:
The term Sepervision & interpretation(S&I) mean that the radiology code is only for the:
The collection of specimens via venipuncture is coded as a:
Under pathology & laboratory codes, a panel is coded when:
all of the listed test are preformed without substitution
If a physician's office collects blood sample & sends it to an outside lab, the physician:
can bill for obtaining the sample.
To bill for the services of a physical therapist, CPT codes would be found in the:
To code for immunizations, the medical office assistant should use:
one code for for the administration & one code for the vaccine
To bill for an audiologist, CPT codes would be found in the :
CPT codes for administering vaccines or immunization can be found in the:
The CPT code 99024 used to identify a postoperative follow up visit included in the surgical package would be found in the :