CBCS
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158 terms
Terms | Definitions |
|---|---|
 Capitation | When the healthcare provider is paid a fixed amount |
| Service and Procedure Based | The CPT coding system is |
| 5 Digits (282.60) | An ICD-9-CM sublassification code must have? |
| MM/DD/CCYY | The patients birth date on the CMS-1500 form is entered in which of these formats? |
| Special Report | A service that is rarely provided, unusual, variable, or new may require a __________ in determining medical appropriateness of the service. |
| Indemnity | A type of insurance whereby the insured pays a specific amount per unit of service and the insurer pays the rest of the cost is called |
| Dread Disease Rider | A rider added to a policy to provide additional benefits for certain conditions is called |
| Stipulations | Rules that insurance companies have that service be outpatient or inpatient are called |
| Gastrectomy | Gastric resection |
| Osteitis | Inflammation of a bone |
| Cystoscopy | Visual examination of the urinary bladder |
| Hepatoma | Tumor of the liver |
| Mammary gland | What gland is not an endocrine gland? |
| Iatrogenic | Pertaining to produced by treatment |
| Electroencephalogram | Record of electricity in the brain |
| Diagnosis | Made on the basis of complete knowledge about the patient's condition |
| Cancerous tumor | Carcinoma |
| Biopsy | Microscopic examination of living tissue |
| Cephalic | Pertaining to the largest part of the brain |
| Adenectomy | Removal of a gland |
| Arthralgia | Pain in a joint |
| Leukemia | Increase in numbers of malignant white blood cells |
| Opthalmoscope | Instrument to view the eye |
| Thrombocyte | A platelet |
| Rhinitis | Inflammation of the nose |
| Cytology | Study of cells |
| Transhepatic | Pertaining to through the liver |
| Nephrosis | Abnormal condition of the kidney |
| Osteotomy | Incision of a bone |
| Hyperglycemia | High level of sugar in blood |
| Code of Hammurabi | Earliest written code of ethincal principles for the medical profession |
| The Principles of Medical Ethics | What is the name of the modern code of ethics that the American Medical Association (AMA) adopted in 1980? |
| Waiver | An attachment to an insurance policy that excludes certain illnesses or disabilites that would otherwise be covered is referred to as |
| Name the 6 main sections of CPT code range | Evaluation & Management 99201-99499 Anesthesia 00100-01999 / 99100-99140 (smallest section) Surgery 10021-69990 (largest section) Radiology 70010-79999 Pathology / Laboratory 80048-89356 Medicine 90281-99199 / 99500-99602 |
| Semicolon (;) | These symbols are used so that test does not need to be repeated for an entire range of codes |
| Bullet | This symbol preceding a CPT code means the code is new for that particular year |
| Triangle | This symbol preceding a code means the code has undergone a revision to the description from the previous year |
| Double Arrows (<>) | Used to identify new and revised text |
| A plus sign (+) | indicates an add-on code |
| Circle with a slash through it | Used to identify codes exempt from modifer 51 |
| Bull's Eye | This symbol was added to indicate those procedures in which the provision of moderate sedation services is considered to be inherent and, therefore, not separetly reported by the same physician performing the primary service. |
| Lightning Bolt | This convention was added to highlight products that are awaiting U.S. Food and Drug Administration (FDA) approval |
| 21 | Prolonged evaluation & Management |
| Unusual procedural services | 22 |
| Unusual aneshesia | 23 |
| Unrelated E/M service by the same physician during a post-operative period | 24 |
| Significant, separately identifiable E & M service by the same physician on the day of a procedure | 25 |
| Professional component | 26 |
| Mandated Services | 32 |
| Bilateral procedure | 50 |
| Multiple procedures | 51 |
| Reduced services | 52 |
| Decision for surgery | 57 |
| Staged or related procedure or service by the same physician during the post-operative period | 58 |
| Distinct procedural service | 59 |
| Repeat procedure by the same physician | 76 |
| Return to the operating room for a related procedure during the post-operative period | 78 |
| Unrelated procedure or service by the same physician during the post-operative period | 79 |
| Assistant surgeon | 80 |
| Reference (outside) laboratory | 90 |
| Multiple modifiers | 99 |
| A claims assistance professional | Works for the consumer and helps patients file insurance claims |
| What is the name of the modern code of ethics tha the American Medical Association (AMA) adopted in 1980? | The Principles of Medical Ethics |
| An attchement to an insurance policy that excludes certain illnesses or disabilities that would otherwise be covered is referred to as a | Waiver |
| Mrs. Thompsett leaves her place of employment. She is eligible to transfer her medical insurance coverage from a group to an individual contract. This is known as | Conversion privlege |
| Why would conversion from a group policy to an individual policy be advantageous? | No physician examination required |
| A patient intake sheet is also called a | Patient registration form |
| The first document obtained in the initial patient visit is a | Patient information sheet |
| The source document for insurance claim data is the | Super bill |
| A medical record is considered | medical information and a health record |
| A medical report is a | Permanent legal document and part of the medical record |
| Parts of the small and large intestines, right ovary, right uterine tube, appendix, and right ureter are found in the | Right lower quadrant |
| Preservation of medical records is governed by | State and local law |
| When is the principle diagnosis applicable? | Inpatient hospital coding |
| E codes are used | to show external cuase of injury |
| What is the name of the book used in the physicians office to code procedures? | Current Procedural Terminology (CPT) |
| The term "encounter records" means | Claim |
| Input of data into a computer system requires the use of a | Keyboard |
| Another name for instructions that make the computer perform a specific task is | Software |
| The storage capacity of a computer is measured in | Bytes |
| The smallest unit of storage possible in a computer is the | Bit |
| Back and forth communicaiton between user and computer that occurs during on-line real time is called | Interactive transaction |
| What is the name of the act designed to address the collection practices of third-party debt collectors and attorneys who regularly collect debts for others? | Fair Debt Collection Practices Act |
| America's oldest privately owned, prepaid medical group is the | Ross-Loos Medical Group |
| Kaiser Permanente's medical plan is a closed panel program, which means | It limits the patient's choice of personal physicians |
| When an HMO is paid a fixed amount for each patient serviced without considering the actual number or nature of services provided to each person, this is known as | Capitation |
| How are physicians paid who work for a prepaid group practice model? | Salary paid by independent group |
| The letters preceding the number on the patients Medicare identification card indicate | Railroad retiree |
| Medigap insurance may cover | the deductible not covered under Medicare |
| Under the prospective payment system (PPS), hospitals treating Medicare patients are reimbursed according to | Preestablished rates for each type of illness treated based on diagnosis. |
| The 1987 Omnibus Budget Reconciliation Act (OBRA) established the | MAAC |
| RBRVS was established as a means to | redistribute Medicare dollars among physicians more equitably |
| Organizations handling claims from hospitals, nursing facilities, intermediate care facilities, long-term care facilities, and home health agencies are called | Fiscal intermediaries |
| The Medicaid program was a direct result of | a law passed by Congress in 1950 |
| The medically needy aged | require help in meeting costs of medical care |
| The federal aspects of Medicaid are the responsibility of | CMS |
| The Omnibus Budget Reconciliation Act | Provided assistance for the aged and diabled who are receiving Medicare and whose incomes are below the poverty level. |
| TRICARE, formerly known as CHAMPUS, is funded through | Congress |
| People NOT entitled to benefits under TRICARE are | CHAMPVA beneficiaries |
| What is the system called that TRICARE claims processors use to verify beneficiary eligibility? | TRI-CHECK |
| A physician who chooses not to participate in TRICARE bills | no more than 115% of the Tricare allowable charge. |
| The time limit within which a TRICARE inpatient claim must be filed is within | one year from a patients discharge from an inpatient facility. |
| The statutes for workers compenatjion laws fall under | Federal and state compensation laws |
| When a case is rated for permanent disability and settled, this is called | Compromise and release |
| In a PD (permanent disability) claim, the physicians final report must include the words | Permanent and stationary |
| The code book used to list procedures on outpatient hospital claims is | CPT |
| The form that accompanies the billing claim form for inpatient hospital services is called a | Detail statement |
| A claims assistance professional should promote and market to | Medicare receipients |
| What association maintains and publishes CPT coding guidelines, codes, and descriptions? | AMA |
| What are the three categories of CPT codes? | Category I, II, III |
| What are three methods procedural main terms are listed in the CPT manual alphabetical index? | Condition, synonyms, abbreviations |
| What three components are used to configure Relative Value Units? | Malpractice insurance cost, physician work, practice expense |
| What are the definitions for facility and non-facility RVU expenses for calculating physician fee schedule payment amounts? | Non-Facility includes privately owned physician practices Facility includes skilled nursing facilities, nursing homes, hospitals |
| Which CPT code set is used voluntarily by physicians to report quality patient performance measurements? | CPT Category II Codes. |
| CPT category III codes are reported to indicate which type of service or procedure? | New and emerging |
| Which CPT Appendix lists clinical examples for E/M coding? | Appendix C |
| Neurectomy | Resection of a nerve |
| Pericardium | Membran surrounding the heart |
| What is the correct term used to determine if a procedure is covered and medically necessary | Preauthorization |
| The computer output device is the | Printer |
| The type of memory in which data may be stored and read but not changed is | ROM |
| An ECP is | an individual who converts insurance claims to standardized electronic format and transmits electronic claims data. |
| A computer printout that is used to look for errors before an insurance claim is transmitted electronically is called | an insurance billing worksheet |
| The _______ describes whether specific medical items, services, treatment procedures, or technologies are considered medically necessary under Medicare. | National Coverage Determinations |
| LCDs only have jurisdiction in their ______area. | Regional |
| A covered entity does not include | Patient |
| Arthritis is an inflammation of what? | Joint |
| A procedure that widens a narrowed vessel or obstructed blood vessel is name an | Angioplasty |
| A patient is diagnosed with inflammation of the testis and epididymis. The medical term for this condition is called | Orchiepididymitis |
| Adrenomegaly is defined as | Enlargement of the adrenal gland |
| What is the Rhinne test? | Test that measures hearing using bone conduction and air conduction |
| A sialography is an x-ray of | Salivary glands |
| In an independent practice association (IPA), physicians are | not employees and are not paid salaries |
| A program that offers a combination of HMO-style cost management and PPO-style freedome of choice is a | Point of service (POS) plan |
| The frequency of Pap tests that may be billed for a Medicare patient who is not at risk is | Once every 3 years |
| A state-based group of doctors working under government guidelines reviewing cases for hospital admission and discharge is known as | PRO |
| RVU component consists of a | RVU component, GAF component, and CF component |
| Medical care that is cost-shared by both Tricare Standard and a civilian source is known as | Cooperative care |
| A health care professional usualy a registered nurse who helps the patient work with his or her primary care manager to locate a specialist or obtain a preauthorization for care is referred toas a | HCF |
| The Veterans Health Care Expansion Act of 1973 authorized the | CHAMPVA program |
| RICARE Prime and TRICARE Extra claims are | filed by the provider to a TRICARE subcontractor |
| If a Tricare Extra claim is submitted with several items and several dates of service, the time limit that would apply to the claim for filling would be | Individual time limits for each item on the claim. |
| Cyst/o | Urinary bladder |
| Ped/o | Child |
| Epi | Above |
| Patho | genic |
| Neuralgia | Pain of nerves |
| Ertythrocyte | Blood cell that carries oxygen |
| Nephrectomy | Resection of a kidney |
| Thrombocyte | A platelet |
| Cystoscopy | Process of visual examination of the urinary bladder |
| Gastrotomy | Incision of the stomach |
| The instructions and conventions of the classification take precedence over | Official Coding Guidelines |
| In 1980 the AMA adopted a modern code of ethics called the | The Principles of Medical Ethics |
| FH | Family History |
| SH | Social History |
| ROS | Review of systems |
| R/O | Rule out |
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