Medical Coding and Claims

The minimal Evaluation and Management CPT level of care is called:

problem focused

V codes found in the ICD-9-CM codes identify health care encounters for:

reasons other than illness or injury.

The largest section in the CPT codes is:

surgery

The new edition of the ICD-CM codes for adoption in the United States is the:

tenth

Coding for an Evaluation and Management office visit involves five components.

three major components are, examination, problem severity, and medical decision making. the two contributory are the coordination of care and time.

The ICD9 : CM codes in use in the United States generally contain:

three to five numeric digits with a decimal after the third.

The process of using several CPT codes to identify procedures normally covered by a single code is referred to as:

unbundling

The fraudulent practice of deliberately using an incorrect code to bill at a higher rate is called:

upcoding

An example of a modifier in CPT coding is:

-E1 upper left eye

The universal health care insurance form currently in use in the United States is called the:

CMS 1500 form

A supplementary classification of ICD-9 coding that denotes the external cause of an injury or poisoning rather than a disease is referred to as a(n):

E-code

Which code would you use on an insurance claim for a patient who received an external injury in order to explain the mechanism of the injury?

E-code

The final appeal for a disputed CMS claim is referred to as:

Federal court review

CMS (formerly HCFA) developed additional codes for use when specific services, materials, drugs, and procedures are not listed in the CPT codebook. These are known as:

HCPCS

The CPT codes are located in the:

HCPCS Level 1

The current edition of the ICD-CM codes used in the United States is the:

Ninth Revision

The primary coding manual for procedures and services performed by doctors and medical personnel is commonly called:

current procedural terminology (CPT)

ICD-9 coding that identifies health care encounters for reasons other than illness are called:

V-codes

The term used when a pathologic reaction to a drug occurs when appropriate doses are given is a(n):

adverse effect

All of the following are examples of HCPCS Level II code charges except a(n):

appendectomy

When a primary condition or disease exists and the patient also has a condition that coexists with the primary condition and complicates the treatment of the primary condition, it is referred to as:

comorbidity

When coding medical services, the term used for the level of care that involves multisystems or complex involvement of one organ system is:

comprehensive

Similar services provided to the same patient on the same day by more than one physician is referred to as:

concurrent care

The CPT section used to code services of a referral physician whose opinion or advice assists in the evaluation of the patient's illness or suspected problem is:

consultation

Unnecessary or excessive referrals of patients to other providers and then back to the primary medical office is referred to as:

pin ponging

The most thorough method for identifying a CPT code is to

determine the code from the body of the manual

A person who has received care from the physician or another physician of the same specialty in the same group practice within three years is a(n):

established patient.

The section of CPT codes most commonly used in the medical office is:

evaluation and management ( E& M)

Improperly altering a diagnosis on a medical claim is:

fraud

The abbreviation NEC in medical insurance coding is used:

if the information is unavailable for specific category coding. Not Elsewhere Classified

When a patient has a fractured ankle but then experiences a malunion of the fracture, the malunion diagnosis is referred to as a(n):

late effect

An addition to the initial CPT code that identifies certain circumstances is a(n):

modifier

A person who has not received care from the physician or another physician of the same specialty in the same group practice within three years is a(n):

new pateint

The abbreviation NOS used for insurance coding means:

not otherwise specified

The fraudulent practice of billing for services or supplies not provided is referred to as:

phantom billing

An example of a HCPCS Level II code is a charge for:

pharmaceutical, ambulance services, and materials.