Medical Billing/Coding 2022

According to the filing guidelines, providers must file claims for their Medicare patients within _____ months of the date of service.

12

For co-surgeons, Medicare pays the lesser of the actual charge or _____ % of the global fee, dividing the payment equally between two surgeons.

125

Medicare publishes the Medicare fee schedule and usually pays what percentage of the amounts indicated for services?

80%

The most major change to the health care industry as a result of HIPAA was a result of what portion of the act?

Administrative Simplification

To what government organization did the Secretary of the Department of Health and Human Services delegate the responsibility for administering the Medicare program?

CMS (Centers for Medicare and Medicaid Services)

The transfer of electronic documentation is accomplished through the use of

Electronic Data

A hydatidiform mole is a tumor that only forms in the uterus. T/F

False

A late effect usually occurs within 1 month of the illness or injury. T/F

False

A patient with primary lung cancer with metastasis to the spine presents for radiation treatment of the spine. The first-listed diagnosis reported is the primary lung cancer.

False

An example of a late effect is hemorrhage after a surgery requiring a return to the operating room. T/F

False

Chapter 12, Diseases of the Skin and Subcutaneous Tissue, describes diseases or conditions of the integumentary and musculoskeletal systems. T/F

False

Chapter 13 of the ICD-10-CM Guidelines for Coding and Reporting indicates the 7th character D is assigned as long as the patient is receiving active treatment for a fracture. T/F

False

Chapter 15 codes are never reported on the mother's record. T/F

False

Cholelithiasis with chronic cholecystitis without obstruction (K80.10) is an example of a dual code. T/F

False

Epiphora is a blockage of the lacrimal passage. T/F

False

External Cause codes are located in the Alphabetic Index for Diseases under External Causes. T/F

False

For patients receiving preoperative evaluations, sequence first a code from the subcategory Z01.81, Encounter for preprocedural examinations, followed by findings related to the preoperative evaluation. T/F

False

ICD-10-CM contains combination codes that identify only definitive diagnoses. T/F

False

If a patient has confirmed diagnosis, the signs and symptoms related to that condition should also be reported. T/F

False

In diabetic retinopathy, the retinopathy is the etiology and the diabetes is the manifestation. T/F

False

In the outpatient setting, it is correct to report a "probable" condition as if it exists, such as probable appendicitis as appendicitis. T/F

False

Methicillin-resistant Streptococcus aureus is also referred to as MRSA. T/F

False

Multiple fractures are sequenced in accordance to the location of the fracture. T/F

False

Report all conditions that coexist, even if they are not addressed or do not affect management/treatment during that encounter. T/F

False

SIRS is the diagnosis when all of the following are diagnosed: hypothermia or fever, tachycardia, tachypnea, increased or decreased white blood count. T/F

False

Section II of the ICD-10-CM Official Guidelines for Coding and Reporting includes instructions on outpatient coding and reporting. T/F

False

Section IV Diagnostic Coding and Reporting Guidelines for Outpatient Services take precedence over the general and disease-specific guidelines. T/F

False

The External Cause codes can be reported as a first-listed diagnosis. T/F

False

The codes are A00 through Z99 are always reported as first-listed diagnoses. T/F

False

The cooperating parties for the development and approval of the Official Guidelines for Coding and Reporting are CMS, AMA, and NCHS. T/F

False

The outcome of delivery is reported only on the newborn's record. T/F

False

To report a hemorrhage, active bleeding must be present. T/F

False

When a patient is admitted to observation for a complication following outpatient surgery, report the complication as the first-listed diagnosis. T/F

False

When a patient presents for outpatient surgery and the surgery is cancelled, report the reason why the surgery was cancelled as the first listed diagnosis. T/F

False

When reporting hypertensive chronic kidney disease, an additional code to report the type of chronic kidney disease is not required. T/F

False

When sequencing codes for residuals and late effects, the late effect code is sequenced first followed by a code describing the residual condition. T/F

False

You may report a code from the Index, without verifying in the Tabular when there is no indication that the code requires additional characters. T/F

False

Within an HMO, there is usually an individual who as been assigned to monitor the services provided to the patient both inside and outside the facility. This person is known as

Gatekeeper

HIPAA stands for

Health Insurance Portability and Accountability Act

In this model of HMO, the HMO contracts with the physician to provide the service at a set fee. These organizations are known as

Individual Practice Associations

Specific regulations for Medicare are contained in the

Internet Only manual

The _____ do the paperwork for Medicare and are usually insurance companies that have bid for a contract with CMS to handle the Medicare program for a specific area.

MACs or Medicare Administrative Contractors

Medicare Part C is also known as

Medicare Advantage

The number that is assigned to all providers as a result of HIPAA:

National Provider

Can a physician charge a patient to complete a Medicare form?

No

What editions of the Federal Register would the outpatient facilities be interested in?

November, December

Under what act was a major change in Medicare in 1989 made possible?

OBRA (Omnibus Budget Reconciliation Act)

An all-inclusive care program for the elderly that provides a comprehensive package of services that permits the client to continue to live at home is known as _____________

Program for All-Inclusive Care for the Elderly (PACE)`

The three components of work, overhead (practice expense), and malpractice are part of an RVU. What do the initials RVU stand for?

Relative Value Unit

What government organization handles the funds for the Medicare program?

Social Security Administration

In this model of HMO, the HMO directly employs the physicians

Staff Model

A Q-Wave or transmural myocardial infarction, also known as STEMI, is the most severe type of infarction. T/F

True

A code is invalid if it has not been reported to the full number of characters available, including the 7th character, if applicable. T/F

True

A dash (-) at the end of an Index entry indicates that an additional character or characters is/are required. T/F

True

Always begin the search for the correct code assignment in the Alphabetic Index. T/F

True

An "Uncertain" neoplasm is one that is not clearly benign or malignant. T/F

True

Code range M00-M02 reports infectious arthropathies due to infections that are direct or indirect. T/F

True

Codes from Chapter 17, Congenital Anomalies, can be reported any time during a person's life, as appropriate. T/F

True

Conditions affecting the nails, sweat glands, and hair are located in Chapter 12. T/F

True

Diabetes mellitus codes are combination codes that include the type of diabetes as well as the body system involved and complications affecting the body system. T/F

True

Diagnosis codes are always reported to the highest number of characters available. T/F

True

For hemiplegia and hemiparesis and other paralytic syndromes, report the right side as dominant if the documentation does not specify which side is dominant. T/F

True

For patients receiving diagnostic services only during an encounter/visit, sequence first the reason for the encounter/visit indicated in the medical record. T/F

True

For reporting purposes, urosepsis is not considered sepsis. T/F

True

Heart transplant status code Z94.1 should not be reported with a code from subcategory T86.2, Complications of heart transplant. T/F

True

Hepatitis A was formerly known as infectious or epidemic hepatitis. T/F

True

If a patient is admitted with pneumonia and while hospitalized develops severe sepsis, you would report the pneumonia first, followed by severe sepsis. T/F

True

If the medical documentation indicates the patient has two conditions that are both included in one diagnosis code, report that diagnosis code only once. T/F

True

If the same condition is described as both acute and chronic, and separate subentries exist in the Alphabetic Index at the same indentation level, report both codes and sequence the acute code first. T/F

True

In most cases the manifestation codes will have in the code title, "in diseases classified elsewhere." T/F

True

In the ICD-10-CM, pressure ulcers are graded and reported based on the depth of the ulcer. T/F

True

Includes and Excludes notes are only listed in the Tabular of the ICD-10-CM. T/F

True

Multiple coding is when it takes more than one code to fully describe the condition, circumstance, or manifestation. T/F

True

Only confirmed cases of Covid-19 can be reported. T/F

True

Routine prenatal outpatient visits for high-risk patients are reported with a first-listed diagnosis from category O09, Supervision of high-risk pregnancy. T/F

True

Septic shock is considered organ failure. T/F

True

The "Code First" note directs the coder to report first the underlying disease. T/F

True

The aftercare Z codes should not be reported for aftercare of injuries. T/F

True

The categories in Chapter 11, Diseases of the Digestive System, begin when food enters the mouth and continue to when it leaves the body through the anus. T/F

True

The first-listed diagnosis for a routine outpatient prenatal visit is a code from category Z34, Encounter for supervision of normal pregnancy. T/F

True

The third trimester is considered 28 weeks 0 days from the first day of LMP until delivery occurs. T/F

True

The two types of indirect infestations are reactive and postinfective arthropathy. T/F

True

Viral hepatitis codes are divided based on the type of hepatitis and if the condition is with or without hepatic coma. T/F

True

When a final diagnosis has not been established by the provider, it is acceptable to report codes for the presenting signs and symptoms. T/F

True

When an encounter is for treatment of anemia due to a malignancy, the first-listed diagnosis would be the malignancy, followed by the anemia. T/F

True

When coding the birth episode in a newborn record, assign a code from Category Z38, Liveborn infants, according to place of birth and type of delivery, as the first-listed diagnosis. T/F

True

When reporting an infection, other than Staphylococcus aureus, that is antibiotic resistant, report the infection first followed by a code from category Z16, Infection with drug resistant microorganisms. T/F

True

When the histological type of neoplasm is documented, reference the Alphabetic Index first rather than going immediately to the Neoplasm Table. T/F

True

When there is an encounter for a complication and no delivery occurred, report the complication as the first-listed condition. T/F

True

Z codes may be reported as a principal diagnosis in the hospital setting. T/F

True

Combination coding is when one code fully describes the conditions and/or manifestations. T/F

True; multiple coding is when it takes more than one code to fully describe the condition, circumstance, or manifestation, and then sequencing of multiple codes is considered

What two groups of persons were added to those eligible for Medicare benefits after the initial establishment of the Medicare program?

a. persons eligible for disability benefits from Social Security b. persons with permanent kidney failure requiring dialysis or transplant

Individuals covered under Medicare are termed _____.

beneficiaries

List two common symptoms associated with acute myocardial infarction.

chest discomfort that builds, discomfort in upper body, shortness of breath, breaking out in cold sweat, feeling dizzy, light-headed or nauseated, belching, vomiting

There are three items that Medicare beneficiaries are responsible for paying before Medicare will begin to pay for services. What are these three items?

deductibles, premiums, and coinsurance

List two common symptoms associated with gastroesophageal reflux.

heartburn, acid regurgitation, belching, hoarseness in the morning, reflux, pain in chest, trouble swallowing, choking feeling, dry cough

The _____ charge historically was specific for each physician, but in 1993, the charge for a service was the same for all physicians within a locality, regardless of specialty.

limiting

List two common symptoms associated with seasonal allergies.

sneezing, runny nose, stuffy nose, watery, itchy eyes, itchy sinuses, throat, or ear canals, ear congestion, postnasal drainage

List two symptoms of a broke nose.

swelling, pain, discoloration, disfiguration

Under the Relative Value Unit system, _____ values are assigned to each service and are determined on the basis of the resources necessary to the physician's performance of the service.

unit