Comprehensive Medical Coding Exam 1 Review
The ____ convention identifies nonessential modifiers that describe the default variations of a term.
( ) Parenthesis
When a healthcare provider is overpaid by Medicare, what should they do?
-Return the payment -Report the over payment to Medicare.
A mid-level job allows coders to:
-expand their skills. -take on more responsibility. -learn new specialties.
The three major sources of private health insurance are?
-group health plans -self insured plans -individual plans
A medical record....
-reports past and present illnesses. -is a comprehensive collection of all information about a patient by a particular provider. -provides a chronological record of the patient's care.
How many alphanumeric characters does each ICD-10-PCS code have?
7
Third-party payers are entities other than the physician or patient who pay for healthcare services.What percentage of healthcare services in the US is paid by third-party payers?
87%
The ____ convention appears after the code number and tells the coder to assign additional characters.
: (colon)
Which coding steps means to read the medical record and determine which elements of the encounter require codes?
Abstracting
What is mistakenly accepting payment for items or services that should not be paid for by Medicare?
Abuse
What is the final step in diagnosis coding when there is more than one diagnosis?
Arrange or sequence the codes in the correct order.
Which of the following things should a coder do when coding an encounter?
Assign codes based on the documentation in the chart.
Which task is the responsibility of coders?
Assign diagnostic and procedure codes for patient encounters after an encounter is completed.
When should the provider verify eligibility with the insurance company?
Before the encounter.
What is the name of a contiguous range of codes within a chapter in ICD-1O-CM?
Block
Which of the following coding certifications is NOT offered by either AAPC or AHIMA?
CBCS
Which code set is used to report dental procedures?
CDT
The ____ convention instructs the coder to sequence the etiology first.
Code First
Which of the following statements about a key rule for abstracting outpatient diagnoses is FALSE?
Code conditions that are cured.
Documentation of current and past medication, along with any medication allergies, is important to the patient's care. What should coders do with this information?
Code the long-term use of specific medications.
What programs include seven major characteristics and are intended to reduce fraud, abuse, and waste?
Compliance
What type of program does the Patient Protection and Affordable Care Act (PPACA) mandate for providers who contact with Medicare, Medicaid, and CHIP?
Compliance
What is the term for the use of symbols, typeface, and layout features to succinctly convey interpretive information?
Conventions
What is the prospective payment method used by Medicare to reimburse inpatient hospitals?
DRG
Which position is an example of an entry-level job?
Data entry clerk
The Office of the Inspector General (OIG) is a division of the:
Department of Health and Human Services.
What should the coder do when there are diagnoses that relate to an earlier episode of care but have no bearing on the current (inpatient) hospital stay?
Do not code the diagnoses.
Who regulates med pay or personal injury protection from automobile insurance policies?
Each state's Department of Insurance
What or who determines which certification is needed for a specific job?
Employers
What type of software allows coders to input key words, such as the Main Term, and access hot links to potential codes?
Encoder
What term describes a specific interaction between a patient and healthcare provider?
Encounter
What kind of job do most coders seek upon graduation in order to gain basic skills, become familiar with the healthcare field, and establish excellent work habits?
Entry level
The ____ convention identifies mutually exclusive codes that should not be used together.
Excludes 1
The ____ convention indicates that the condition excluded is not part of the condition represented by the code, but the patient may have both conditions at the same time.
Excludes 2
Codes in square brackets [ ] should always be sequenced first.
False
The FIRST step in assigning ICD-10-CM diagnosis codes is to search the Tabular List by the condition.
False
The Main Term is always the anatomical site, such as lung, heart, etc.
False
The conventions NOS and NEC are used interchangeably.
False
What term means knowingly submitting a bill to a government healthcare program, such as Medicare, that contains incorrect codes?
False Claim
What is the health status of immediate family members, causes of death (if known), and diseases common in the family?
Family history
What is the name for the diagnosis, in the outpatient setting, that describes the diagnosis, condition, problem, or other reason for the encounter shown in the medical record to be chiefly responsible for the services provided?
First-listed
What is knowingly billing for services that were never given or billing for a service that has a higher reimbursement than the service provided?
Fraud
HCPCS stands for:
Healthcare Common Procedure Coding System
Which service is an example of an inpatient encounter?
Hospital admission
Which of the following type of healthcare employees will NOT use codes as part of their jobs?
Human Resource generalists
E16.8 is an example of the code format for which HIPAA-mandated code set?
ICD-10-CM
What code set is used for diagnosis coding?
ICD-10-CM
What code set is used for hospital inpatient procedure coding?
ICD-10-PCS
Who does the RAC program use to identify Medicare over payments and underpayments to healthcare providers and suppliers?
Independent contractors
Which method of posting job openings makes them available only to current employees for a period of time before they are advertised to the public?
Internally
ICD-10-PCS stands for:
International Classification of Diseases, 10th Revision Procedure Coding System
Which of the following is TRUE about Medicare Part D?
It is also known as "prescription drug coverage."
Which of the following is NOT true about the surgical history?
It is unimportant to the patient's current condition in most instances.
The FCA was passed during the Civil War for what reasons?
It was intended to combat widespread fraud when contractors sold the government faulty rifles, ammunition, rotten food, and sick horses.
Which OGCR topic defines separate codes for the right and left sides of the body?
Laterality
The social history is an integral part of a patient's health record and can provide information that could potentially be coded. Which of the following information should be coded?
Lifestyle habits.
When the first listed diagnosis is unclear, what should the coder do when sequencing additional diagnoses?
List the additional diagnoses in order of importance to the encounter.
Which type of condition can qualify a patient for a higher-paying DRG?
MCC
Which of the following is TRUE about managed care plans?
Managed care plans seek to achieve better outcomes while controlling the cost of healthcare.
What program is funded jointly by the federal and state governments?
Medicaid
What is an example of the medical necessity criterion evidence-based practice?
Medications proven to benefit patients based on scientific studies.
What is Medicare supplement insurance policy sold by private insurance companies to fill gaps in Part A and Part B coverage?
Medigap
What organization maintains and updates the UB-04?
NUBC
What are the rules that complement the conventions and instructional notes to provide additional information and direction in identifying the diagnosis to be reported?
OGCR
Who investigates fraud, abuse, and other noncompliance matters in the Medicare and Medicaid programs?
OIG
When was ICD-10-CM implemented?
October 1, 2015
What is Medicare's hospital insurance that covers a specific list of services for inpatient hospital care, skilled nursing facilities, hospice, and home healthcare?
Part A
What is the name for the diagnosis, in an inpatient setting, that is condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care?
Principal
The _____ is a statement that lists all the services the provider billed, which ones were accepted for payment, how much the insurance company will pay, how much the patient owes, and how much will not be paid.
RA
What method does Medicare use to establish physician reimbursement rates?
RBRVS
Payers are allowed to do which of the following in order to process a claim for payment?
Request additional information to verify whether or not the service is covered.
Prior to assigning a default code, the coder should do which of the following?
Review all subterms and locate a more specific code if available.
Which section of the OGCR contains the most commonly used conventions?
Section 1.A.
The ____ convention instructs the coder to reference another Main Term or condition to locate the correct code.
See
What is health insurance coverage for family members of active duty personnel and for retired military personnel and their families?
TC
Which of the following is NOT true about the OGCR?
They are always published on October 1st of each year, just like the updated coding manual.
The Main Term is the name of the condition or reason for the visit, usually presented as a noun in the ICD-10-CM Index to Diseases and Injuries.
True
When a coder encounters a "Use additional code" note, the coder should NOT assign a code from the list unless it is documented in the record.
True
What type of diagnosis are preceded by the words probable, possible, suspected, questionable, rule out, working diagnosis, or a similar word?
Uncertain
Which of the following statements about a key rule for abstracting inpatient diagnoses is FALSE?
Uncertain diagnoses should never be coded.
The ____ convention instructs the coder to sequence the manifestation second.
Use Additional Code
Typically, which of the following is NOT a reason claims for payment may be suspended?
When the claim manager has a hunch, something is inaccurate.
When should signs and symptoms be coded in the inpatient setting?
When they are relevant to the current admission and are not integral to the confirmed diagnosis.
The ____ convention means that one condition is associated with or due to the other.
With
The ____ convention is a placeholder in codes with less than six characters that require a seventh character.
X
The ____ convention is used in the Index to identify a code that should be sequenced second.
[ ]
The three skills of an "ace" coder are to ____ information from the medical record, ____ the accurate code, and ____ the codes in proper order.
abstract, assign, arrange
Surgical encounters that do not require an overnight inpatient stay in the hospital are known as:
ambulatory surgery
What services include laboratory, radiology, or physical therapy?
ancillary
Which of the following is NOT one of an "ace" coder's skills?
appraising
The _____ physician oversees and coordinates all aspects of the patient's care.
attending
The physician usually treats a patient throughout the patient's stay at an inpatient facility is known as the:
attending physician.
Within in the ICD-10-CM chapters, a contiguous range of codes within a chapter is known as a:
block.
A _____ is the progression of jobs and responsibilities throughout one's working life.
career path
What are health plans, healthcare clearinghouses, and healthcare providers who electronically transmit any health information in connection with transactions for which the Department of Health and Human Services (HHS) has adopted standards.
covered entities
A code listed next to the Main Term in the ICD-10-CM Index is referred to as a:
default code.
What codes describe patient illnesses, diseases, conditions, injuries, or other reasons for seeking healthcare services?
diagnosis
Which type of codes describes pt illnesses, diseases, conditions, injuries, and other reasons for seeking healthcare services?
diagnosis
When the following provider documents that a patient has both an acute and chronic form of the same condition, the sequencing is determined by:
how the Index presents the acute and chronic conditions.
The Qui Tam provision of the False Claims Act:
includes financial rewards to whistleblowers that turn in violators.
A/an _____ encounter is a physician interaction with a patient who has been formally admitted to a healthcare facility, such as an acute care hospital, long-term care facility, or rehabilitation facility.
inpatient
When processing claims, excellent documentation in a patient's paper or electronic health record can do all of the following EXCEPT:
insure the patient will not file a medical malpractice suit.
The United States National Center for Health Statistics (NCHS) adapted and expanded ICD-10 to focus on_____ in the United States.
morbidity
An eponym is:
named after a person.
When a payment of service is denied by the insurance company, an accounts receivable specialist:
needs to investigate the situation.
Workers' compensation programs are:
not subject to HIPAA regulations.
A/an _____ encounter is a physician interaction with a patient who has not been formally admitted to a healthcare institution, such as an acute care hospital, long-term facility, or rehabilitation facility.
outpatient
Dr. Lorenzo asks his patient, Bella, questions about the pain she is currently experience in relation to the security level, what makes it worse or better, and if she's experienced this pain before. This is an example of:
performing a medical history.
The _____ plan may include medication, surgery, lifestyle changes, or therapy.
procedure
A _____ is a written communication asking for clarification and/ or additional details.
query
The chief complaint is defined as?
the cause of the patient's current symptoms.
A coding problem that could cause a rejected or denied claim is:
the code has too many or too few characters.
Official coding guidelines require proper sequencing of diagnosis and procedure codes. The sequencing depends on:
the codes assigned and the circumstances of the encounter.
Patients who have injuries or health problems that cannot be delaying without harming the patient are usually treated at:
the emergency department.
When there is a "Code first" note and an underlying condition is present:
the underlying condition should be sequenced first.
Once Medicare publishes a final rule....
their stance is that providers should know about it and follow it.
Verifying a code in the Tabular List is essential for all the following reasons EXCEPT
there is no need to verify codes in the Tabular List.
The life cycle of an insurance claim begins:
when the patient contacts the physician to make an appointment.
Case production standards are based on all of the following EXCEPT
which encoder is being utilized.
