Chapter 47 Exam

Question 1

What does the American Medical Association have to do with coding?

Answer 1

• they are the ones who publish CPT codes

Question 2

What are uses for procedure codes (3)?

Answer 2

• to justify medical services to insurance companies by correlating procedures to diagnosis
• to collect statistics about the outcome and effectiveness of treatment
• to help physicians and hospitals set fees based on the amount of time and skill required to provide a specific service

Question 3

How often are new code books or computer code sets purchased by the medical office?-

Answer 3

Must purchase updated versions of code books/computer files containing all the codes used for insurance billing EVERY YEAR

Question 4

What are modifiers?

Answer 4

-An addition to the procedure code that indicates unusual circumstances related to the procedure, such as more extensive procedure or two procedures performed in the same session

Question 5

What is the format of most CPT codes?

Answer 5

5 character numeric codes

Question 6

What is the Evaluation and Management section of the CPT manual?

Answer 6

• contains codes for office visits provided by primary care practioners and specialists. Cover service oriented parts of medical care.

Question 7

What is it used for?

Answer 7

they are used to attempt to link reimbursement to the completeness of the examination and the amount of skill required to manage the patient’s problem(s).

Question 8

What factors determine the level of service used in this section?

Answer 8

• the extent of the medical history
  
  • the extent of the physical examination
  • the complexity of decision making

Question 9

Problem focused history

Answer 9

addresses chief complaint with a brief history of the illness/problem. Used for a straightforward problem.

Question 10

Expanded problem focused history

Answer 10

addresses chief complaint, brief history of present illness/problem, and review of systems that have to do with chief complaint. Used for more complicated problem or single diagnosis w/more than one body system involved.

Question 11

Detailed history

Answer 11

addresses chief complaint , extended history of present illness, and review of body systems (beyond relating to chief complaint), and family history as it relates to present problem. Used w/ more complicated medical problems or multiple.

Question 12

Comprehensive history

Answer 12

Chief complaint, extended history of present illness, a review of all body systems, complete family history. Used when patient has severe, acute medical condition or serious changes in a long-term condition.

Question 13

Straightforward complexity

Answer 13

minimal diagnosis, minimal complexity, minimal risk of complications

Question 14

Low complexity

Answer 14

limited number of diagnosis, limited complexity, low risk of complications

Question 15

Moderate complexity

Answer 15

multiple diagnoses, moderate complexity, moderate risk of complications

Question 16

High complexity

Answer 16

extensive diagnoses, extensive complexity, high risk of complications

Question 17

What defines an established patient?

Answer 17

-one who has been seen in the previous 3 years

Question 18

What type of anesthesia that does not receive a separate code?

Answer 18

Local anesthesia by infiltration

Question 19

In anesthesia, what do standard modifiers indicate?

Answer 19

Used throughout the CPT code manual

Question 20

What do physical status modifiers indicate?

Answer 20

The patient’s condition at the time the anesthesia was administered

Question 21

In relation to anesthesia, what is included in the code for a surgery?

Answer 21

local or topical anesthesia or a digital nerve block

Question 22

What diagnostic tests are included in the Radiology section of the CPT manual?

Answer 22

• Plain x-ray films
• computed tomography (CT or CAT)
• magnetic resonance imaging (MRI)
• magnetic resonance angiography (MRA)
• standard angiography

Question 23

What is a panel in diagnostic testing?

Answer 23

-a group of laboratory tests, usually ordered together for diagnosis or screening, such as a cardiac panel

Question 24

Which types of specimens can the office charge for collection even if the specimen is sent to a laboratory for testing?

Answer 24

Pathology testing, such as PAP tests or biopsies

Question 25

What does HCPCS stand for?

Answer 25

Healthcare common procedure coding system

Question 26

level II HCPCS codes…..

Answer 26

five-digit alphanumeric coding system and designates specific services and equipment. Primarily used for items/services that do not have level 1 codes.

Question 27

What does ICD-9-CM stand for?

Answer 27

International Classification of Disease, 9th Revision, Clinical Modification

Question 28

What does ICD-10-CM stand for?

Answer 28

International Classification of Disease, 10th Revision, Clinical Modification

Question 29

Why were diagnosis codes originally developed?

Answer 29

Fulfill 4 purposes:
-track disease processes, classify causes of death, collect data for medical research, and evaluate hospital service utilization

Question 30

What does the WHO have to do with ICD codes?

Answer 30

published the first edition of the International Classification of Diseases, which assigned numbers to specific diseases and has revised it several times since 1948

Question 31

What do E and M codes stand for?

Answer 31

-Evaluation and management codes

Question 32

What are V codes?

Answer 32

Codes that begin with the letter V
-Identify factors influencing health status or an encounter with health services when there is no disease or injury, such as to receive an immunization.

Question 33

when are v codes used?

Answer 33

Used primarily for physical exams, well baby and well-child visits, and visits during pregnancy

Question 34

What does NOS stand for?

Answer 34

not otherwise specified

Question 35

what does NOS mean with respect to codes?

Answer 35

it is used when there is not enough information given to select a more specific code

Question 36

What does NEC stand for?

Answer 36

-not elsewhere classified

Question 37

what does NEC mean in respect to codes?

Answer 37

it is used when a more specific code for the condition is not available

Question 38

what is upcoding?

Answer 38

Using a code to obtain a higher level of reimbursement than is justified by medical procedures performed as documented in the medical record. This can result in serious fines and penalties.

Question 39

what is downcoding?

Answer 39

Codes do not reflect a high enough level of service, resulting in lower levels of reimbursement than are justified