Final Review

Question 1

charging for a higher procedure than what was provided

Answer 1

upcode

Question 2

individuals covered under Medicare

Answer 2

beneficiaries

Question 3

who is responsible for the administration of the Federal Medicare program

Answer 3

DHHS

Question 4

who is responsible for collecting and handling funds

Answer 4

Social Security Administration

Question 5

largest third party payer

Answer 5

government through Medicare

Question 6

Part A

Answer 6

Hospital insurance

Question 7

Part B

Answer 7

Supplemental Insurance

Question 8

coinsurance

Answer 8

20% medicare does not pay

Question 9

computerized health record limited to one practice

Answer 9

EMR

Question 10

the entire health record compiled from multiple sources

Answer 10

EHR

Question 11

Where are national changes posted?

Answer 11

Federal Register

Question 12

November/December Federal Register

Answer 12

Outpatient

Question 13

October Federal Register

Answer 13

Hospital

Question 14

Parts of RVU

Answer 14

Work
Overhead
Malpractice

Question 15

practice expense

Answer 15

overhead

Question 16

Amount of time, intensity, and technical expertise

Answer 16

work

Question 17

total RVUs of a service is

Answer 17

sum of the units established for each component of the service

Question 18

national dollar amount that is applied to all services paid on the basis of the Medicare Fee Schedule

Answer 18

conversion factor

Question 19

limiting charge does not apply when

Answer 19

a nonphysician provider performs a technical component of a service that is on the fee schedule

Question 20

percentage over the allowable

Answer 20

limiting charge

Question 21

when do the general multiple-procedures not apply

Answer 21

when a CPT code description states “additional”

Question 22

medicare set s the payment level for assistants-at-surgery at

Answer 22

16% of the fee schedule amount

Question 23

how much of the global fee does medicare pay

Answer 23

125%

Question 24

manages claims payment, oversees fiscal audit and/or overpayment prevention and recovery, and develops and monitors the payment safeguards necessary to detect and respond to payment errors or abusive patterns of service delivery

Answer 24

CMS

Question 25

responsible for developing a work plan that outlines the ways in which the Medicare program is monitored to identify fraud and abuse

Answer 25

DHHS

Question 26

oversees Medicare’s payment safeguard program related to fraud, audit, medical review, collection of overpayments, imposition of civil monetary penalties for certain violations of medicare law (CMPS)

Answer 26

OBI

Question 27

establishes the specific regulations in the Internet-Only Manuals for the providers and carriers to follow

Answer 27

CMS

Question 28

group that is responsible for the health care services offered to an enrolled group or person, coordinates or manages the care of the enroller

Answer 28

MCO

Question 29

primary care physician of the patient

Answer 29

gatekeeper

Question 30

providers who form a network and provide services at a discounted rate

Answer 30

PPO

Question 31

which HMO are enrollees usually responsible for paying a portion of the costs when using a (___) provider, pay additional cost for healthcare outside this HMO

Answer 31

PPO

Question 32

which HMO does not use a gatekeeper

Answer 32

PPO

Question 33

what is the “total package” approach to healthcare organizations

Answer 33

HMO

Question 34

enrollee is assigned a PCP and is the gatekeeper

Answer 34

HMO

Question 35

services are prepaid by

Answer 35

HMO

Question 36

benefits allow enrollees to receive services outside of the HMOs health care network, but at increased cost in copayments, in coinsurance, or in a deductible

Answer 36

POS

Question 37

three sections of the alphabetic index

Answer 37

1. Index to Diseases and Injuries
2. Table of Drugs and Chemicals
3. External Cause of Injuries Index

Question 38

provide greater specificity for proper code assignment

Answer 38

essential modifier

Question 39

used for alle xclusion notes and to identify those codes that are not usually sequenced as the first-listed diagnosis

Answer 39

italicized type

Question 40

equivalent of “unspecified”, information at hand does not permit a more specific code assignment

Answer 40

NOS

Question 41

“other specified”, used when ICD-10 does not have any codes that provide greater specificity

Answer 41

NEC

Question 42

enclose synonyms, alternative wording, explanatory phrases

Answer 42

brackets

Question 43

enclose supplementary words

Answer 43

parenthesis

Question 44

located in the Tabular List after an incomplete terms that needs one or more of the modifiers that follow in order to make the condition assignable

Answer 44

colon

Question 45

“NOT CODED HERE”, code excluded should not be assigned at the same time as the code

Answer 45

Excludes1

Question 46

“Not included here”, condition excluded is not part of the condition it is excluded from and a patient may have both conditions at the same time

Answer 46

Excludes2

Question 47

“use additional code” note at the

Answer 47

etiology code

Question 48

“Code first” note at the

Answer 48

manifestation code

Question 49

“In diseases classified elsewhere” codes are never

Answer 49

first-listed diagnosis

Question 50

two codes may be required to fully describe a condition

Answer 50

“Code also”

Question 51

T/F A corresponding procedure code must accompany a Z code to describe any procedure performed

Answer 51

True

Question 52

Encounter for screening for intestinal Infectious diseases

Answer 52

Z11.0

Question 53

encounters for inoculations and vaccinations

Answer 53

Z23

Question 54

lingering effect

Answer 54

sequelae

Question 55

Z codes are most often assigned in the ______ settigns

Answer 55

outpatient

Question 56

two categories of Z codes that report observation are

Answer 56

Z03 and Z04

Question 57

when are uncertain diagnoses reported

Answer 57

in an inpatient setting

Question 58

Z34

Answer 58

Encounter for supervision of normal pregnancy

Question 59

O09

Answer 59

Supervision of high-risk pregnancy

Question 60

not specifically manifestation codes but may be due to an underlying case

Answer 60

“code first”

Question 61

indicate that this code may be assigned as a principal diagnosis when the casual condition is unknown or not applicable

Answer 61

“Code, if applicable, any casual condition first”

Question 62

codes identified with a bullet

Answer 62

new codes

Question 63

codes identified with a triangle

Answer 63

changed or modified

Question 64

codes identified with a left and right triangle

Answer 64

beginning and end of the text changes

Question 65

appendix that lists all modifiers that are used to alter or modify codes

Answer 65

A

Question 66

appendix that contains a complete list of the additions to, deletions from, and revisions of the CPT manual

Answer 66

B

Question 67

appendix that contains clinic examples of many of the Evaluation and Management

Answer 67

C

Question 68

appendix that lists all add-on codes (+)

Answer 68

D

Question 69

lightning bolt symbol

Answer 69

identifies codes that are being tracked by the AMA

Question 70

complete list of modifier -51 exempt codes

Answer 70

E

Question 71

circle with a line through it

Answer 71

modifier -51 exempt

Question 72

codes with a bullseye

Answer 72

Moderate Sedation codes

Question 73

codes with full description

Answer 73

stand-alone

Question 74

codes listed under associated stand-alone codes

Answer 74

indented

Question 75

the use of a _____ between code numbers indicates the presence of only those numbers displayed

Answer 75

comma

Question 76

range is indicated by a

Answer 76

hyphen

Question 77

list of key components (3)

Answer 77

1. history
2. examination
3. medical decision making complexity

Question 78

contributory factors (4)

Answer 78

1. counseling
2. coordination of care
3. nature of presenting problem
4. time