Questions Flashcards
T/F If there are separate codes for both the acute and chronic forms of a condition, the code for the chronic condition is sequenced first as long as both codes are listed at the same indentation level of the Index.
F
T/F A late effect is the residual effect after the acute phase of an illness or injury has passed.
T
T/F It is unacceptable to report an impending condition as if it exists in an outpatient facility.
T
T/F Assign codes as directed in the Index, only after verifying the code in the Tabular.
T
T/F It is important to follow any cross-reference instructions in the Index of the I-10, such as see also.
T
T/F An adverse effect occurs when a drug has been correctly prescribed and properly administered and the patient develops s reaction.
T
T/F ICD-10-CM codes are alphanumeric, with all codes beginning with a number.
F
T/F ICD-10-CM codes have a maximum of five characters.
F
T/F There are 21 chapters in the ICD-10-CM.
T
T/F The I-10 has instructional notations to provide guidance.
T
T/F Z codes cannot be used in the outpatient setting.
T
T/F The term “primary diagnosis” is the same as the first-listed diagnosis.
T
T/F In the outpatient setting, a diagnosis that is documented as “rule out” should not be reported.
T
T/F Code all the documented conditions that coexist at the time of an encounter/visit and require or affect patient care, treatment, or management.
T
T/F In the inpatient hospital setting, probable, suspected, and rule-out diagnoses cannot be reported by the facility as though the condition exists.
F
Primary diagnosis
1st listed diagnosis, used in the outpatient setting to identify the reason for the encounter
Principal diagnosis
defined as that condition established after study to be chiefly responsible for occasioning the admission of the patient to the hospiital forcare, the principal diagnosis is sequenced first
first list diagnosis
out pt diagnosis
T/F If the type of diabetes mellitus is not documented in the medical record, the default is type 2 diabetes mellitus.
T
T/F I-10 presumes a cause-and-effect relationship between hypertension and acute kidney disease.
T
T/F I-10 presumes a cause-and-effect relationship between hypertension and heart and renal disease.
T
T/F The secondary cancer should be listed before the primary cancer if the secondary cancer is the reason for the visit.
T
T/F If a patient is admitted for dehydration due to chemotherapy, the dehydration is the first-listed diagnosis.
T
T/F If a patient with coronary artery disease is admitted due to an acute myocardial infarction (AMI), the AMI should be sequenced before the coronary artery disease.
T
T/F A stage 2 pressure ulcer is considered a full-thickness loss of skin.
F
T/F A symptom code should not be assigned when it is considered to be routinely associated with a disease process.
T
T/F The outcome of delivery is indicated on the mother’s medical record only.
T
T/F The perinatal period extends from before birth through 28 days after birth.
T
T/F A congenital anomaly is an abnormality one was born with.
T
T/F Superficial injuries such as an abrasion or contusion are reported when associated with more severe injuries of the same site.
F
T/F An adverse effect occurs when a drug has been correctly prescribed and properly administered and the patient develops a reaction.
T
a dash (-) at the end of an alphabetic index entry indicates what requirement
additional characters
instructional notes are included in what list
tabular
section IV of the icd 10 official guidelines for coding and reporting is for what type of coding
outpatient
locating terms in the alphabetic index must be verifed with codes in what list
tabular
how many characters are possible in icd-10-cm coding
7
when a code first note is indicated and the patient has an underlying condition documented, which is listed as the principle or first listed diagnosis
underlying condition
dehydration with pneumonia is not considered an ____ part of a disease process
integral
when a condition is described as both acute and chronic with separate subentries in the index at the same indention level, which is coded first
acute
when on code can identify two dx or a dx with an associated complication it is considered what type of code
combination
what type of dx codes do you report when the acute phase of an illness or injury has passed but residual remains
late effects
reference the ____ ____ to determine if the condition has a subentry term for impending
alphabetic index
how many times are you able to report each specific icd-10-cm code per encounter
once
laterality refers to what type of organs
paired
multiple coding
use of more than one icd-10-cm code to fully describe a condition
combination code
single code used to clasify 2 dx
acute
sudden onset and short duration
sequela
a condition that follows an illness
bilateral
occurring on 2 sides
what type of sedation is not reported with anesthesia codes but rather with medicine codes
moderate sedation
most anesthesia codes are divided by what site
anatomic
the formula for anesthesa services is based on what three units
base, time and modifying factors
physical status modifier inicate the pts __________at the time anesthesia was administered
condition
national dollar amt that is applied to all services paid on the medicare fee schedule basis is what
CF-conversion factor
comparison of anesthesia services, published by the american society of anesthesiologist (ASA)
RVG-relative value guide
unit value assigned to each service
RVU-relative value unit
5-digit CPT codes that describe situations or conditions that affect the administration of anesthesia
qualifying circumstances
codes that can never be reported alone but must be used in addition to another code to provide additional information
add on codes
office, hospital, ed and nursing home locations describe what factor in code assignments
place of service
what pt status is assigned to an encounter that has been seen by the same specialty within the past 3 yrs
established
this status is assigned to a pt who has been formally admitted to a health care facility
inpatient
the levels of service are based on key components and what factors
contributory
documented key components include hx, examinationa and
MDM
subjective information given by the pt is part of what key component
hx
documented observation by the physician about the pts complaint or problem is considered what type of information
objective
2 of 3 elements must be met or exceeded to qualify for a level of??
MDM
when a physician arranges for other services to be provided to the pt, this considered what type of contributory factor
coordination of care
what CPT code reports services provided inan office for which the physician may not be present
99211
the last subsection in the E/M section describing an unlisted code is what type of evaluation and management services
other
CMS developed a set of standards for documentation of E/M services which are called
documentation guidelines
a general multi-system exam that ncludes 1-5 elements identified by a bullet in one or more or or ba according the 1995 documentation guidelines is a
problem focused examination
a discussion with a pt and/or family is what
couneling
service rendered by a physician whose opinion or advice is requested by another physician
consultation
counseling, coordinaiton of care, nature of presenting problem and time
contributory factors
evaluation and determination of care management of a newly born infant
newborn care
what part of the CPT manual lists a full description for all modifiers
appendix A
when a CPT code does not fully explain an unusual procedure, what should be added to the code
modifier
what modifier is applied to a surgical procedure to indicate increased physician work was performed
-22
what modifier is applied to indicate a service for which general anesthesia was used when normally local anesthesia would be indicated
-23
what modifier is applied to indicate and E/M encounter was erformed and not related to a current global period
-24
when a pt comes into theoffice twicein one day for different medical reasons teh -25 modifier should be applied to which visit
second e/m
what modifier indicates the professional component of a diagnostic test
-26
3rd pary payers require the modifier for a mandated service
-32
modifier -33 indicates a covered preventive service, what organization grades preventive serivices
USPSTF-US preventative serivces task force
modifier -47 anesthesia by the surgeon, is never added to what cpt code
anesthesia codes
how may units of service may be billed when reporting the -50 modifier to medicare
1 unit
when reporting -51 modifier to indicate multiple procedures performed, which procedure should be reported first on the claim
primary procedure
some payers may decrease the payment on a procedure when this modifier is applied
-52
modifier -53, discontinued procedure, is never reported with e/m codes or codes based on what
time
when the surgeon transfers postoperative care to another physician, report with what modifier
-54
modifier -55 is used for services provided tothe pt afterwhat disposition
discharge from hospital
medicare considers what service to be part of the surgery and bundled payment not allowing the -56 modifier
preoperative
e/m services provided the day before or the day of a major surgery are included in what package
global days
a planned procedure intended to include the original procedure plus one or more subsequent procedures is indicated by what modifier
-58
modifier -59 is applicable to all cpt codes except what type of codes
e/m codes and weekly radiation management
period of time a surgical procedure is being performed
intraoperative
inform 3rd pary payers of circumstances that may affec the way payment is made
modifiers
describing a physicians services in radiology or pathology
professional component
describing the services provided by the facility
technical component
bundling together of time, effort, and services for a specific procedure into one code instead of reporting each component separately
surgical package
how many modifiers areas are available on a cms-1500 insurance claim form for one line item charge
4
when providers use an outside laboratory, who is responsible for billing these medicare services
outside laboratories
most surgery subsections are defined according to body system or
medical specialty
notes in teh cpt manual may appear before subsections, subheadings, categories, and
subcategories
unlisted codes identify procedures or services throughout the surgery section that indicate what
no specific cpt for that procedure
pertinent info in a special report should include an adequate____or____of the nature, extent, and need for the procedure
definition or description
the term separate procedure is an indication of how, or if, the code should be
assigned
general anesthesia services are reported separately by what type of provider
anesthesiologist
surgery “general subsection” codes are divided based on what criteria
if imaging guidance was used during the aspiration
includes nature, extent, and need for the procedure and the time, effort, and equipment necessary to provide the service
special report
procedures that, when performed at the same time as a major procedure, are considered incidental and not reported separately
separate procedures
considered unusual, experimental, or new and do not have a specific cpt code assigned
unlisted procedures
through the skin
percutaneous
use of a needle and syringe to withdraw fluid
aspiration
is there a restriction on what type of providers may report codes form the integumentary systme subsection
no
incision and drainage codes are first divided according to what
the condition
what modifier should not be applied to nail removal codes
-51 multiple procedures
what type of repair involves complicated wound closure
complex
what type of biopsy is reported when the entire lesion is removed
excisional
what type of mastectomy is reported when the entire breast is removed in addition to the pectoral muscles and axillary lymph nodes
radical
killing of tissue by means of electrocautery, laser or chemicals
destruction
cleansing of or removal of dead tissue from a wound
debridement
destruction of lesions using extreme cold
cryosurgery
tissue graft b/t individuals who are not of the same genotype
allograft
surgical repair of the skin
dermatoplasty
what goverment organization handles the funds for the medicare program
social security administration
3 items that medicare beneficiaries are responsible for
dedcutibles, premiums and co-insurance
medicare usually pays what % of the amts indicated for services
80%
filing guidelines, providers must file claims for their medicare pts within____months of the DOS
12
part c medicare is known as what
medicare advantage organization
HIPPA stands for what
health insurance portability and accountability act
transfer of electronic documentation is accomplished throught the us of EDI-stands for
electronic data interchange technology
co-surgeons, medicare pays the lesser of the actual charge or ________of the global fee, dividing the payment equally b/t the 2 surgeons
125%
T/F the national center for health statisstics is responsible for the disease classification system in the US
true
format for the tabular list 1st to last
chapter, section, category (3 characters), subcategory (4 characters), and subclassification (5-7 characters)
main term in chronic pancreatitis
pancreatitis
main term in anus abscess
abcess
main term in acute cholecystitis
cholecystitis
main term in abdominal pain
pain
main term in neonatal mastitis
neonatal
T/F when a pt presents for out pt surgery and the surgery is canceld, report the reason why the surgery was cx as the 1st listed dx, what else do you code
T also code for the cancellation due to othe contraindication Z53.09
T/F when a final dx has not been established by the provider, it is acceptable to report codes for the presenting signs and symptoms
true
T/F the external cause codes can be reported as a 1st listed dx
false
T/F codes form chapter 17, congenital anomalies, can be reported any time during a persons life, as appropriate
true
T/F chapter 15 codes are neer reported on the mothers record
false
T/F the 1st listed dx for a routine outpatient prenatal visit is a code from category Z34, encounter for supervision of normal pregnancy
true
T/F the outcome of delivery is reported only on the newborns record
false
a hydatidiform mole is a tumor that only forms in the uterus T/F
false
when there is an encounter for a complication and no delivery occurred, report the complication as the 1st listed condition T/F
true
T/F when coding the birth episode in a newborn record, assign a code from category Z38, liveborn infantsm according to place of birth and type of delivery, as the 1st listed diagnosis T/F
true
T/F aftercare Z codes should not be reorted for aftercare of injuries T/F
true
T/F multiple fx are sequenced in accordance to the location of the fx
false
anoamaly
an abnormality of a structure or organ
according to the guidelines, when sequencing multiple fx sequence in accordance with _______of the fx
severity
what association publishes the CPT
AMA
