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MAP 150 > Week 4 > Flashcards

Week 4 Flashcards

1
Q

What records are used for CPT coding?

A

Descriptive terms and identifying codes for reporting professional and technical services

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2
Q

Modifiers 50

A

Bilateral

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3
Q

Alphabetical Index
Where is it located?

A

For CPT in the back
ICD10 in the front

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4
Q

What is the “humerus”?

A

Is your “funny bone” and also an anatomical site.

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5
Q

Tubular Index

A

There are 6 sections
Evacuation and management
Anesthesia
Surgery
Radiology
Pathology and laboratory
Medicine

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6
Q

Doctor can put how many diagnoses in one claim?

A

12

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7
Q

What are categories 1,2, and 3 used for?

A

Category 2 (A9921,E9921)

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8
Q

Paper Claim Form

A

CMS1500

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9
Q

NP (New patients)

A

99201
99202 (Cheapest charge) (
99203
99204
99205 (Most expensive charge)

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10
Q

EP (Established patients)

A

99211
99212 (Problem focused)
99213
99214
99215 (Bring more expenses )

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11
Q

Medical Supplies

A

HCPCSA codes

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12
Q

Downcoding

A

Use of a lower-level procedure code than is
justified

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13
Q

Upcoding

A

Use of a higher-level procedure code than is
supported in the documentation of medical
necessity

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14
Q

DME

A

HCPCS E codes

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15
Q

Fraud

A

Intentional deception (Service not provided)

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16
Q

Abuse

A

Knowingly take advantage, overcharge uploading

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17
Q

_____ are used to help measure performance and outcome.

A

CPT codes category 2

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18
Q

A ___ is used in the Alphabetic Index portion of the CPT book.

A

Eponym

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19
Q

Code range 70000 and 79999 belong to the ______ section

A

Radiology Procedures

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20
Q

Medical records used for procedural coding can include _____.

A

Encounter forms, progress notes, pathology reports, and radiology reports

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21
Q

Searching the Alphabetic Index, “humerus” would be found in _____

A

Anatomical site

22
Q

___________ is a level of history includes review of systems that relate to the chief complaint

A

Expanded problem focused

23
Q

With or Without manipulation and/or traction is known as what type of treatment?

A

Closed treatment of a fracture

24
Q

Pathology means:

A

Study and diagnosis of disease. Qualative & quantitative codes for drug tests.

25
Q

HCPCS code ranges from A4000 to A8999 would be found in the _____ supplies and ________ supplies

A

Medical & Durable medical equipment

26
Q

What would be a “26” modifier be used for?

A

Professional component

27
Q

code ___ represents an urgent care facility as the place of service.

A

20 (POS)

28
Q

How many sections in the CPT manual?

A

6 sections (

29
Q

Are “revised” codes highlighted in the CPT manual?

A

Yes

30
Q

Are subcategories the lowest level of code description?

A

Yes

31
Q

What is the meaning of “Electronic data interchange”?

A

Transfer of information electronically

32
Q

Audit means:

A

When a company comes in and they examine claims to make sure they are accurate and complete

33
Q

What information is needed in “Block #1” of a CMS-1500 form?

A

Type of insurance the patient has

34
Q

Which block on the CMS_1500 form, would you find the patient name?

A

Block #2

35
Q

What is the physician’s office place-of-service code?

A

11

36
Q

On a CMS-1500 form _____ amount of codes can be used

A

12

37
Q

Dirty claim means:

A

wrong information, missing information, or errors

38
Q

Which steps of medicine billing should be performed prior to rendering medical services?

A

Make sure you have the right information. Make sure they have eligibility and insurance covers

39
Q

In _____ of the CMS-1500, you will find information about the patient and the insured

A

2

40
Q

Two examples of a Federal Tax ID # (Box 25) that the provider uses for filling claims

A

Social Security Number & EIN

41
Q

Why would a claim be rejected?

A

It is sent to the wrong insurance company due to having wrong address

42
Q

What information is found on an Explanation of benefits (EOB)?

A

Patient deductible, Co-insurance, and anything that the patient has to pay

43
Q

In order for the physician to receive payment for services directly, the patient must sign a _______

A

assignment form

44
Q

What is a clearinghouse?

A

An outside party that institutions can pay to make their claims

45
Q

Why would a claim be returned to the provider for correction?

A

Missing information, Having inaccurate information, being dent to the wrong address

46
Q

We will copy the ____ and _____ of the patient’s insurance card.

A

Front & Back

47
Q

We should always follow the office ____ for review and signatures.

A

Policies

48
Q

A patient’s billing records should have ___ information in it?

A

Insurance billing

49
Q

If the ICD-10CM codes and the CPT-HCPCS codes do not match, would it should medical necessity?

A

NO

50
Q

What are the steps in filling a claim with a third party?

A

Always obtain accurate information and check eligibility

51
Q

What are the steps for obtaining a preauthorization?

A

Call the insurance company, Give them all the information, and give them the diagnosis code and CPT codes. Then they will give you an authorization number

MAP 150 (4 decks)

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