Week 4

Question 1

What records are used for CPT coding?

Answer 1

Descriptive terms and identifying codes for reporting professional and technical services

Question 2

Modifiers 50

Answer 2

Bilateral

Question 3

Alphabetical Index
Where is it located?

Answer 3

For CPT in the back
ICD10 in the front

Question 4

What is the “humerus”?

Answer 4

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

Question 5

Tubular Index

Answer 5

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

Question 6

Doctor can put how many diagnoses in one claim?

Answer 6

12

Question 7

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

Answer 7

Category 2 (A9921,E9921)

Question 8

Paper Claim Form

Answer 8

CMS1500

Question 9

NP (New patients)

Answer 9

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

Question 10

EP (Established patients)

Answer 10

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

Question 11

Medical Supplies

Answer 11

HCPCSA codes

Question 12

Downcoding

Answer 12

Use of a lower-level procedure code than is
justified

Question 13

Upcoding

Answer 13

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

Question 14

DME

Answer 14

HCPCS E codes

Question 15

Fraud

Answer 15

Intentional deception (Service not provided)

Question 16

Abuse

Answer 16

Knowingly take advantage, overcharge uploading

Question 17

_____ are used to help measure performance and outcome.

Answer 17

CPT codes category 2

Question 18

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

Answer 18

Eponym

Question 19

Code range 70000 and 79999 belong to the ______ section

Answer 19

Radiology Procedures

Question 20

Medical records used for procedural coding can include _____.

Answer 20

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

Question 21

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

Answer 21

Anatomical site

Question 22

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

Answer 22

Expanded problem focused

Question 23

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

Answer 23

Closed treatment of a fracture

Question 24

Pathology means:

Answer 24

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

Question 25

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

Answer 25

Medical & Durable medical equipment

Question 26

What would be a "26" modifier be used for?

Answer 26

Professional component

Question 27

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

Answer 27

20 (POS)

Question 28

How many sections in the CPT manual?

Answer 28

6 sections (

Question 29

Are "revised" codes highlighted in the CPT manual?

Answer 29

Yes

Question 30

Are subcategories the lowest level of code description?

Answer 30

Yes

Question 31

What is the meaning of "Electronic data interchange"?

Answer 31

Transfer of information electronically

Question 32

Audit means:

Answer 32

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

Question 33

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

Answer 33

Type of insurance the patient has

Question 34

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

Answer 34

Block #2

Question 35

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

Answer 35

11

Question 36

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

Answer 36

12

Question 37

Dirty claim means:

Answer 37

wrong information, missing information, or errors

Question 38

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

Answer 38

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

Question 39

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

Answer 39

2

Question 40

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

Answer 40

Social Security Number & EIN

Question 41

Why would a claim be rejected?

Answer 41

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

Question 42

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

Answer 42

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

Question 43

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

Answer 43

assignment form

Question 44

What is a clearinghouse?

Answer 44

An outside party that institutions can pay to make their claims

Question 45

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

Answer 45

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

Question 46

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

Answer 46

Front & Back

Question 47

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

Answer 47

Policies

Question 48

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

Answer 48

Insurance billing

Question 49

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

Answer 49

NO

Question 50

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

Answer 50

Always obtain accurate information and check eligibility

Question 51

What are the steps for obtaining a preauthorization?

Answer 51

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