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Test your basic knowledge |
Medical Billing And Coding Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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Match each statement with the correct term.
Don't refresh. All questions and answers are randomly picked and ordered every time you load a test.
This is a study tool. The 3 wrong answers for each question are randomly chosen from answers to other questions. So, you might find at times the answers obvious, but you will see it re-enforces your understanding as you take the test each time.
1. Represent changes in the text or definition between the triangles.
Two triangular symbols (a
Keratin
sebaceous(oil) glands and the suddoriferous (sweat) glands
Medical necessity
2. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.
-51 - Multiple Procedures
Occipital Bone
Health Maintenance Organization (HMO)
Established Patient
3. The CPT Index is arranged in alphabetical order by main terms which are further divided by subterms. There are five location methods: 1. Service or Procedure 2. Anatomic site 3. Condition or Disease 4. Synonym/Eponym 5. Abbreviation
Chief complaint (CC)
Location Methods
Liability insurance
Sesamoid bones
4. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo
Palatine bones
CPT SECTIONS.
Compliance Regulations
HCPCS Level II codes (National Codes)
5. This modifier is used when the same procedure is performed on a mirror-image part of the body..
-26 - Professional Component
encounter form
-50 - Bilateral Procedure
Impacted
6. Are the finger bones. Each finger has three phalanges - except for the thumb. The three phalanges are the proximal - middle and a distal phalanx. The thumb has a proximal and distal.
Commercial Carriers
phalanges (phalanx.s)
Add-on codes
Limited ROM
7. This is also known as fee-for-service. Under this plan - the services that are paid for are listed in the policy and payments are based on the fees physicians charge for the service. Each year - the beneficiary must meet a deductible - after which -
Impacted
Surgical Package
Indemnity Insurance
Rejected claim
8. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag
Birthday rule
National Correct Coding Initiative (NCCI)
HCPCS Level I codes
Employee Liability
9. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an
Health Insurance Portability and Accountability Act (HIPAA)
Participating physician
Uncertain behavior
Subcategories
10. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.
Category III Codes CPT
Add-on codes
Fee Schedule
Fissure
11. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ
Chapters
Medigap (Medicare Supplemental Insurance)
Chief complaint (CC)
Relative Value Payment Schedules Method
12. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Long bones
There are three layers to the skin
Full ROM
Medical necessity
13. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Section 3 Index to External Causes of Injury (E codes)
Lipocyte
Palatine bones
Participating physician
14. numbers 8-10 - are attached to the sternum by cartilage
Fissure
False ribs
Unspecified (hypertension)
Accident
15. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.
Alphabetic Index (Volume 2)
Hypertension Table
Sesamoid bones
Nonparticipating physician
16. Is a patient who receives treatment in any of the following settings: physician's office ;hospital clinic - emergency department - hospital same-day surgery unit - ambulatory surgical center ( patient is released within 23 hours) ;hospital admission
nonessential modifiers
Chief complaint
Rejected claim
Outpatient
17. Benign growth extending from the surface of the mucous membrane
Polyp
CPT SECTIONS.
Reasons for Documentation
Coding
18. This is an alternative to paper claims submitted to the third-party payer directly by the physician or through a clearinghouse. Electronic claims are usually paid faster than paper claims and most electronic claims software have self-editing features
Electronic Claim
The St. Anthony Relative Value for Physicians (RVP)
Health Maintenance Organization (HMO)
Indemnity Insurance
19. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.
Sesamoid bones
Chief complaint (CC)
Preferred Provider Organization (PPO)
Undetermined
20. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Electronic Claim
Accident
Unspecified nature
Hairline
21. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.
Capitated Rates
National Correct Coding Initiative (NCCI)
Neoplasm Table
Accept assignment
22. most synarthroses are immovable joints held together by fibrous tissue.
Indemnity Insurance
No ROM
bullet (a
triangle (a
23. paired bones at the corner of each eye that cradle the tear ducts.
New patient
Lacrimal bones
Accident
Parietal Bones
24. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.
Section 3 Index to External Causes of Injury (E codes)
No ROM
Group Provider Number
Maxilla
25. Number assigned to the physician by Medicare program.
Spinal/Vertebral Column
Primary malignancy
Vomer
Unique Provider Identification Number (UPIN)
26. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.
Electronic Claim
Albino
Accept assignment
New patient
27. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p
Keratin
Primary malignancy
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Clearinghouse
28. Are the main division in the ICD-9-CM; they are divided into sections. e.g.. - 3. Endocrine - Nutritional and Metabolic Diseases - and Immunity Disorders (240-279).
Pelvis
Section 3 Index to External Causes of Injury (E codes)
Chapters
A plus sign (+)
29. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Employer Identification Number (EIN)
False Claims Act (FCA)
Qualified diagnosis
Alopecia
30. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..
Musculoskeletal System
Capitated Rates
No ROM
TRICARE PLANS
31. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.
Personal Insurance
-26 - Professional Component
ligaments
Preferred Provider Organization (PPO)
32. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances
-99 - Multiple Modifiers
Pelvis
Inpatient
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
33. This consists of the patient's personal experiences with illnesses - surgeries and injuries. It also contains information of illnesses predominant in the family. It contains the patient's educational background - occupation - marital status - and oth
Two triangular symbols (a
Past - family and social history (PFSH)
Modifiers
Sections
34. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Personal Insurance
bullet (a
Hairline
35. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.
nonessential modifiers
Pre-paid Health Plan
Peer Review Organization (PRO)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
36. This is not specified as benign or malignant in the diagnosis or medical record.
Unspecified (hypertension)
Health Maintenance Organization (HMO)
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Maxilla
37. This is used to indicate that the service provided was required by a third-party payer - governmental - legislative - or regulatory body. This does not include second opinion requested by a patient - family member - or another physician.
-32 - Mandated Services
Categorically needy -MEDICAID
Compliance Regulations
Secondary malignancy
38. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Hairline
Spinal/Vertebral Column
Fiscal Intermediary
Categorically needy -MEDICAID
39. Is the lower medial arm bone.
ulna
ligaments
State License Number
TRICARE PLANS
40. Is one who has received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years....
Established patient
Social Security Number
Nodule
Uncertain behavior
41. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Tabular List (Volume 1)...
MEDICARE Part C
Salter-Harris
Group Provider Number
42. The reason the patient came to see the physician.
Chief complaint (CC)
Clean claim
Workers Compensation
Liability insurance
43. anterior to the temporal bones.
Relative Value Payment Schedules Method
Nodule
Sphenoid Bones
Alphabetic Index (Volume 2)
44. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Malignant
The Good Samaritan Act
ligaments
Subcategories
45. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Group Provider Number
Categories
Unspecified (hypertension)
Deductible
46. uncertain whether benign or malignant; borderline malignancy
Group Insurance
Uncertain behavior
Accept assignment
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
47. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t
-51 - Multiple Procedures
Surgical Package
Reasons for Documentation
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
48. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re
Reasons for Documentation
Sebaceous glands
Coinsurance
Patient Confidentiality
49. Is a working diagnosis which is not yet established.
Melanin
False Claims Act (FCA)
The Current Procedural Terminology (CPT)
Qualified diagnosis
50. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
Carcinoma (Ca) in situ
Inferior nasal conchae
Flat bones
Personal Insurance