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Medical Billing And Coding Vocab

Instructions:
  • Answer 50 questions in 15 minutes.
  • If you are not ready to take this test, you can study here.
  • 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. 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






2. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime






3. The fractured area of bone collapses on itself.






4. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu






5. Cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body






6. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin






7. 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






8. Number assigned by the insurance company to a physician who renders services to patients.






9. open sore on the skin or mucous






10. is defined as one who has not received any medical services within the last three years.






11. This is not specified as benign or malignant in the diagnosis or medical record.






12. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.






13. The bone is broken and pierces an internal organ






14. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.






15. Mild or controlled hypertension and no damage to the vascular system or organs.






16. paired bones at the corner of each eye that cradle the tear ducts.






17. Superior and widest bone






18. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela






19. Small collection of clear fluid;blister






20. forms the two lower sides of the cranium.






21. Deficient in pigment (melanin)






22. Is when two insurance companies work together to coordinate payment of the benefits.






23. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t






24. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.






25. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi






26. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)






27. Is a term used when a patient is admitted to the hospital with the expectation that the patient will stay for a period of 24 hours or more.






28. uncertain whether benign or malignant; borderline malignancy






29. Also known as Federal tax identification number. This is issued by the Internal Revenue Service






30. Discolored - flat lesion (freckles - tattoo marks)






31. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.






32. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:






33. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay






34. cancer that is localized and has not spread to adjacent tissues or distant parts of the body






35. Are composed of three-digit codes representing a single disease or condition.






36. Is a policy that covers losses to a third party caused by the insured - by an object owned by the insured - or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries - lost wages






37. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.






38. 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.






39. 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






40. male of household is primary payer






41. Is the qualifying factor or factors that must be met before a patient receives benefits.






42. Lower portion of the pelvic bone






43. Poisoning was due to: Accidental overdose; Wrong substance taken; Accidents in use of drugs and biologicals; External causes of poisonings classifiable to 980-989 Therapeutic Use: instances when a correct substance properly taken is the cause of adve






44. Law passed by the federal government to prosecute cases of Medicaid fraud.






45. Number assigned to the physician by Medicare program.






46. 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..






47. Contains complete - necessary information - but is incorrect or illogical in some way.






48. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of






49. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'






50. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.