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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. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).






2. 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.






3. Pre-determined set of benefits covered under one set annual fee.






4. Any fracture occurring spontaneously as a result of disease.






5. Consists of the skull - rib cage - and spine






6. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o






7. Represents a new procedure or service code added since the previous edition of the manual.






8. Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection with a claim. It also protects and rewards persons involved in whistle-blower cases.






9. Is a group of two or more physicians and non-physician practitioners legally organized in a partnership - professional corporation - foundation - not-for-profit corporation - faculty practice plan - or similar association.






10. Noninvasive - non-spreading - nonmalignant






11. 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






12. 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.






13. 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.






14. 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






15. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).






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






17. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.






18. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.






19. 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






20. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients






21. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.






22. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.






23. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers






24. the bone is broken and the ends are driven into each other.






25. Is defined as a doctor of medicine or osteopathy - dental medicine - dental surgery - podiatric medicine - optometry - or chiropractic medicine legally authorized to practice by the state in which he/she performs.






26. Absence of hair from areas where it normally grows






27. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.






28. is defined as reimbursement for income lost as a result of a temporary or permanent illness or injury. When patients are treated for disability diagnoses and other medical problems - separate patient records must be maintained. Disability insurance






29. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari






30. This modifier is used when the same procedure is performed on a mirror-image part of the body..






31. This is a set of information the physician gathers from the patient regarding the following:






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






33. Prescription Drugs The Medicare Prescription Drug - Improvement - and Modernization Act enacted in December 2003 and began implementation in January 2006 where Medicare beneficiaries can enroll in the Medicare prescription drug plan. The beneficiari






34. Is the lower medial arm bone.






35. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.






36. solid - round or oval elevated lesion more than 1 cm in diameter






37. uncertain whether benign or malignant; borderline malignancy






38. 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.






39. Has all required fields accurately filled out - contains no deficiencies and passes all edits. The carrier does not require investigation outside of the carrier's operation before paying the claim.






40. This modifier is used to report a procedure or service that has more than one Modifier but the third-party payer does not allow the addition of multiple modifiers to the code. Modifier -99 is attached to the procedure code and the multiple Modifiers






41. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.






42. 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






43. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben






44. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.






45. The reason the patient came to see the physician.






46. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.






47. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.






48. most synarthroses are immovable joints held together by fibrous tissue.






49. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.






50. Is a requirement for some health insurance plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed 'medically necessary'.