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Medical Billing And Coding Vocab

Instructions:
  • Answer 50 questions in 15 minutes.
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  • Match each statement with the correct term.
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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. This modifier is used when the same procedure is performed on a mirror-image part of the body..






2. Under capitation - the physician provides a full range of contracted services to covered patients for a fixed amount on a periodic basis. While guaranteed a fixed amount - the physician assumes the risk that the cost of providing the care to the pati






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






4. numbers 8-10 - are attached to the sternum by cartilage






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






6. Groove or crack like sore






7. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.






8. 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.






9. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.






10. 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






11. 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.






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






13. 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'.






14. contains errors or omissions. Usually - these claims do not pass front-end edits. They are either processed manually for resolving problems - or rejected for payment.






15. The E&M section includes codes that pertain to the nature of the physicians' work. The codes depend on type of service - patient status - and place where service was rendered. The E&M section is divided into broad categories such as office visits - h






16. 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






17. Is the lateral lower arm bone (in line with the thumb).






18. Forms the sides of the cranium






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






20. numbers 8-10 - are attached to the sternum by cartilage






21. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e






22. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.






23. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)






24. 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.






25. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from






26. Number assigned to the physician by Medicare program.






27. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia






28. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.






29. Is the lateral lower arm bone (in line with the thumb).






30. A fracture of the epiphyseal plate in children.






31. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.






32. To report a circumstance in which the physician returns to the operating room to address a complication stemming from the initial procedure - modifier -78 is attached to the subsequent procedure code.






33. death of tissue associated with loss of blood supply






34. The lower anterior part of the bone






35. Small collection of clear fluid;blister






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






37. forms the roof of the nasal cavity.






38. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv






39. 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






40. Is the lower medial arm bone.






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






42. 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 -






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






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






45. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr






46. 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






47. A pregnant woman who has had at least one previous pregnancy.






48. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.






49. 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






50. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s