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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. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas
Mutually Exclusive Edits
Greenstick
Workers Compensation
Patient Confidentiality
2. 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
Pre-determination
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Subcategories
MEDICARE Part A
3. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
There are three layers to the skin
Fissure
stand-alone codes
4. 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
Hypertension Table
Complicated
Electronic Claim
The Universal Claim Form
5. is a traumatic injury to a joint involving the soft tissue.
Parietal Bones
sprain
Patient Confidentiality
Inpatient
6. 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)...
Pubic bone
Medical Records
Coinsurance
7. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Accept assignment
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
-50 - Bilateral Procedure
Outpatient
8. 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
stand-alone codes
Health practitioner
Disability insurance
-26 - Professional Component
9. the bone is crushed and or shattered.
Comminuted fracture
Malignant
-32 - Mandated Services
Limited ROM
10. Is a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must
Consultation
Inpatient
Past - family and social history (PFSH)
Limited ROM
11. requires investigation and needs further clarification.
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Rejected claim
Explanation of Benefits (EOB)
Commercial Carriers
12. 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
Impetigo
Neoplasm Table
Clearinghouse
lunula
13. 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.
Macule
-32 - Mandated Services
Medically needy
A plus sign (+)
14. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
Medicare Claim Status
There are two types of sweat glands
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Provider Identification Number (PIN)
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
Two triangular symbols (a
Evaluation and Management Review
Add-on codes
Tabular List (Volume 1)...
16. uncertain whether benign or malignant; borderline malignancy
Outpatient
Review of Systems (ROS)
Two triangular symbols (a
Uncertain behavior
17. Most billing-related cases are based on HIPAA and False Claims Act.
Compliance Regulations
Wheal
Medigap (Medicare Supplemental Insurance)
Point-of-Service plan (POS)
18. 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'.
Sphenoid Bones
Pre-authorization
Inpatient
History of present illness (HPI)
19. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
bullet (a
axial skeleton
Greenstick
A plus sign (+)
20. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U
Civil Monetary Penalties Law (CMPL)
Subcategories
Spinal/Vertebral Column
Medicare
21. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
circle with a line through it)
-90 - Reference (Outside) Laboratory
Primary malignancy
Social Security Number
22. Is a working diagnosis which is not yet established.
Unspecified (hypertension)
Qualified diagnosis
Category III Codes CPT
-26 - Professional Component
23. Law passed by the federal government to prosecute cases of Medicaid fraud.
Fiscal Intermediary
Clean claim
Medical necessity
Civil Monetary Penalties Law (CMPL)
24. This is the inventory of the constitutional symptoms regarding the various body systems.
appendicular skeleton .
Comminuted fracture
Review of Systems (ROS)
Group Insurance
25. 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
Relative Value Payment Schedules Method
Health Insurance Portability and Accountability Act (HIPAA)
Personal Insurance
Column 1/Column 2 (previously called Comprehensive/Component) Edits
26. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt
False ribs
Full ROM
There are three layers to the skin
There are two types of sweat glands
27. 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
Categorically needy -MEDICAID
Clean claim
Hairline
MEDICARE Part D
28. 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.
Preferred Provider Organization (PPO)
nonessential modifiers
Blue Cross/Blue Shield Plans
Collagen
29. anterior to the temporal bones.
Sphenoid Bones
Colles
Musculoskeletal System
Medicare
30. Are composed of three-digit codes representing a single disease or condition.
bullet (a
National Correct Coding Initiative (NCCI)
Macule
Categories
31. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
essential modifiers
Pre-certification
MEDICAID COVERAGE
Electronic Claim
32. Is the cost of insurance coverage paid annually - semi-annually or monthly to keep a policy in effect.
Zygoma
premium
MEDICARE Part A
Social Security Number
33. 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
HCPCS Level I codes
Invalid claim
Sub classification
-99 - Multiple Modifiers
34. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Tabular List (Volume 1)...
Impetigo
Benign
Salter-Harris
35. 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.
Chief complaint
Participating physician
Medicaid
-32 - Mandated Services
36. Is the qualifying factor or factors that must be met before a patient receives benefits.
Mutually Exclusive Edits
Eligibility
essential modifiers
Qualified diagnosis
37. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.
Lipocyte
Category II Codes CPT
Fissure
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
38. Any fracture occurring spontaneously as a result of disease.
Pathologic
Chapters
Retention of Medical Records
Health Care Financing Administration Common Procedure Coding System
39. 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.
MEDICARE Part B
Group Provider Number
Medicaid
HCPCS Level II codes (National Codes)
40. The moon like white area at the base of the nail.
Birthday rule
Complicated
lunula
MEDICARE Part A
41. 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
Liability insurance
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Category II Codes CPT
Commercial Carriers
42. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
CPT SECTIONS.
State License Number
Occipital Bone
Column 1/Column 2 (previously called Comprehensive/Component) Edits
43. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.
Primary malignancy
Category III Codes CPT
triangle (a
The Good Samaritan Act
44. Numbers 1-7 - attach directly to the sternum in the front of the body.
Advance Beneficiary Notice
Tabular List (Volume 1)...
true ribs
State License Number
45. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Unauthorized benefit
Exclusions and Limitations
Hairline
Commercial Carriers
46. forms the roof of the nasal cavity.
Sub classification
Health Care Financing Administration Common Procedure Coding System
Ethmoid Bone
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
47. Absence of hair from areas where it normally grows
Alopecia
Unlisted Procedures Procedures
Pathologic
Impacted
48. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the
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49. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.
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50. numbers 8-10 - are attached to the sternum by cartilage
False ribs
Civil Monetary Penalties Law (CMPL)
No ROM
lunula