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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. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present






2. This is the inventory of the constitutional symptoms regarding the various body systems.






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






4. Most billing-related cases are based on HIPAA and False Claims Act.






5. This is the inventory of the constitutional symptoms regarding the various body systems.






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






7. They are for profit organizations that operate in the private sector selling different health insurance benefits plans to groups or individuals. Most commercial plans have predefined patient yearly deductibles and coinsurance generally based on 80/2






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






9. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).






10. Represent changes in the text or definition between the triangles.






11. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.






12. is a traumatic injury to a joint involving the soft tissue.






13. 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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14. Describes the services billed and includes a breakdown of how the payment is determined






15. 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.






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






17. 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






18. Is a regionally managed healthcare program for active duty and retired members of the armed forces - their families - and survivors. It is a service benefit program and contains no premium. TRICARE is the new title for the CHAMPUS program (Civilian H






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






20. Groove or crack like sore






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






22. Is an entity that receives transmissions of claims from physicians' offices - separates the claims by carriers and performs software edits on each claim to check for errors. Once this process is complete - the claim is then sent to the proper insuran






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






24. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot






25. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse






26. Absence of hair from areas where it normally grows






27. Forms the anterior part of the skull and the forehead






28. 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






29. 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






30. Are a group of independently licensed local companies - usually nonprofit that contracts with physicians and other health entities to provide services to their insured companies and individuals. Most BC/BS plans offer HMO's - PPO's and POS plans. Blu






31. means the provider agrees to accept what the insurance company approves as payment in full for the claim.






32.






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






34. Most billing-related cases are based on HIPAA and False Claims Act.






35. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which






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






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






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






39. Is a working diagnosis which is not yet established.






40. Describes the services billed and includes a breakdown of how the payment is determined






41. 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






42. 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).






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 basically the same as HMO in the sense that the health care provider enters into contract with the MCOs to render services to the beneficiaries. However - PPO's charge a higher premium than HMO's in exchange for more flexibility and more options






45. 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..






46. 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.






47. 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






48. 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.






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






50. 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







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