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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. Groove or crack like sore






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






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






4. The break of the distal end of the radius at the epiphysis often occurs when the patient has attempted to break his or her fall.






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






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






7. Poisoning cannot be determined whether intentional or accidental.






8. 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






9. 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.






10. Noninvasive - non-spreading - nonmalignant






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






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






13. Poisoning cannot be determined whether intentional or accidental.






14. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.






15. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called






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






17. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe






18. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.






19. Small collection of clear fluid;blister






20. This is the traditional method used by providers for submission of charges to insurance companies. The most commonly used form is the CMS-1500. Few plans still accept the physician's encounter form or superbill and Medicare will only accept claims on






21. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances






22. 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






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






24. 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.


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






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






27. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t






28. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.






29. 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






30. 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






31. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.






32. 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






33. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services






34. 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).






35. 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.






36. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t






37. Is an electronic or paper-based report of payment sent by the payer to the provider.






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






39. 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






40. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.






41. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.






42. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.






43. 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






44. In July 2001 - the Health Care Financing Administration (HCFA) became the Centers for Medicare & Medicaid Services (CMS) - and the universal claim form HCFA-1500 became the CMS-1500.Virtually all third-party payers will accept it - and Medicare requ






45. 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






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






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






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






49. Benign growth extending from the surface of the mucous membrane






50. Indicates add-on codes