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Test your basic knowledge |
Medical Billing And Coding Vocab
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Subject
:
medical-transcription
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. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Group practice
bullet (a
Unspecified nature
Add-on codes
2. 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
There are three layers to the skin
Category III Codes CPT
National Correct Coding Initiative (NCCI)
Section 3 Index to External Causes of Injury (E codes)
3. Forms the sides of the cranium
Medical necessity
Group Provider Number
Eligibility
Parietal Bones
4. Lower portion of the pelvic bone
Ischium
History of present illness (HPI)
Lipocyte
Fee-for-Service
5. Provide the means by which the reporting physician can indicate that a service or procedure that has been performed has been altered by some specific circumstance but not changed in its definition or code.
Commercial Carriers
Malignant
Rejected claim
Modifiers
6. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Medical necessity
Categorically needy -MEDICAID
Accept assignment
The Good Samaritan Act
7. Are conditions - situations - and services not covered by the insurance carrier.
Accept assignment
Exclusions and Limitations
Accident
Employer Identification Number (EIN)
8. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.
Coordination of Benefits (COB)
Personal Insurance
Health Care Financing Administration Common Procedure Coding System
Keratin
9. 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.
Multigravida
Paper Claim
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Unauthorized benefit
10. 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.
phalanges (phalanx.s)
New patient
A plus sign (+)
Social Security Number
11. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
sprain
Unspecified nature
Patient Confidentiality
The Good Samaritan Act
12. Consists of the skull - rib cage - and spine
true ribs
axial skeleton
Vesicle
Keratin
13. 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
Indemnity Insurance
Accept assignment
Preferred Provider Organization (PPO)
Lacrimal bones
14. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported
Alphabetic Index (Volume 2)
Fissure
Temporal Bone
Unlisted Procedures Procedures
15. 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
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Consultation
False Claims Act (FCA)
Established patient
16. 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.
Nonparticipating physician
Qualified diagnosis
Accept assignment
Group practice
17. Is one who has no contract with the health insurance plan.
Palatine bones
Nonparticipating physician
Established Patient
Medically needy
18. the bone is crushed and or shattered.
Unspecified nature
-26 - Professional Component
Comminuted fracture
ulna
19. Codes from the CPT codebook are used to report services and procedures by physicians. It is published and updated annually by the American Medical Association (AMA) with a new one coming out each November and becoming effective on January 1st of the
Coinsurance
The Current Procedural Terminology (CPT)
Inpatient
Established Patient
20. 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
Location Methods
Clearinghouse
Past - family and social history (PFSH)
Mandible
21. Used for procedures that is always performed during the same operative session as another surgery in addition to the primary service/procedure and is never performed separately.
Outpatient
Add-on codes
There are two types of sweat glands
Past - family and social history (PFSH)
22. Numbers 1-7 - attach directly to the sternum in the front of the body.
lunula
Benign
true ribs
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
23. Is defined by Medicare as 'the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury.'
Lipocyte
Established patient
Retention of Medical Records
Medical necessity
24. Noninvasive - non-spreading - nonmalignant
Participating physician
Benign
Subcategories
-32 - Mandated Services
25. 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.
true ribs
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Coinsurance
New patient
26. Lower portion of the pelvic bone
nonessential modifiers
Medigap (Medicare Supplemental Insurance)
Ischium
Contracted Rates with MCOs
27. 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
Consultation
-50 - Bilateral Procedure
stand-alone codes
Outpatient
28. This is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.
Long bones
Section 3 Index to External Causes of Injury (E codes)
New Patient
Fee Schedule
29. 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.
Remittance Advice
-99 - Multiple Modifiers
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
30. is a traumatic injury to a joint involving the soft tissue.
Advance Beneficiary Notice
sprain
Short bones
Nonparticipating physician
31. 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
Spinal/Vertebral Column
Modifiers
Pre-determination
Mutually Exclusive Edits
32. 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
MEDICAID COVERAGE
Unspecified nature
Capitated Rates
TRICARE
33. The reason the patient came to see the physician.
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Chief complaint (CC)
bullet (a
Mandible
34. open sore on the skin or mucous
Clearinghouse
nonessential modifiers
Ulcermembranes
appendicular skeleton .
35. Knowingly and intentionally deceiving or misrepresenting information that may result in unauthorized benefits is known as fraud.. Common forms of fraud are billing for services not furnished - unbundling - and misrepresenting diagnosis to justify pay
Fraud
Dirty claim
Impacted
Workers Compensation
36. This is not specified as benign or malignant in the diagnosis or medical record.
Unspecified (hypertension)
Category II Codes CPT
essential modifiers
Pathologic
37. 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
Evaluation and Management Review
Carpals
Group Provider Number
Contracted Rates with MCOs
38. 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
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Category III Codes CPT
Sphenoid Bones
Preferred Provider plan
39. 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
Health Maintenance Organization (HMO)
A plus sign (+)
Fraud
Blue Cross/Blue Shield Plans
40. 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.
Spinal/Vertebral Column
Medicaid
Inferior nasal conchae
essential modifiers
41. A pregnant woman who has had at least one previous pregnancy.
Multigravida
Medicare
HCPCS Level II codes (National Codes)
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
42. 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
Inferior nasal conchae
Electronic Claim
Point-of-Service plan (POS)
Group practice
43. A fracture of the epiphyseal plate in children.
Salter-Harris
Primary malignancy
Rejected claim
Eligibility
44. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Unauthorized benefit
Mutually Exclusive Edits
Full ROM
Unique Provider Identification Number (UPIN)
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
Sub classification
Contracted Rates with MCOs
MEDICARE Part D
Category II Codes CPT
46. 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
Spinal/Vertebral Column
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
eponychium
Commercial Carriers
47. 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
Employer Liability
Unlisted Procedures Procedures
Fraud
Subcategories
48. - 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.
Indemnity Insurance
Personal Insurance
Unauthorized benefit
Sesamoid bones
49. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.
Peer Review Organization (PRO)
Remittance Advice
triangle (a
Group practice
50. Further classified as to primary - secondary - or carcinoma in situ.
Secondary malignancy
Malignant
False Claims Act (FCA)
Eligibility