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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. 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.






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






3. are small with irregular shapes. They are found in the wrist and ankle.






4. poisoning was inflicted by another person with intent to kill or injure






5. Upper jaw bone






6. 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.






7. 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






8. - To pay for medical services and items that Medicare does not cover and Medicare's coinsurance and deductibles - beneficiaries may purchase a supplemental insurance. Medigap is a private insurance designed to help pay for those amounts that are typ






9. 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






10. 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






11. 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






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






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






14. 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.






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. The physician must obtain this number in order to practice within a state.






17. open sore on the skin or mucous






18. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:






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






20. found in the Index under the main term 'Hypertension' - and it contains a list of conditions that are due to or associated with hypertension. The table classifies the conditions as:






21. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.






22. 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






23. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.






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






25. the bone is crushed and or shattered.






26. 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






27. 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 -






28. Represents a new procedure or service code added since the previous edition of the manual.






29. 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.






30. The plan of the parent whose birthday falls earlier in the year (month and day - not year) is primary to that whose birthday falls later in the year. If both parents have the same birthday - then the plan of the parent who has had the longest coverag






31. Produce secretions that allow the body to be moisturized or cooled.






32. Is to determine the patient's benefits and the maximum dollar amount that the insurance company will pay. Often the first step of the insurance verification process - it is completed prior to the first visit.






33. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.






34. requires investigation and needs further clarification.






35. Most procedures have both professional (physician) and technical components. This modifier is attached to the procedure to indicate that the physician provided only the professional component.






36. Is a document provided to a Medicare beneficiary by a provider prior to service being rendered letting the beneficiary know of his/her responsibility to pay if Medicare denies the claim.






37. Forms the sides of the cranium






38. male of household is primary payer






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






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






41. 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






42. uncertain whether benign or malignant; borderline malignancy






43. 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






44. 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






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 bone is broken and pierces an internal organ






47. The original cancer site. Malignant tumors are considered primary unless documented as secondary or metastatic.






48. 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.






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






50. Are temporary codes for emerging technology - services and procedures. If a Category III code is available - it is reported instead of a Category I unlisted code.







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