Test your basic knowledge |

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. 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






2. Is made up of the shoulder - collar - pelvic and arms and legs






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






4. 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






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






6. 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






7. 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.






8. A medical record is documentation on the patient's social and medical history - family history - physical examination findings - progress notes - radiology and lab results - consultation reports and correspondence to patient.






9. - 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






10. major skin pigment






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






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






13. 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:






14. Families - pregnant women - and children ;Aid to Families with Dependent Children (AFDC)-related groups ;Non-AFDC pregnant women and children;Aged and disabled persons ;Supplemental Security Income (SSI)-related groups ;Qualified Medicare Beneficiari






15. Are conditions - situations - and services not covered by the insurance carrier.






16.






17. 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






18. 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






19. 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.






20. 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






21. 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






22. Groove or crack like sore






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






24. A fracture of the epiphyseal plate in children.






25. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.






26. male of household is primary payer






27. forms the back of the skull. There is a large hole at the ventral surface in this bone - called the foramen magnum - which allows the brain communication with the spinal cord






28. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.






29. - 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.






30. 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.






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






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






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






34. 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






35. paired bones at the corner of each eye that cradle the tear ducts.






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






37. 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.






38. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.






39. Lower portion of the pelvic bone






40. 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.






41. Upper jaw bone






42. Is the lower medial arm bone.






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






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






45. 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.






46. Is when two insurance companies work together to coordinate payment of the benefits.






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






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






49. 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).






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