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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. 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






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






3. Is the qualifying factor or factors that must be met before a patient receives benefits.






4. 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






5. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.






6. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi






7. Under this schedule - a procedure's relative value is the sum total of three elements: Work: represents the amount of time - intensity of effort - and medical skill required of the physician. Overhead: practice costs related to the performing of the

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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.






9. open sore on the skin or mucous






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






11. Created the Health Care Fraud and Abuse Control Program enacted to check for fraud and abuse in the Medicare and Medicaid programs - and private payers.






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






13. This modifier is used when: more than one procedure is performed during the same surgical episode; one code does not describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure. The followin






14. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.






15. 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.






16. 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.






17. 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






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






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






20. 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






21. This is not specified as benign or malignant in the diagnosis or medical record.






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






23. 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






24. 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.






25. 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.






26. This modifier is used when: more than one procedure is performed during the same surgical episode; one code does not describe all of the procedures performed; and the secondary procedure is not minor or incidental to the major procedure. The followin






27. All patients have a right to privacy and all information should remain privileged. Discuss patient information only with the patient's physician or office personnel that need certain information to do their job. Obtain a signed consent form to releas






28. Superior and widest bone






29. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of






30. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u






31. the bone is broken and the ends are driven into each other.






32. .. lower jaw bone.






33. Is a fee that is charged for each procedure or service performed by the physician. This fee is obtained from a fee schedule - which is a list of charges or allowance that have accepted for specific medical services. The system in which fee schedules






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






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






36. Upper jaw bone






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. 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






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






40. Discolored - flat lesion (freckles - tattoo marks)






41. Also known as Federal tax identification number. This is issued by the Internal Revenue Service






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






43. 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






44. Is a policy that covers losses to a third party caused by the insured - by an object owned by the insured - or on premises owned by the insured. Liability insurance claims are made to cover the cost of medical care for traumatic injuries - lost wages






45. Number assigned to the physician by Medicare program.






46. 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.






47. 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.






48. 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.






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.






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