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Test your basic knowledge |
Medical Billing And Coding Vocab
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Subject
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medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
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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. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
-90 - Reference (Outside) Laboratory
Add-on codes
-99 - Multiple Modifiers
Civil Monetary Penalties Law (CMPL)
2. Is also called the superbill; it is a listing of the diagnoses - procedures - and charges for a patient's visit.
encounter form
circle with a line through it)
Medical Records
Comminuted fracture
3. 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
Medicare Claim Status
Disability insurance
National Correct Coding Initiative (NCCI)
Humerus
4. 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
Commercial Carriers
Vomer
Fiscal Intermediary
Assault
5. Is the type of plan a patient may have where they can see providers outside their plan. The patient is responsible to pay the higher portion of the fee.
Health practitioner
Medically needy
-51 - Multiple Procedures
Preferred Provider plan
6. Numbers 1-7 - attach directly to the sternum in the front of the body.
Vomer
Employer Liability
true ribs
Suicide Attempt
7. Further classified as to primary - secondary - or carcinoma in situ.
Pelvis
Malignant
MEDICAID COVERAGE
The St. Anthony Relative Value for Physicians (RVP)
8. 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
Pre-certification
State License Number
Category II Codes CPT
Location Methods
9. Are supplemental codes used for performance measurements. Although these codes are intended to facilitate data collection about the quality of care - their use is optional. Category II codes are published twice a year: January 1st and July 1st.
Fraud
Complicated
Category II Codes CPT
Collagen
10. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
Spinal/Vertebral Column
Multigravida
Category I Codes CPT
phalanges (phalanx.s)
11. Lower portion of the pelvic bone
Mutually Exclusive Edits
upper appendicular skeleton
Alopecia
Ischium
12. open sore on the skin or mucous
Ulcermembranes
Musculoskeletal System
MEDICARE Part C
Unspecified nature
13. .. lower jaw bone.
Patient Confidentiality
Malignant
phalanges (phalanx.s)
Mandible
14. - 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.
Occipital Bone
Unauthorized benefit
upper appendicular skeleton
Nonparticipating physician
15. uncertain whether benign or malignant; borderline malignancy
-32 - Mandated Services
Subcategories
Carpals
Uncertain behavior
16. 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
The Current Procedural Terminology (CPT)
Ulcermembranes
Coordination of Benefits (COB)
Preferred Provider Organization (PPO)
17. Poisoning cannot be determined whether intentional or accidental.
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Benign
A plus sign (+)
Undetermined
18. solid - round or oval elevated lesion more than 1 cm in diameter
National Correct Coding Initiative (NCCI)
Sesamoid bones
Unspecified nature
Nodule
19. Pre-determined set of benefits covered under one set annual fee.
lunula
Qualified diagnosis
Pre-paid Health Plan
Benign (hypertension)
20. 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.'
Medical necessity
Clean claim
Outpatient
Employer Liability
21. 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.
Pre-determination
Medical Records
Medicare Claim Status
Two triangular symbols (a
22. 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.
Pelvis
Category III Codes CPT
Electronic Claim
MEDICARE Part A
23. Is an entity that receives transmissions of claims from physicians' offices - separates the claims by carriers and performs software edits on each claim to check for errors. Once this process is complete - the claim is then sent to the proper insuran
Ulcermembranes
nonessential modifiers
Gangrene
Clearinghouse
24. 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
Ischium
Temporal Bone
Birthday rule
Pre-certification
25. The reason the patient came to see the physician.
Coding
Chief complaint (CC)
Past - family and social history (PFSH)
Malignant
26. Is the upper arm bone.
Humerus
Past - family and social history (PFSH)
Evaluation and Management Review
HCPCS Level II codes (National Codes)
27. the bone is crushed and or shattered.
Comminuted fracture
Eligibility
Coding
Undetermined
28. is defined as one who has not received any medical services within the last three years.
New Patient
premium
Melanin
Coinsurance
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
-32 - Mandated Services
Group Insurance
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Benign
30. 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
Civil Monetary Penalties Law (CMPL)
Occipital Bone
Medical Records
Exclusions and Limitations
31. is a traumatic injury to a joint involving the soft tissue.
Subcategories
Secondary malignancy
Established Patient
sprain
32. Is a state-required insurance plan - the coverage of which provides benefits to employees and their dependents for work related injury - illness or death. Each state has an established minimum number of employees required before this law comes into e
Workers Compensation
Disability insurance
Peer Review Organization (PRO)
Pathologic
33. forms the roof of the nasal cavity.
Ethmoid Bone
Medical Records
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Health Care Financing Administration Common Procedure Coding System
34.
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Lacrimal bones
-26 - Professional Component
Accident
35. death of tissue associated with loss of blood supply
Benign
Modifiers
Gangrene
Indemnity Insurance
36. Is a percentage of the cost of covered services that a policyholder or a secondary insurance pays. A common payment percentage for coinsurance is 80/20 which indicates that 20% is the coinsurance for which the beneficiary or secondary insurance is re
Peer Review Organization (PRO)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Workers Compensation
Coinsurance
37. contains errors or omissions. Usually - these claims do not pass front-end edits. They are either processed manually for resolving problems - or rejected for payment.
Dirty claim
Employer Liability
Fissure
Group Provider Number
38. 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.
-26 - Professional Component
The Patient Care Partnership (Patient's Bill of Rights)
Categorically needy -MEDICAID
Health Insurance Portability and Accountability Act (HIPAA)
39. Superior and widest bone
Rejected claim
The St. Anthony Relative Value for Physicians (RVP)
Pelvis
Electronic Claim
40. 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
Hairline
The St. Anthony Relative Value for Physicians (RVP)
The Current Procedural Terminology (CPT)
Preferred Provider Organization (PPO)
41. Includes - but is not limited to - physician assistant - certified nurse-midwife - qualified psychologist - nurse practitioner - clinical social worker - physical therapist - occupational therapist - respiratory therapist - certified registered nurse
ulna
Category I Codes CPT
MEDICAID COVERAGE
Health practitioner
42. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients
HCPCS Level I codes
Social Security Number
Neoplasm Table
Full ROM
43. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Nonparticipating physician
Medically needy
Suicide Attempt
44. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Sections
-50 - Bilateral Procedure
Group Provider Number
Fiscal Intermediary
45. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Peer Review Organization (PRO)
Gender rule
Category II Codes CPT
HCPCS Level I codes
46. forms the roof of the nasal cavity.
Pelvis
stand-alone codes
There are three layers to the skin
Ethmoid Bone
47. .. lower jaw bone.
Benign
Mandible
Group Insurance
Full ROM
48. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.
Rejected claim
Civil Monetary Penalties Law (CMPL)
Carpals
Complicated
49. Are composed of three-digit codes representing a single disease or condition.
Comminuted fracture
Categories
-32 - Mandated Services
Categorically needy -MEDICAID
50. Smooth - slightly elevated - edematous(swollen) area that is redder or paler than the surrounding skin.
Add-on codes
Physician
Chapters
Wheal