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Medical Billing And Coding Vocab
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medical-transcription
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. Groove or crack like sore
Suicide Attempt
Hairline
Modifiers
Fissure
2. 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
Maxilla
Employer Liability
axial skeleton
Chief complaint (CC)
3. Are conditions - situations - and services not covered by the insurance carrier.
Group Provider Number
Chief complaint
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Exclusions and Limitations
4. 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
Assault
Category I Codes CPT
lunula
5. the bone is broken and the ends are driven into each other.
Social Security Number
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Impacted
Fissure
6. Is when two insurance companies work together to coordinate payment of the benefits.
Coordination of Benefits (COB)
Wheal
phalanges (phalanx.s)
Unspecified nature
7. 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
-51 - Multiple Procedures
Two triangular symbols (a
Alphabetic Index (Volume 2)
Frontal Bone
8. numbers 8-10 - are attached to the sternum by cartilage
Sphenoid Bones
Spinal/Vertebral Column
False ribs
Limited ROM
9. 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.
Temporal Bone
Rejected claim
New patient
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
10. The fractured area of bone collapses on itself.
Personal Insurance
Compression fracture
Add-on codes
Evaluation and Management Review
11. Represent changes in the text or definition between the triangles.
bullet (a
The St. Anthony Relative Value for Physicians (RVP)
Non-covered benefit
Two triangular symbols (a
12. 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.
Medicare Claim Status
-26 - Professional Component
Subcategories
Commercial Carriers
13. the bone is crushed and or shattered.
Comminuted fracture
eponychium
Mutually Exclusive Edits
Column 1/Column 2 (previously called Comprehensive/Component) Edits
14. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Hypertension Table
Salter-Harris
Accident
Employer Identification Number (EIN)
15. The CPT manual is composed of eight sections. Each section begins with guidelines that provide specific coding rules for that section. Guidelines at the beginning of the section are applicable to all codes in the section - while notes that pertain t
Employee Liability
CPT SECTIONS.
Rejected claim
Categorically needy -MEDICAID
16. 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
Location Methods
itemized statement
Pre-authorization
Fee-for-Service
17. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Gender rule
Full ROM
Uncertain behavior
Non-covered benefit
18. Are supplementary classification codes used to describe the reason or external cause of injury - poisoning and other adverse effects. These codes can be found in both Volumes I and II. E codes are used to classify environmental events - circumstances
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Explanation of Benefits (EOB)
Lacrimal bones
Disability insurance
19. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Blue Cross/Blue Shield Plans
Ulcermembranes
Coding
bullet (a
20. 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.
Unlisted Procedures Procedures
Qualified diagnosis
Lacrimal bones
Colles
21. Also called 'global surgery' - includes a variety of services rendered by a surgeon which includes the following: Surgical procedure performed Local infiltration - metacarpal/metatarsal/digital block - or topical anesthesia Preoperative E/M services
Humerus
Radius
Surgical Package
Clearinghouse
22. paired bones at the corner of each eye that cradle the tear ducts.
Hairline
sebaceous(oil) glands and the suddoriferous (sweat) glands
The St. Anthony Relative Value for Physicians (RVP)
Lacrimal bones
23. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..
History of present illness (HPI)
Add-on codes
Health Maintenance Organization (HMO)
Musculoskeletal System
24. This is not specified as benign or malignant in the diagnosis or medical record.
Paper Claim
Unspecified (hypertension)
Pubic bone
true ribs
25. 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.
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Category II Codes CPT
Unspecified nature
CPT SECTIONS.
26. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Compliance Regulations
Health Insurance Portability and Accountability Act (HIPAA)
CPT SECTIONS.
Pre-authorization
27. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Coding
Carcinoma (Ca) in situ
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
HCPCS Level II codes (National Codes)
28. The poisoning was self-inflicted.
Suicide Attempt
Indemnity Insurance
Lacrimal bones
ligaments
29. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Lacrimal bones
Unlisted Procedures Procedures
MEDICARE Part B
Full ROM
30. 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.
Clean claim
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Advance Beneficiary Notice
31. Hair fibers are composed of tightly fused meshwork of cells filled with hard protein called
Categorically needy -MEDICAID
Keratin
Clearinghouse
bullet (a
32. Make up part of the interior of the nose.
Radius
Sebaceous glands
Inferior nasal conchae
Medicaid
33. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Benign (hypertension)
Undetermined
Hairline
Fraud
34. 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
Vesicle
History
Peer Review Organization (PRO)
TRICARE
35. Prescription Drugs The Medicare Prescription Drug - Improvement - and Modernization Act enacted in December 2003 and began implementation in January 2006 where Medicare beneficiaries can enroll in the Medicare prescription drug plan. The beneficiari
Disability insurance
MEDICARE Part D
Multigravida
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
36. Is a working diagnosis which is not yet established.
Deductible
Qualified diagnosis
Albino
Location Methods
37. It is important that every patient seen by the physician has comprehensive legible documentation about the patient's illness - treatment and plans for the following reasons Avoidance of denied or delayed payments by insurance carriers investigating t
Health Maintenance Organization (HMO)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Reasons for Documentation
Fraud
38. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Deductible
There are two types of sweat glands
Fraud
MEDICARE Part D
39. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Flat bones
Fee Schedule
Group Insurance
40. 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
MEDICAID COVERAGE
Birthday rule
Category III Codes CPT
nonessential modifiers
41. 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
National Correct Coding Initiative (NCCI)
Preferred Provider Organization (PPO)
Spinal/Vertebral Column
Performing Provider Identification Number (PPIN)
42. 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
History
Disability insurance
Sesamoid bones
Radius
43. forms the two lower sides of the cranium.
Temporal Bone
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Collagen
Inpatient
44. Represent changes in the text or definition between the triangles.
Primary malignancy
lunula
MEDICARE Part B
Two triangular symbols (a
45. 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
Blue Cross/Blue Shield Plans
-51 - Multiple Procedures
Comminuted fracture
-26 - Professional Component
46. Are composed of three-digit codes representing a single disease or condition.
Preferred Provider plan
Categories
Reasons for Documentation
Unauthorized benefit
47. 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
Personal Insurance
Health practitioner
Sphenoid Bones
Carpals
48. 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.
Undetermined
National Correct Coding Initiative (NCCI)
No ROM
Categories
49. male of household is primary payer
Malignant
Add-on codes
Comminuted fracture
Gender rule
50. Forms the sides of the cranium
Dirty claim
stand-alone codes
Location Methods
Parietal Bones
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