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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. is referred to as Supplementary Medical Insurance (SMI). This coverage is a supplement to Part A - which covers medical expenses - clinical laboratory services - home health care - outpatient hospital treatment - blood - and ambulatory surgical serv
Electronic Claim
Parietal Bones
itemized statement
MEDICARE Part B
2. represents Exemption from the use of modifier -51
circle with a line through it)
Secondary malignancy
Subcategories
-26 - Professional Component
3. The main term in the index may by followed by terms within parenthesis.
-50 - Bilateral Procedure
Alphabetic Index (Volume 2)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
State License Number
4. Forms the anterior part of the skull and the forehead
Electronic Claim
Frontal Bone
-50 - Bilateral Procedure
Indemnity Insurance
5. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present
Social Security Number
History of present illness (HPI)
Birthday rule
Nonparticipating physician
6. Was developed to promote the interests and well being of the patients and residents of the healthcare facility. This bill has still not become a law.
7. Is a requirement for some health insurance plans to obtain permission for a service or procedure before it is done. It indicates that a specific procedure or service is deemed 'medically necessary'.
Electronic Claim
Pre-authorization
Assault
Patient Confidentiality
8. Upper jaw bone
Humerus
Birthday rule
Maxilla
Full ROM
9. Are small - rounded bones that resemble a sesame seed. They are found near joints and increase the efficiency of muscles near a joint. An example of sesamoid bone is the knee cap.
Sesamoid bones
Past - family and social history (PFSH)
Established patient
Group practice
10. Contains complete - necessary information - but is incorrect or illogical in some way.
Social Security Number
Blue Cross/Blue Shield Plans
There are three layers to the skin
Invalid claim
11. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.
Limited ROM
Explanation of Benefits (EOB)
Pubic bone
Health Insurance Portability and Accountability Act (HIPAA)
12. 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
Evaluation and Management Review
Zygoma
encounter form
Albino
13. 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
-50 - Bilateral Procedure
Complicated
Blue Cross/Blue Shield Plans
False ribs
14. 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
False Claims Act (FCA)
Fraud
Reasons for Documentation
Relative Value Payment Schedules Method
15. 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.
Eligibility
-32 - Mandated Services
-51 - Multiple Procedures
Medical Records
16. Is one who has no contract with the health insurance plan.
Unlisted Procedures Procedures
Nonparticipating physician
Pre-certification
bullet (a
17. This modifier is used to explain that the procedure or service done during a postoperative period was planned at the time of the original procedure. This is also used if a therapeutic procedure is performed because of the findings from a diagnostic p
Albino
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
National Correct Coding Initiative (NCCI)
18. Indicates add-on codes
Outpatient
A plus sign (+)
Subcategories
Unspecified (hypertension)
19. Identifies code pairs that - for clinical reason - are unlikely to be performed on the same patient on the same day.
Compression fracture
Mutually Exclusive Edits
Categories
Greenstick
20. 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
eponychium
Coding
Eligibility
Accident
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.
Medical Records
-99 - Multiple Modifiers
Electronic Claim
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
22. 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
Medical necessity
Established Patient
Column 1/Column 2 (previously called Comprehensive/Component) Edits
23. open sore on the skin or mucous
Fraud
Ulcermembranes
Spinal/Vertebral Column
A plus sign (+)
24. 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.
Collagen
Preferred Provider plan
Mutually Exclusive Edits
Colles
25. This modifier is used when the same procedure is performed on a mirror-image part of the body..
Chapters
-50 - Bilateral Procedure
Melanin
Reasons for Documentation
26. Groove or crack like sore
No ROM
Chief complaint
Fissure
History
27. A pregnant woman who has had at least one previous pregnancy.
-51 - Multiple Procedures
Maxilla
Multigravida
Musculoskeletal System
28. Represents a new procedure or service code added since the previous edition of the manual.
appendicular skeleton .
Medicare
Liability insurance
bullet (a
29. 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
Remittance Advice
Rejected claim
False ribs
Surgical Package
30. 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
Fissure
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Blue Cross/Blue Shield Plans
Section 3 Index to External Causes of Injury (E codes)
31. 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
32. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Carcinoma (Ca) in situ
Radius
Health Care Financing Administration Common Procedure Coding System
Ethmoid 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
Ethmoid Bone
Group practice
Nodule
Fee-for-Service
34. the bone is broken and the ends are driven into each other.
Remittance Advice
Carcinoma (Ca) in situ
stand-alone codes
Impacted
35. Are codes formulated thru the joint efforts of the CMS - the Health Insurance Association of America - and the Blue Cross and Blue Shield Association. Level II contains five position alpha-numeric codes for physician and non-physician services not fo
New patient
Radius
No ROM
HCPCS Level II codes (National Codes)
36. 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.
Accept assignment
Pubic bone
Mutually Exclusive Edits
Pre-determination
37. 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:
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Medically needy
Hypertension Table
New Patient
38. Forms the anterior part of the skull and the forehead
-90 - Reference (Outside) Laboratory
History
Frontal Bone
eponychium
39. The physician must obtain this number in order to practice within a state.
Benign
State License Number
Spinal/Vertebral Column
Unique Provider Identification Number (UPIN)
40. 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.
Category II Codes CPT
Maxilla
MEDICARE Part C
Sub classification
41. 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.
Physician
Malignant
Category II Codes CPT
Chief complaint
42. forms the two lower sides of the cranium.
Electronic Claim
Civil Monetary Penalties Law (CMPL)
Long bones
Temporal Bone
43. The fractured area of bone collapses on itself.
Keratin
Compression fracture
Invalid claim
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
44. Is made up of the shoulder - collar - pelvic and arms and legs
appendicular skeleton .
Long bones
Wheal
co-payment
45. 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
Exclusions and Limitations
Past - family and social history (PFSH)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
true ribs
46. 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
Benign (hypertension)
Exclusions and Limitations
-99 - Multiple Modifiers
Palatine bones
47. Mild or controlled hypertension and no damage to the vascular system or organs.
Contracted Rates with MCOs
Benign (hypertension)
eponychium
Macule
48. 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.
The Patient Care Partnership (Patient's Bill of Rights)
Pre-paid Health Plan
Invalid claim
-32 - Mandated Services
49. 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
Occipital Bone
Long bones
Categorically needy -MEDICAID
Inpatient
50. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Category III Codes CPT
Coding
Flat bones
Employer Identification Number (EIN)