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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. 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






2. represents Exemption from the use of modifier -51






3. The main term in the index may by followed by terms within parenthesis.






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






5. A chronological account of the development of the complaint from the first sign or symptom that the patient experienced to the present






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'.






8. Upper jaw bone






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.






10. Contains complete - necessary information - but is incorrect or illogical in some way.






11. amphiathroses are joints joined together by cartilage that is slightly moveable - such as the vertebrae of the spine or the pubic bone.






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






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






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






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.






16. Is one who has no contract with the health insurance plan.






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






18. Indicates add-on codes






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






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






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.






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.






23. open sore on the skin or mucous






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.






25. This modifier is used when the same procedure is performed on a mirror-image part of the body..






26. Groove or crack like sore






27. A pregnant woman who has had at least one previous pregnancy.






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






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






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






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






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






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






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.






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:






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






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






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.






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.






42. forms the two lower sides of the cranium.






43. The fractured area of bone collapses on itself.






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






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






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






47. Mild or controlled hypertension and no damage to the vascular system or organs.






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.






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






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