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Test your basic knowledge |
Medical Billing And Coding Vocab
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Subject
:
medical-transcription
Instructions:
Answer 50 questions in 15 minutes.
If you are not ready to take this test, you can
study here
.
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 a service performed by a physician whose opinion or advice is requested by another physician in the evaluation or treatment of a patient's illness or suspected problem. The consultant does not assume responsibility for the patient's care and must
Consultation
Subcategories
Fissure
Benign (hypertension)
2. 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.'
-51 - Multiple Procedures
Unspecified (hypertension)
Alopecia
Medical necessity
3. 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.
Capitated Rates
Radius
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
Pre-authorization
4. This is located in the Index under the main term 'Neoplasm' and is organized by anatomic site. Each site has six columns with six possible codes determined by whether the neoplasm is malignant - benign - of uncertain behavior - or of unspecified natu
Disability insurance
Pelvis
Radius
Neoplasm Table
5. 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
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Mutually Exclusive Edits
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Occipital Bone
6. means the provider agrees to accept what the insurance company approves as payment in full for the claim.
Established patient
Accept assignment
Consultation
Salter-Harris
7. Pre-determined set of benefits covered under one set annual fee.
Blue Cross/Blue Shield Plans
No ROM
Vesicle
Pre-paid Health Plan
8. 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.
Add-on codes
Compression fracture
Salter-Harris
Clearinghouse
9. The poisoning was self-inflicted.
Suicide Attempt
Category I Codes CPT
Inpatient
Accident
10. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Contracted Rates with MCOs
Greenstick
Unspecified (hypertension)
11. Small collection of clear fluid;blister
Rib Cage
Paper Claim
Medicare Claim Status
Vesicle
12. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
triangle (a
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Tabular List (Volume 1)...
The St. Anthony Relative Value for Physicians (RVP)
13. Are supplementary classification codes used to identify health care encounters that occur for reasons other than illness or injury or to identify patients whose illness is influenced by special circumstances or problems. The codes can be found in bot
Deductible
ulna
Relative Value Payment Schedules Method
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
14. There are 12 pairs of ribs. The first 7 pairs join the sternum anteriorly through cartilaginous attachments called costal cartilages.
Full ROM
Rib Cage
Disability insurance
Medical Records
15. Most billing-related cases are based on HIPAA and False Claims Act.
The Integumentary System
Spinal/Vertebral Column
Compliance Regulations
State License Number
16. 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
Health practitioner
MEDICAID COVERAGE
Radius
Paper Claim
17. Is when two insurance companies work together to coordinate payment of the benefits.
Nodule
Coordination of Benefits (COB)
Deductible
Invalid claim
18. Has all required fields accurately filled out - contains no deficiencies and passes all edits. The carrier does not require investigation outside of the carrier's operation before paying the claim.
Flat bones
Chapters
Preferred Provider Organization (PPO)
Clean claim
19. This is the traditional method used by providers for submission of charges to insurance companies. The most commonly used form is the CMS-1500. Few plans still accept the physician's encounter form or superbill and Medicare will only accept claims on
Paper Claim
-26 - Professional Component
Relative Value Payment Schedules Method
Limited ROM
20. Further classified as to primary - secondary - or carcinoma in situ.
Malignant
-51 - Multiple Procedures
Exclusions and Limitations
Hypertension Table
21. 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
Carcinoma (Ca) in situ
Paper Claim
bullet (a
Accident
22. Discolored - flat lesion (freckles - tattoo marks)
Comminuted fracture
Vomer
Macule
History
23. open sore on the skin or mucous
Impacted
-32 - Mandated Services
The Good Samaritan Act
Ulcermembranes
24. Is a statement of the patient's account history - showing dates of service - detailed charges - payments (i.e. deductibles and co-pays) - the date the insurance claim was submitted - applicable adjustments and account balance.
Long bones
Suicide Attempt
Evaluation and Management Review
itemized statement
25. 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
CPT SECTIONS.
Employer Liability
ligaments
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
26. numbers 8-10 - are attached to the sternum by cartilage
False ribs
Medical Records
Limited ROM
Surgical Package
27. 'Errors and omissions insurance' is protection against loss of monies caused by failure through error or unintentional omission on the part of the individual or service submitting the insurance claim. Some physicians' contract with a billing service
Sections
Unauthorized benefit
Peer Review Organization (PRO)
Employee Liability
28. Medically indigent low-income individuals and families ;Low-income persons losing employer health insurance coverage ( Medicaid purchase of COBRA coverage)
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Medicaid
Medically needy
Evaluation and Management Review
29. 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
Malignant
Commercial Carriers
Employer Identification Number (EIN)
Health Maintenance Organization (HMO)
30. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
Hairline
Zygoma
Medicaid
Peer Review Organization (PRO)
31. 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
Radius
Carpals
Abuse
32. Identifies code pairs that should not be billed together because one code (Column 1) includes all the services described by another code (Column 2).
Mandible
No ROM
Column 1/Column 2 (previously called Comprehensive/Component) Edits
Group practice
33. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Evaluation and Management Review
State License Number
Carcinoma (Ca) in situ
Abuse
34. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
Employer Identification Number (EIN)
Clearinghouse
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
Established Patient
35. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)
Full ROM
Greenstick
MEDICARE Part B
sprain
36. Make up part of the interior of the nose.
Coordination of Benefits (COB)
Inferior nasal conchae
No ROM
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
37. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.
essential modifiers
There are two types of sweat glands
Unspecified nature
Category II Codes CPT
38. Mild or controlled hypertension and no damage to the vascular system or organs.
Physician
Chief complaint (CC)
essential modifiers
Benign (hypertension)
39. These parenthetic terms are called because their presence or absence does not have an effect on the selection of the code listed for the main term.
Review of Systems (ROS)
Lacrimal bones
nonessential modifiers
Group practice
40. Retention of medical records is governed by state and local laws and may vary from state-to-state. Most physicians are required to retain records indefinitely; deceased patient records should be kept for at least five (5) years.
Retention of Medical Records
Coding
Indemnity Insurance
Two triangular symbols (a
41. 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
MEDICARE Part B
Tabular List (Volume 1)...
Uncertain behavior
HCPCS Level II codes (National Codes)
42. 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.
Impacted
Established patient
Unspecified (hypertension)
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
43. Represents a new procedure or service code added since the previous edition of the manual.
bullet (a
Indemnity Insurance
Sphenoid Bones
Explanation of Benefits (EOB)
44. 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
Wheal
-26 - Professional Component
MEDICARE Part B
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
45. Are located in the dermal layer of the skin over the entire body - except for the palms of the hands and soles of the feet. The sebaceous glands secrete an oily substance called sebum. Sebum contains lipids that help lubricate the skin and minimize w
Sebaceous glands
Maxilla
Qualified diagnosis
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
46. Further classified as to primary - secondary - or carcinoma in situ.
There are two types of sweat glands
Consultation
upplementary Classification of Factors Influencing Health Status and Contact with Health Services (V Codes)
Malignant
47. forms the two lower sides of the cranium.
Albino
stand-alone codes
Impacted
Temporal Bone
48. This is the traditional method used by providers for submission of charges to insurance companies. The most commonly used form is the CMS-1500. Few plans still accept the physician's encounter form or superbill and Medicare will only accept claims on
Paper Claim
essential modifiers
Ischium
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
49. 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
Health Maintenance Organization (HMO)
Surgical Package
lunula
Location Methods
50. Standard - fee-for-service - cost-sharing plan ; Extra - preferred provider organization ;Prime - health maintenance organization plan with a point-of-service option All of the above-mentioned plans covered under TRICARE - with the exception of Prime
Vesicle
Peer Review Organization (PRO)
Personal Insurance
TRICARE PLANS