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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 is the index for the E codes.It classifies - in alphabetical order - environmental events and other conditions as the cause of injury and other adverse effects.
Add-on codes
Vomer
Employer Identification Number (EIN)
Section 3 Index to External Causes of Injury (E codes)
2. 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.
-32 - Mandated Services
Hypertension Table
phalanges (phalanx.s)
Keratin
3. 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.
lunula
Pathologic
triangle (a
Advance Beneficiary Notice
4. 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
Lacrimal bones
Radius
Alphabetic Index (Volume 2)
-51 - Multiple Procedures
5. 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.
National Correct Coding Initiative (NCCI)
Preferred Provider Organization (PPO)
Nonparticipating physician
Physician
6. Forms the anterior part of the skull and the forehead
Section 3 Index to External Causes of Injury (E codes)
Salter-Harris
Frontal Bone
MEDICAID COVERAGE
7. 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
Coordination of Benefits (COB)
Evaluation and Management Review
Location Methods
8. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Malignant
MEDICARE Part A
-26 - Professional Component
9. Various terms are used to describe the state of submitted forms. The following are some of the terms that are typically used by insurance carriers.
Medicare Claim Status
Deductible
Pre-paid Health Plan
Sebaceous glands
10. Is a working diagnosis which is not yet established.
Sub classification
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Qualified diagnosis
Employer Identification Number (EIN)
11. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.
HCPCS Level I codes
Health Maintenance Organization (HMO)
-90 - Reference (Outside) Laboratory
Impetigo
12. Is the process of converting diagnoses - procedures - and services into numeric and alphanumeric characters.
Coding
Group Insurance
Nodule
Categorically needy -MEDICAID
13. Poisoning cannot be determined whether intentional or accidental.
Undetermined
Primary malignancy
Medicare
Location Methods
14. An accelerated - severe form of hypertension with vascular damage and a diastolic pressure of 130mmHg or greater.
Complicated
Malignant
Pre-determination
Established Patient
15. Forms the anterior part of the skull and the forehead
Frontal Bone
Medicare
stand-alone codes
axial skeleton
16. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
essential modifiers
False ribs
Two triangular symbols (a
Impetigo
17. There are also terms indented two spaces to the right below the main term called subterms. These subterms are because they have bearing in the selection of the right code. Everything in the Index is listed by condition - that is - diagnosis - signs -
Neoplasm Table
essential modifiers
Electronic Claim
Invalid claim
18. Is a patient who receives treatment in any of the following settings: physician's office ;hospital clinic - emergency department - hospital same-day surgery unit - ambulatory surgical center ( patient is released within 23 hours) ;hospital admission
Hypertension Table
-51 - Multiple Procedures
Outpatient
Rejected claim
19. Is one who has no contract with the health insurance plan.
Peer Review Organization (PRO)
Nonparticipating physician
nonessential modifiers
Flat bones
20. 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
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
HCPCS Level II codes (National Codes)
Fiscal Intermediary
False Claims Act (FCA)
21. The bone is broken and pierces an internal organ
Preferred Provider Organization (PPO)
Complicated
Patient Confidentiality
Personal Insurance
22. A neoplasm is identified; however - no nature of the tumor is documented in the diagnosis or medical record.
Unspecified nature
Short bones
Chapters
MEDICAID COVERAGE
23. Represent services and procedures widely used by many health care professionals in clinical practice in multiple locations and have been approved by the FDA.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Category I Codes CPT
Compression fracture
Modifiers
24. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
-32 - Mandated Services
Sub classification
Musculoskeletal System
Hairline
25. Structural protein found in the skin and connective tissue
Pubic bone
Provider Identification Number (PIN)
False ribs
Collagen
26. Law passed by the federal government to prosecute cases of Medicaid fraud.
Physician
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Explanation of Benefits (EOB)
Civil Monetary Penalties Law (CMPL)
27. Deals with the prevention of healthcare fraud and abuse of patients on Medicare and Medicaid.
Lipocyte
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Maxilla
Health Insurance Portability and Accountability Act (HIPAA)
28. 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)
The St. Anthony Relative Value for Physicians (RVP)
encounter form
appendicular skeleton .
29. The spinal /vertebral column is divided into five regions from the neck to the tailbone. There are 26 bones in the spine and they are referred to as the vertebrae. The following list explains the bones of the spine: Cervical -Neck Bones -Thoracic -U
Patient Confidentiality
Spinal/Vertebral Column
There are two types of sweat glands
circle with a line through it)
30. Represents a change in the code description since the last edition. The change may be minor or significant and it could be an addition - deletion or revision.
Health Insurance Portability and Accountability Act (HIPAA)
Sebaceous glands
triangle (a
Accident
31. 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.
Pre-determination
TRICARE
Pre-authorization
Secondary malignancy
32. Typically not used on the claim form unless the provider does not have an EIN.
Retention of Medical Records
Section 3 Index to External Causes of Injury (E codes)
Albino
Social Security Number
33. 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
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34. Is a cumulative out-of-pocket amount that must be paid annually by the policyholder before benefits will be paid by the insurance company.
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Performing Provider Identification Number (PPIN)
Deductible
-99 - Multiple Modifiers
35. 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.
Sections
Colles
Clearinghouse
Carcinoma (Ca) in situ
36. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Fiscal Intermediary
Modifiers
Remittance Advice
Abuse
37. Pre-determined set of benefits covered under one set annual fee.
Sub classification
encounter form
Two triangular symbols (a
Pre-paid Health Plan
38. This is a set of information the physician gathers from the patient regarding the following:
History
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
New Patient
Polyp
39. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.
eponychium
Coding
The Integumentary System
Peer Review Organization (PRO)
40. Unlike the RBRVS - the RVP has no geographic adjustment factor or individual RVU component to calculate. However - for each category of procedures - a separate conversion factor must be developed....
The St. Anthony Relative Value for Physicians (RVP)
Employee Liability
Qualified diagnosis
Undetermined
41. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.
Salter-Harris
Preferred Provider plan
The Good Samaritan Act
-99 - Multiple Modifiers
42. Is the federal government's health insurance program created by the Social Security Act of 1965 titled 'Health Insurance for the Aged and Disabled'. It is administered by the Centers for Medicare and Medicaid Services (CMS) - formerly known as Health
Medicare
Peer Review Organization (PRO)
CPT SECTIONS.
Invalid claim
43. A pregnant woman who has had at least one previous pregnancy.
Deductible
Multigravida
true ribs
essential modifiers
44. A physician has a separate PPIN for each group office/clinic in which he or she practices. In the Medicare program - in addition to a group number - each member of a group is issued an 8-character performing provider identification number.
Performing Provider Identification Number (PPIN)
Consultation
Undetermined
Wheal
45. Small collection of clear fluid;blister
Unauthorized benefit
Pre-determination
Pre-paid Health Plan
Vesicle
46. Is a brief statement describing the symptom - problem - diagnosis - or condition that is the reason a patient seeks medical care.
Unspecified nature
Sphenoid Bones
MEDICAID COVERAGE
Chief complaint
47. The reason the patient came to see the physician.
MEDICARE Part A
Chief complaint (CC)
New Patient
Musculoskeletal System
48. Is defined as someone who has received medical services with in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice.
Tabular List (Volume 1)...
Limited ROM
Established Patient
Malignant
49. .. lower jaw bone.
A plus sign (+)
true ribs
co-payment
Mandible
50. the bone is broken and the ends are driven into each other.
circle with a line through it)
Unique Provider Identification Number (UPIN)
Impacted
Clean claim
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