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Medical Billing And Coding Vocab

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. 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






2. 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.






3. The bone is partially bent and partially broken; this is a common fracture in children because their bones are still soft.






4. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.






5. 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.






6. This involves the use of relative value scales which assign a relative weight to individual services according to the basis for the scale. Services that are more difficult - time consuming - or resource intensive to perform typically have higher rela






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






8. HCPCS Reference Manual The CMS assigns a standard unique identifier known as the National Provider Identifier (NPI) The CMS also developed a two-part coding system called the Healthcare Common Procedure Coding System ( HCPCS ) which is a collection o






9. Diathroses are joints that have free movement. Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints. (synovial joints)






10. The Usual - Customary - and Reasonable: The UCR method is used mostly in reference to fee-for-service reimbursement. To arrive at a payment amount for a claim - the carrier compares: The physician's most frequent charge for a given service (the usual






11. poisoning was inflicted by another person with intent to kill or injure






12. Benign growth extending from the surface of the mucous membrane






13. Is a cost-sharing requirement for the insured to pay at the time of service. This amount is usually a specific dollar amount (e.g.. $15 - $20 - $25)






14. 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.






15. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.






16. '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






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. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.






19. represents Exemption from the use of modifier -51






20. 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






21. 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.






22. Upper jaw bone






23. When a group of employees and their dependents are insured under one (1) group policy issued to the employer. Generally - the employer pays the premium or a portion of the premium and the employee pays the difference. This all depends on the type of






24. paired bones at the corner of each eye that cradle the tear ducts.






25. 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






26. This number is used instead of the individual physician's number for the performing provider who is a member of a group practice that submits claims to insurance companies under the group name.






27. are small with irregular shapes. They are found in the wrist and ankle.






28. Is the upper arm bone.






29. - is a procedure or service provided without proper authorization or was not covered by a current authorization. The claim is denied and the provider cannot bill the patient for the charges.






30. 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






31. 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.






32. are found covering soft body parts. These are the shoulder blades - ribs - and pelvic bones.






33. 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






34. Is the lower medial arm bone.






35. Discolored - flat lesion (freckles - tattoo marks)






36. is a federal program administered by state governments to provide medical assistance to the needy. Each state sets its own guidelines for eligibility and services - therefore benefits and coverage may vary widely from state to state.






37. Is a state based group of physicians working under government guideline to review cases and determine their appropriateness and quality of professional care.






38. open sore on the skin or mucous






39. 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






40. The poisoning was self-inflicted.






41. 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.






42. .. lower jaw bone.






43. anterior to the temporal bones.






44. 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






45. Forms the sides of the cranium






46. The bone is broken and pierces an internal organ






47. death of tissue associated with loss of blood supply






48. Consist of codes found in the CPT manual. They are five position numeric codes used to report physician services rendered to patients






49. the bone is crushed and or shattered.






50. 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.