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Medical Billing And Coding Vocab
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medical-transcription
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. 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
Greenstick
Spinal/Vertebral Column
Social Security Number
Medicare
2. 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
Palatine bones
HCPCS Level II codes (National Codes)
Established Patient
Paper Claim
3. 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
true ribs
Two triangular symbols (a
History
Surgical Package
4. Bacterial inflammatory skin disease characterized by lesion - pustules and vesicles.
Medigap (Medicare Supplemental Insurance)
History of present illness (HPI)
Impetigo
-26 - Professional Component
5. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.
Pre-determination
Modifiers
Tabular List (Volume 1)...
Subcategories
6. Number assigned by the insurance company to a physician who renders services to patients.
Melanin
Provider Identification Number (PIN)
Keratin
Comminuted fracture
7. Developed by the CMS to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment of Part B health insurance claims.
National Correct Coding Initiative (NCCI)
-24 - Unrelated E/M Service by the Same Physician During a Postoperative Period
Assault
Liability insurance
8. open sore on the skin or mucous
Gender rule
Parietal Bones
Ulcermembranes
Vesicle
9. The fractured area of bone collapses on itself.
Qualified diagnosis
Compression fracture
Suicide Attempt
Established patient
10. The bones are connected to one another by fibrous bands of tissue . Muscles are attached to the bone by tendons. The fibrous covering of the muscles is called the fascia
Comminuted fracture
Patient Confidentiality
axial skeleton
ligaments
11. Is a managed care plan that gives beneficiaries the option whom to see for services. If the beneficiary goes to see a physician within the network - s/he will receive benefits similar to an HMO. But if the beneficiary chooses to see a physician from
State License Number
Pelvis
Floating ribs Ribs 11 and 12 are - because they are not attached at all.
Point-of-Service plan (POS)
12. are composed of a group of three-digit categories representing a group of conditions or related conditions; they are divided into categories. e.g. . - Disorders of Thyroid Gland (240 - 246).
Uncertain behavior
State License Number
Sections
encounter form
13. 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
Keratin
Reasons for Documentation
Fissure
Accident
14. Are typically very strong - are broad at the ends and have large surfaces for muscle attachment.
Alopecia
The Patient Care Partnership (Patient's Bill of Rights)
Gangrene
Long bones
15. Is to determine coverage for a specific treatment such as surgery - hospitalization or tests - under the insured's policy.
Participating physician
CPT SECTIONS.
-50 - Bilateral Procedure
Pre-certification
16. 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.
Salter-Harris
Malignant
Group Insurance
-78 - Return to the Operating Room for a Related Procedure During the Postoperative Period
17. Are wrist bones. There are 2 rows of four bones in the wrist. The metacarpals are the five radiating bones in the fingers. These are the bones in the palm of the hand.
Carpals
MEDICARE Part D
Group Provider Number
Inferior nasal conchae
18. most synarthroses are immovable joints held together by fibrous tissue.
Participating physician
Medicaid
No ROM
Unspecified nature
19. make up part of the roof of the mouth
Palatine bones
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Long bones
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
20. solid - round or oval elevated lesion more than 1 cm in diameter
Lacrimal bones
Nodule
-58 - Staged or Related Procedure or Service by the same Physician during the Postoperative Period
MEDICARE Part A
21. Bone that forms posterior/inferior part of the nasal septal wall between the nostrils.
bullet (a
Vomer
Point-of-Service plan (POS)
Compliance Regulations
22. Superior and widest bone
Advance Beneficiary Notice
Pelvis
Fee Schedule
MEDICARE Part C
23. Contain the full description of the procedure for the code indented codes: these are codes listed under associated stand-alone codes. To complete the description for indented codes - one must refer to the portion of the stand alone code description b
stand-alone codes
HCPCS Level I codes
Supplementary Classification of External Causes of Injury and Poisoning (E Codes)
Deductible
24. Is an insurance company that bids for a contract with CMS to handle the Medicare program in a specific area.
Location Methods
Health Care Financing Administration Common Procedure Coding System
Rib Cage
Fiscal Intermediary
25. is defined as one who has not received any medical services within the last three years.
Contracted Rates with MCOs
New Patient
Secondary malignancy
History of present illness (HPI)
26. Groove or crack like sore
Fissure
Parietal Bones
HCPCS Level I codes
-26 - Professional Component
27. 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
Fee-for-Service
Secondary malignancy
Personal Insurance
The Universal Claim Form
28. Also called the Hospital Insurance for the Aged and Disabled. It covers institutional providers for inpatient - hospice - and home health services - such as the
MEDICARE Part A
Surgical Package
A plus sign (+)
Fraud
29. 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
The Integumentary System
Employer Liability
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
30. 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
Gender rule
Preferred Provider Organization (PPO)
Past - family and social history (PFSH)
Spinal/Vertebral Column
31. 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
Pelvis
Invalid claim
TRICARE PLANS
Exclusions and Limitations
32. - 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.
Medicare's Resource Based Relative Value Scale (RBRVS) Payment Schedule
Unauthorized benefit
Hairline
Qualified diagnosis
33. provides a five-digit code which gives the highest specificity of description to a condition. Use of it is mandatory if it is available. A code not reported to the full number of digits required is invalid. e.g. 240.01 Toxic diffuse goiter with thyr
Radius
Parietal Bones
Sub classification
Undetermined
34. male of household is primary payer
Gender rule
Sesamoid bones
Nodule
Full ROM
35. are small with irregular shapes. They are found in the wrist and ankle.
A plus sign (+)
Short bones
Temporal Bone
lunula
36. Also known as Federal tax identification number. This is issued by the Internal Revenue Service
eponychium
Chief complaint
Explanation of Benefits (EOB)
Employer Identification Number (EIN)
37. Number assigned by the insurance company to a physician who renders services to patients.
Unspecified nature
Impacted
Provider Identification Number (PIN)
Primary malignancy
38. Is when two insurance companies work together to coordinate payment of the benefits.
Secondary malignancy
Coordination of Benefits (COB)
Undetermined
upper appendicular skeleton
39. Small collection of clear fluid;blister
Vesicle
Unauthorized benefit
Peer Review Organization (PRO)
Capitated Rates
40. 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
Location Methods
Remittance Advice
-32 - Mandated Services
Fissure
41. 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.
The Good Samaritan Act
sebaceous(oil) glands and the suddoriferous (sweat) glands
Colles
Advance Beneficiary Notice
42. A minor fracture appears as a thin line on x-ray and may not extend completely through the bone.
Hairline
Flat bones
Parietal Bones
Spinal/Vertebral Column
43. cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Maxilla
Carcinoma (Ca) in situ
Disability insurance
ulna
44. This is defined as incidents or practices - not usually considered fraudulent - that are inconsistent with the accepted medical business or fiscal practices in the industry. Examples of abuse are submitting a claim for a service or procedure performe
Abuse
Palatine bones
Medicaid
Impacted
45. This modifier is used to indicate that the procedure or service provided during the postoperative period was not associated with the initial procedure. Payment for the full fee of the subsequent procedure is requested and a new global period starts.
79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period
Review of Systems (ROS)
Health Care Financing Administration Common Procedure Coding System
Pubic bone
46. Was created to provide medical benefits to spouses and children of veterans with total - permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service-related disability. It is a service ben
Liability insurance
Medical necessity
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
sprain
47. 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.
Point-of-Service plan (POS)
Sesamoid bones
itemized statement
TRICARE PLANS
48. Contains complete - necessary information - but is incorrect or illogical in some way.
Employer Identification Number (EIN)
Invalid claim
-90 - Reference (Outside) Laboratory
Tabular List (Volume 1)...
49. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.
Section 3 Index to External Causes of Injury (E codes)
CHAMPVA (Civilian Health and Medical Program of the Veterans Affairs)
Participating physician
Non-covered benefit
50. 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:
History of present illness (HPI)
ulna
Hypertension Table
Keratin
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