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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. 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






2. Is one who has a contract with a health insurance plan and accepts whatever the plan pays for procedures or services rendered.






3. Consists of the skull - rib cage - and spine






4. Is a managed care benefits plan that provides a wide range of medical services to individuals that have been enrolled into the program. It is generally the least costly but at the same time also the most restrictive. This plan uses a gatekeeper physi






5. 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






6. This is the inventory of the constitutional symptoms regarding the various body systems.






7. Number assigned to the physician by Medicare program.






8. .. lower jaw bone.






9. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.






10. Is an electronic or paper-based report of payment sent by the payer to the provider.






11. This modifier is used to indicate that the procedure was done by an outside laboratory and not by the reporting facility or clinic.






12. Provide a four-digit code (one digit after the decimal point) which is more specific than category code (3-digit) in terms of cause - site - or manifestation of the condition. This must be used if available. From subcategory - specificity moves to an






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






14. 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






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






16. is one who has not received professional services from the physician or another physician of the same specialty in the same group within the past three (3) years.






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 -






18. The epidermis - the dermis - and the subcutaneous layer. The epidermis is a thin - cellular membrane layer that contains keratin. The dermis is a dense - fibrous - connective tissue that contains collagen. The subcutaneous layer is a thicker and fatt






19. Are composed of three-digit codes representing a single disease or condition.






20. 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






21. This is attached to the code of the E/M service provided to a patient during the postoperative period to indicate that that service is not part of the postoperative care which is usually part of a package of services of the surgery performed. Major s






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






23. The cuticle at the lower part of the nail and this is sometimes referred to as the






24. Is the lower medial arm bone.






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






26. Physicians agree to provide services at a discount of their usual fee in return for a pool of existing patients.






27. Considered experimental - newly approved - or seldom used may not be listed in the CPT manual. These codes can be coded as unlisted procedures. They are located at the end of the subsections or subheadings. When an unlisted procedure code is reported






28. Physicians are legally responsible for their own conduct and any actions of their employees (their designee) performed within the context of their employment. This is referred to as 'vicarious liability -' also known as 'respondent superior -' which






29. Cheekbone






30. includes the shoulder girdle which is made up of the scapula - clavicle and upper extremities. The scapula - or shoulder blades are flat bones that help support the arms. The clavicle - or collarbone - is curved horizontal bones that attach to the u






31. 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






32. An insurance plan issued to an individual. Premium rates are usually higher than group rates and service availability is lessened with this type of coverage.






33. 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.






34. 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






35. Structural protein found in the skin and connective tissue






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






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






38. 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).






39. The skin and its accessory organs.Integument means covering. The skin covers over an area of 22 square feet ( an average adult). It is a complex system of specialized tissues containing glands - nerves and blood vessels. The main function of the skin






40. Eccrine sweat glands are the most common and the apocrine sweat glands that secrete an odorless sweat.






41. 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.






42. Is the qualifying factor or factors that must be met before a patient receives benefits.






43. Are conditions - situations - and services not covered by the insurance carrier.






44. Was developed to protect healthcare professionals from liability of any civil damages as a result of rendering emergency care.






45. major skin pigment






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






47. Small collection of clear fluid;blister






48. consists of 17 chapters based on either body system or cause or type of disease. The codes range from 001-999.






49. The musculoskeletal system includes the bones - muscles - and joints The musculoskeletal system acts as a framework for the organs - protects many of those organs - and also provides the organism the ability to move..






50. 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