Module 105 Final Study

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  • 1/85 Questions

    The original intent for coded health care data was for use in research and study. Currently, coded health care data are:

    • The primary key to reimbursement
    • Used for statistical analysis by hospitals, insurance companies, and health care facilities
    • Used for research and study
    • All of the above
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About This Quiz

Module 105 Final Study assesses knowledge on healthcare data coding, focusing on ICD utilization, CMS regulations, and diagnosis coding. It is crucial for understanding health service management and cost control, highlighting the significance of accurate coding in healthcare.

Module 105 Final Study - Quiz

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  • 2. 

    The combined classification of "mortality and morbidity" in ICD-6 refers to:

    • Complications

    • Death and disease

    • Complications, death and disease

    • None of the above

    Correct Answer
    A. Death and disease
    Explanation
    The combined classification of "mortality and morbidity" in ICD-6 refers to death and disease. This means that the classification system in ICD-6 includes categories and codes for both fatal outcomes (mortality) and non-fatal outcomes (morbidity) of diseases and conditions. It provides a comprehensive framework for categorizing and coding information related to both death and disease, allowing for accurate and standardized reporting and analysis of health data.

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  • 3. 

    The Centers for Medicare and Medicaid Services (CMS) utilize diagnosis code data to:

    • Determine budget requirements for the year

    • Ensure appropriate utilization of health care services and control health care costs

    • Assess health care needs

    • Non of the above

    Correct Answer
    A. Ensure appropriate utilization of health care services and control health care costs
    Explanation
    The Centers for Medicare and Medicaid Services (CMS) utilize diagnosis code data to ensure appropriate utilization of health care services and control health care costs. By analyzing diagnosis codes, CMS can identify patterns and trends in the types of services being provided, which can help them determine if there is overutilization or unnecessary utilization of certain services. This allows them to implement strategies to control costs and ensure that resources are being allocated efficiently.

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  • 4. 

    Codes used to describe patient conditions to explain the medical necessity of services and items provided to third-party payers are:

    • Diagnosis codes

    • ICD-9-CM Volume III codes

    • Procedure codes

    • All of the above

    Correct Answer
    A. Diagnosis codes
    Explanation
    The correct answer is diagnosis codes. Diagnosis codes are used to describe patient conditions and provide information about the medical necessity of services and items to third-party payers. These codes help in identifying and classifying diseases, injuries, symptoms, and other health conditions. By using diagnosis codes, healthcare providers can communicate with insurance companies and justify the need for specific treatments or procedures. ICD-9-CM Volume III codes are used to describe procedures, while procedure codes are specific codes used to identify and bill for medical procedures. However, in this case, the correct answer is diagnosis codes as they encompass all patient conditions.

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  • 5. 

    The major most significant reason for patient care services rendered in a physician's office is the

    • Principal diagnosis

    • Admitting diagnosis

    • Primary diagnosis

    • All of the above

    Correct Answer
    A. Primary diagnosis
    Explanation
    The primary diagnosis is the most significant reason for patient care services rendered in a physician's office. This diagnosis is the main reason for the patient's visit and determines the course of treatment and care provided. It helps the physician in making decisions regarding further tests, medications, and referrals. The primary diagnosis is essential for insurance billing and reimbursement purposes as well. Therefore, it plays a crucial role in guiding the overall patient care services in a physician's office.

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  • 6. 

    Diagnosis codes are recorded on the claim form as follows

    • The principal diagnosis is recorded in FL 67-76 on the CMS-1450

    • The primary diagnosis is recorded in Block 21 and referenced in Block 24E on the CMS-1500

    • Other conditions treated or those affecting treatment are also reported

    • All of the above

    Correct Answer
    A. All of the above
    Explanation
    The correct answer is "All of the above." This means that all of the options mentioned in the question are correct explanations for how diagnosis codes are recorded on claim forms. The principal diagnosis is recorded in FL 67-76 on the CMS-1450 form, the primary diagnosis is recorded in Block 21 and referenced in Block 24E on the CMS-1500 form, and other conditions treated or those affecting treatment are also reported.

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  • 7. 

    In the ICD-9-CM manual, the tabular list of disease, two supplemental classifications, and appendices are in

    • Volume III

    • Volume II

    • Volume I

    • All of the above

    Correct Answer
    A. Volume I
    Explanation
    The correct answer is Volume I. In the ICD-9-CM manual, Volume I contains the tabular list of diseases. It is the main section of the manual and provides a comprehensive list of codes for various diseases and conditions. Volume II contains the alphabetic index, which helps in finding the appropriate code based on the diagnosis or condition. Volume III contains the procedural codes, used for reporting medical procedures. The appendices in the ICD-9-CM manual provide additional information and guidelines for coding.

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  • 8. 

    Volume III is used by hospitals and other facilities to code

    • Significant procedures

    • Noninvasive outpatient procedures

    • Laboratory procedures

    • None of the above

    Correct Answer
    A. Significant procedures
    Explanation
    Volume III is used by hospitals and other facilities to code significant procedures. This means that Volume III is specifically designed to assign codes to important or major medical procedures that are performed in healthcare settings. It is not used for coding noninvasive outpatient procedures or laboratory procedures.

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  • 9. 

    The hypertension table is used to identify a code describing

    • High blood pressure

    • Low blood pressure

    • Malignant or benign hypertension

    • All of the above

    Correct Answer
    A. Malignant or benign hypertension
    Explanation
    The hypertension table is used to identify a code describing malignant or benign hypertension. This means that the table provides specific codes that can be used to classify and document cases of hypertension that are either malignant (severe and rapidly progressing) or benign (mild or moderate). By using this table, healthcare professionals can accurately categorize and track different types of hypertension, leading to better diagnosis and treatment decisions.

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  • 10. 

    The alphabetic and tabular listings of procedures are found in the ICD-9-CM in

    • Volume I

    • Volume III

    • Volume II

    • All of the above

    Correct Answer
    A. Volume III
    Explanation
    The alphabetic and tabular listings of procedures are found in Volume III of the ICD-9-CM. This volume specifically focuses on procedures and provides a comprehensive list of codes for various medical procedures. Volume I of the ICD-9-CM contains the tabular list of diseases and Volume II contains the alphabetic index of diseases. Therefore, the correct answer is Volume III.

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  • 11. 

    Term that describes special terms, punctuation marks, abbreviations, or symobls used as shorthand in a coding system to communicate special instructions efficiently to the coder

    • Guidelines

    • Instructions

    • Conventions

    • All of the above

    Correct Answer
    A. Conventions
    Explanation
    The term "conventions" refers to special terms, punctuation marks, abbreviations, or symbols used as shorthand in a coding system to communicate special instructions efficiently to the coder. It encompasses all the options provided in the question, including guidelines and instructions. Conventions are established practices or standards that help ensure consistency and understanding in a coding system.

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  • 12. 

    Numeric listing of patient signs, symptoms, injury, illness, disease, and other reasons for the visit

    • Volume I

    • Volume III

    • Volume II

    • All of the above

    Correct Answer
    A. Volume I
    Explanation
    The correct answer is "Volume I" because it refers to a numeric listing of patient signs, symptoms, injury, illness, disease, and other reasons for the visit. This suggests that Volume I contains the necessary information for documenting and categorizing patient conditions and reasons for their visit.

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  • 13. 

    Condition determined after study

    • Principal diagnosis

    • Admitting diagnosis

    • Primary diagnosis

    • All of the above

    Correct Answer
    A. Principal diagnosis
    Explanation
    The principal diagnosis refers to the condition that is primarily responsible for the patient's admission to the hospital. It is the main reason for the patient seeking medical care and is determined after a thorough study of the patient's symptoms, medical history, and diagnostic tests. The principal diagnosis helps healthcare providers in planning and providing appropriate treatment for the patient. Therefore, the principal diagnosis is the correct answer in this case as it accurately represents the condition determined after study.

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  • 14. 

    Location where diagnosis codes are listed on the CMS-1450

    • Form locators 42-42

    • Form locators 80-81

    • Form locators 67-76

    • All of the above

    Correct Answer
    A. Form locators 67-76
    Explanation
    The CMS-1450 form, also known as the UB-04 form, is used for submitting medical claims for reimbursement. Form locators 67-76 are the specific fields on the form where diagnosis codes are listed. These codes provide information about the patient's medical condition or reason for the medical services provided. Therefore, the correct answer is form locators 67-76.

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  • 15. 

    Volume of the ICD-9-CM used for coding diagnosis and inpatient procedures

    • Volume I

    • Volume II

    • Volume III

    • All of the above

    Correct Answer
    A. All of the above
    Explanation
    The correct answer is "All of the above" because the question is asking about the volume of the ICD-9-CM used for coding diagnosis and inpatient procedures. The ICD-9-CM is divided into three volumes: Volume I contains codes for diagnosis, Volume II contains codes for inpatient procedures, and Volume III contains codes for outpatient procedures. Therefore, all three volumes are used for coding diagnosis and inpatient procedures.

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  • 16. 

    In 1983 the Health Care Financing Administration (HCFA), now know as Centers for Medicare and Medicaid Services (CMS), adopted this procedure coding system, and other payers such as Blue Cross/Blue Shield followed suit and adopted the system

    • Health Care Common Procedure Coding System (HCPCS)

    • International Classification of Disease (ICD-9-CM)

    • Current Procedural Terminology (CPT)

    • All of the above

    Correct Answer
    A. Health Care Common Procedure Coding System (HCPCS)
    Explanation
    The correct answer is Health Care Common Procedure Coding System (HCPCS). This system was adopted by the Health Care Financing Administration (HCFA), now known as Centers for Medicare and Medicaid Services (CMS), in 1983. Other payers, such as Blue Cross/Blue Shield, also adopted this system. HCPCS is used for reporting medical procedures and services provided to Medicare and Medicaid patients. It is a standardized coding system that helps in the reimbursement process and ensures accurate and consistent reporting of healthcare services.

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  • 17. 

    Which procedure coding system is used for reporting significant procedures and services in FL 80-81 on the CMS-1450

    • HCPCS Level I and II

    • ICD-9-CM Volume III

    • HCPCS and National Drug Codes

    • None of the above

    Correct Answer
    A. ICD-9-CM Volume III
    Explanation
    ICD-9-CM Volume III is used for reporting significant procedures and services in FL 80-81 on the CMS-1450. This coding system specifically focuses on procedures and services, making it the appropriate choice for reporting them on the form. HCPCS Level I and II are used for reporting healthcare procedures and services in other contexts, but they are not specifically designed for reporting on the CMS-1450 form. Similarly, while HCPCS and National Drug Codes are relevant for reporting certain types of information, they are not the appropriate coding systems for reporting significant procedures and services in FL 80-81 on the CMS-1450.

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  • 18. 

    What codes are used on claim forms to describe services and procedures billed to third-party payers?

    • Procedure codes

    • Diagnosis codes

    • Procedure and diagnosis codes

    • All of the above

    Correct Answer
    A. Procedure codes
    Explanation
    Procedure codes are used on claim forms to describe services and procedures billed to third-party payers. These codes provide a standardized way to communicate the specific services rendered to the payer, allowing for accurate billing and reimbursement. Diagnosis codes, on the other hand, are used to describe the patient's medical condition or reason for seeking healthcare services. While both procedure and diagnosis codes are used on claim forms, the correct answer is "Procedure codes" as it specifically addresses the codes used to describe services and procedures billed to third-party payers.

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  • 19. 

    Three coding systems used for coding procedures, services, and items are

    • ICD-9-CM Volume I, Volume II, and Volume III

    • HCPCS Level I CPT, Level II Medicare National Codes, and ICD-9-CM Volume III Procedures

    • HCPCS I and II and ICD-9-CM

    • All of the above

    Correct Answer
    A. HCPCS Level I CPT, Level II Medicare National Codes, and ICD-9-CM Volume III Procedures
    Explanation
    The correct answer is "HCPCS Level I CPT, Level II Medicare National Codes, and ICD-9-CM Volume III Procedures". This answer is correct because it includes all three coding systems used for coding procedures, services, and items. ICD-9-CM Volume I and Volume II are not used for coding procedures, services, and items, so the first option is incorrect. HCPCS I and II and ICD-9-CM also do not include all three coding systems, so the third option is also incorrect. The second option includes all three coding systems, so it is the correct answer.

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  • 20. 

    Providers must explain on the claim form why procedures and services are required by using

    • Descriptions of conditions

    • Procedure codes

    • Diagnosis codes

    • None of the above

    Correct Answer
    A. Diagnosis codes
    Explanation
    Providers must explain on the claim form why procedures and services are required by using diagnosis codes. Diagnosis codes are alphanumeric codes that represent specific medical conditions or diseases. By including diagnosis codes on the claim form, providers can provide a clear and concise explanation of why certain procedures and services are necessary for the patient's condition. These codes help ensure accurate billing and reimbursement, as well as facilitate communication between healthcare providers and insurance companies.

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  • 21. 

    What procedure coding system is used to report procedures, services, and items for hospital OUTPATIENT services?

    • ICD-9-CM Volume I, II

    • HCPCS Level I and/or HCPCS Level II

    • ICD-9-CM Volume III

    • All of the above

    Correct Answer
    A. HCPCS Level I and/or HCPCS Level II
    Explanation
    HCPCS Level I and/or HCPCS Level II is the correct answer because these coding systems are specifically designed to report procedures, services, and items for hospital outpatient services. ICD-9-CM Volume I, II is used for diagnosis coding, while ICD-9-CM Volume III is used for procedure coding in inpatient hospital settings. Therefore, the correct coding system for reporting procedures, services, and items in hospital outpatient services is HCPCS Level I and/or HCPCS Level II.

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  • 22. 

    What claim form is used to submit hospital OUTPATIENT PROFESSIONAL services?

    • CMS-1500

    • CMS-1450

    • CMS-1500 and CMS-1450

    • All of the above

    Correct Answer
    A. CMS-1500
    Explanation
    The correct answer is CMS-1500. The CMS-1500 claim form is used to submit hospital outpatient professional services. It is a standard form used by healthcare providers to bill Medicare and Medicaid, as well as other insurance companies. This form includes information about the patient, the services provided, and the charges associated with those services. It is important for healthcare providers to accurately complete and submit the CMS-1500 form in order to receive reimbursement for their services.

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  • 23. 

    What procedure coding systems are used to report procedures, services, and items for hospital ambulatory surgery?

    • ICD-9-CM Volume I, II

    • HCPCS Level I and/or HCPCS Level II, and some payers may require ICD-9-CM Volume III

    • ICD-9-CM Volume III

    • All of the above

    Correct Answer
    A. HCPCS Level I and/or HCPCS Level II, and some payers may require ICD-9-CM Volume III
    Explanation
    The correct answer is HCPCS Level I and/or HCPCS Level II, and some payers may require ICD-9-CM Volume III. HCPCS Level I and II are procedure coding systems that are commonly used to report procedures, services, and items for hospital ambulatory surgery. Some payers may also require the use of ICD-9-CM Volume III for certain procedures. ICD-9-CM Volume I and II are not specifically used for reporting procedures in hospital ambulatory surgery.

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  • 24. 

    What claim form is used to submit hospital inpatient services?

    • CMS-1500

    • CMS-1450

    • CMS-1500 and CMS-1450

    • All of the above

    Correct Answer
    A. CMS-1450
    Explanation
    The correct answer is CMS-1450. The CMS-1450 form, also known as the UB-04 form, is used to submit hospital inpatient services. It is used by hospitals and other healthcare facilities to bill for services provided to patients during their stay. The form includes information such as the patient's demographic details, diagnosis codes, and the services provided.

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  • 25. 

    What procedure coding systems are used to report significant procedures, services, and items for hospital inpatient services?

    • ICD-9-CM Volume I, II

    • HCPCS Level I and/or HCPCS Level II

    • ICD-9-CM Volume III

    • All of the above

    Correct Answer
    A. ICD-9-CM Volume III
    Explanation
    ICD-9-CM Volume III is used to report significant procedures, services, and items for hospital inpatient services. This volume of the ICD-9-CM coding system specifically focuses on procedures and is used to code inpatient procedures performed in hospitals. HCPCS Level I and/or HCPCS Level II are not specific to inpatient services and are used for reporting services and procedures in other healthcare settings. Therefore, the correct answer is ICD-9-CM Volume III.

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  • 26. 

    These codes are found in the CPT in sections titled E/M, Anesthesia, Surgery, Radiology, Pathology/Laboratory, and Medicine

    • Category I codes

    • Category II codes

    • Category II codes

    • All of the above

    Correct Answer
    A. Category I codes
    Explanation
    The explanation for the correct answer is that Category I codes are found in the CPT in sections titled E/M, Anesthesia, Surgery, Radiology, Pathology/Laboratory, and Medicine. These codes are used to describe procedures and services performed by healthcare providers. They are the most commonly used codes and are used for billing and reimbursement purposes. Category I codes are updated annually by the American Medical Association (AMA) and are recognized by insurance companies and Medicare.

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  • 27. 

    These codes are found after the Medicine section in CPT, and they represent new procesures or services and emerging technology

    • Category I codes

    • Category II codes

    • Category III codes

    • All of the above

    Correct Answer
    A. Category III codes
    Explanation
    Category III codes are a set of codes found after the Medicine section in the Current Procedural Terminology (CPT) manual. These codes are used to represent new procedures or services and emerging technology that have not yet been widely adopted. Unlike Category I codes, which are the most commonly used codes, Category III codes are temporary and may be reevaluated or reclassified as Category I or Category II codes in the future. Therefore, the correct answer is Category III codes.

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  • 28. 

    A coder determines whether to use an HCPCS Level I CPT or HCPCS Level II code following thses guidelines

    • Use a CPT code unless a code that adequately describes the service, procedure, or item cannot be found in CPT

    • When a code cannot be found in CPT, refer to HCPCS Level II manual

    • Use HCPCS Level II codes when required by the payer

    • All of the above

    Correct Answer
    A. All of the above
    Explanation
    The given answer, "All of the above," is correct because it encompasses all the guidelines mentioned. According to the guidelines, a coder should first use a CPT code unless a suitable code cannot be found in CPT, in which case they should refer to the HCPCS Level II manual. Additionally, if required by the payer, the coder should use HCPCS Level II codes. Therefore, all the given options are accurate and comprehensive.

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  • 29. 

    HCPCS Level II codes are

    • Three to five numeric digits

    • Five digit alphanumeric codes; the first letter is alphabetic

    • Five numeric digits

    • All of the above

    Correct Answer
    A. Five digit alphanumeric codes; the first letter is alphabetic
    Explanation
    HCPCS Level II codes are five digit alphanumeric codes; the first letter is alphabetic. This means that the codes are a combination of letters and numbers, with the first character always being a letter. This format allows for a greater number of codes to be created and provides more specificity in describing medical procedures, supplies, and services. The alphanumeric nature of the codes also helps to differentiate them from other code sets, such as CPT codes, which are primarily numeric.

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  • 30. 

    This ICD-9-CM convention is found only in Volume III, and it tells the coder that other procedures should be reorted as individual components

    • Code also synchronous

    • Code first underlying procedure

    • Omit code

    • All of the above

    Correct Answer
    A. Code also synchronous
    Explanation
    The correct answer is "Code also synchronous". This convention is found only in Volume III of ICD-9-CM and it instructs the coder to report other procedures as individual components in addition to the main procedure being coded. This means that if there are multiple procedures performed simultaneously, they should all be coded separately.

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  • 31. 

    These procedures and services are significant procedures

    • MRI, Comprehensive metabolic panel

    • Infusion therapy, Craniotomy

    • Chest X-ray, Catheterization

    • All of the above

    Correct Answer
    A. Infusion therapy, Craniotomy
    Explanation
    Infusion therapy and craniotomy are both significant procedures that require specialized medical attention. Infusion therapy involves the administration of fluids, medications, or nutrients directly into the bloodstream, often used for patients who cannot take oral medications or require immediate treatment. Craniotomy is a surgical procedure that involves opening the skull to access the brain, often performed to remove tumors, treat brain injuries, or relieve pressure. Both procedures are complex and carry potential risks, making them significant in terms of medical care. The other options, MRI, comprehensive metabolic panel, chest X-ray, and catheterization, are important diagnostic and treatment procedures, but may not carry the same level of complexity and significance as infusion therapy and craniotomy.

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  • 32. 

    What is(are) the claim form(s) that require(s) the use of Volume III procedures for inpatient services?

    • CMS-1500

    • CMS-1500 and CMS 1450

    • CMS-1450

    • None of the above

    Correct Answer
    A. CMS-1450
    Explanation
    The correct answer is CMS-1450. The CMS-1450 form, also known as the UB-04 form, is used for inpatient hospital services. It is required for submitting claims for inpatient services and is used to provide detailed information about the services provided, such as the type of accommodation, dates of service, and procedures performed. The CMS-1500 form, on the other hand, is used for outpatient services. Therefore, only the CMS-1450 form requires the use of Volume III procedures for inpatient services.

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  • 33. 

    The content of ICD-9-CM Volume III includes an

    • Alphabetic and numeric listing of disease

    • Alphabetic index and tabular listing of procedures and services

    • Alphabetic and numerical listing of diease and procedures

    • All of the above

    Correct Answer
    A. Alphabetic index and tabular listing of procedures and services
    Explanation
    The content of ICD-9-CM Volume III includes an alphabetic index and tabular listing of procedures and services. This means that it provides a comprehensive list of procedures and services in alphabetical order, making it easy to locate specific information. The tabular listing further organizes the procedures and services in a structured format, allowing for quick reference and understanding. This combination of alphabetic index and tabular listing ensures that healthcare professionals can easily find the necessary information they need for coding and billing purposes.

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  • 34. 

    The ICD-9-CM Volume III coding system is used to

    • Describe significant procedures performed during a hospital inpatient stay

    • Code the physician's portion of surgical procedures

    • Describe laboratory services performed during a hospital visit

    • All of the above

    Correct Answer
    A. Describe significant procedures performed during a hospital inpatient stay
    Explanation
    The ICD-9-CM Volume III coding system is used to describe significant procedures performed during a hospital inpatient stay. This means that it is used to assign specific codes to the procedures that were performed on a patient while they were admitted to the hospital. This coding system allows for accurate documentation and tracking of procedures, which is important for billing purposes, research, and quality improvement initiatives. It is not used to code the physician's portion of surgical procedures or to describe laboratory services performed during a hospital visit.

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  • 35. 

    This ICD-9-CM convention is found only in Volume III, and tells the coder that the procedure is an integral part of a more comprehensive procedure and should not be coded separately

    • Code also synchronous

    • Code first underlying procedure

    • Omit code

    • All of the above

    Correct Answer
    A. Omit code
    Explanation
    The correct answer is "Omit code". This answer is correct because the given statement mentions that the procedure is an integral part of a more comprehensive procedure and should not be coded separately. Therefore, the coder should omit coding this specific procedure separately.

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  • 36. 

    What procedure is performed for definitive treatment of the principal diagnosis

    • Significant

    • Principal

    • Primary

    • None of the above

    Correct Answer
    A. Principal
    Explanation
    The principal procedure is performed for definitive treatment of the principal diagnosis. This means that the main procedure that is done is intended to treat the primary reason for the patient's condition. The principal diagnosis refers to the main reason for the patient's hospitalization or visit to the healthcare facility. Therefore, the principal procedure is the one that is done to address and treat this main diagnosis.

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  • 37. 

    Codes developed in the 1980's to provide a standard system for reporting supplies, equipment, medication, and other items to Medicare carriers

    • HCPCS Level II Medicare National Codes

    • CPT

    • ICD-9-CM Volume III

    • None of the above

    Correct Answer
    A. HCPCS Level II Medicare National Codes
    Explanation
    The correct answer is HCPCS Level II Medicare National Codes. HCPCS Level II codes were developed in the 1980s to provide a standardized system for reporting supplies, equipment, medication, and other items to Medicare carriers. These codes are used for billing Medicare and are specific to Medicare's needs and requirements. CPT (Current Procedural Terminology) codes are used for reporting medical procedures and services, while ICD-9-CM Volume III codes are used for reporting procedures in hospitals. None of the above options are correct because only HCPCS Level II codes are specifically designed for reporting items to Medicare carriers.

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  • 38. 

    The term used to describe a procedure that is surgical, carries high procedural risk or high anesthetic risk, or requires specialized training

    • Principal procedure

    • Significant procedure

    • Primary procedure

    • None of the above

    Correct Answer
    A. Significant procedure
    Explanation
    A significant procedure is a term used to describe a medical procedure that is surgical and carries a high risk, either in terms of the procedure itself or the anesthesia involved. It may also refer to procedures that require specialized training or expertise. This term is used to distinguish these procedures from less complex or risky ones.

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  • 39. 

    Payers do not pay for services that are not covered or services that are not deemed reasonable and necessary in response to the patient's condition. Payers will only pay for services that are covered and considered to be

    • Covered procedures

    • Inpatient-only procedures

    • Medically necessary

    • None of the above

    Correct Answer
    A. Medically necessary
    Explanation
    Payers will only pay for services that are covered and considered to be medically necessary. This means that the services must be deemed essential for the patient's condition and must meet the payer's criteria for medical necessity. If a service is not covered or is not considered medically necessary, the payer will not provide payment for it.

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  • 40. 

    The process of assigning codes to written descriptions of procedures, services, or items is known as

    • Diagnosis coding

    • Coding services and procedures

    • Procedure coding

    • All of the above

    Correct Answer
    A. Procedure coding
    Explanation
    Procedure coding is the correct answer because it refers to the process of assigning codes to written descriptions of procedures, services, or items. This coding system helps in identifying and categorizing medical procedures and services for billing, reimbursement, and statistical purposes. It ensures uniformity and accuracy in healthcare documentation and allows for effective communication between healthcare providers, insurers, and other stakeholders.

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  • 41. 

    The principal procedure is

    • The major procedure performed

    • The procedure performed for definitive treatment of the principal diagnosis or the one closest to it

    • The procedure that is invasive

    • None of the above

    Correct Answer
    A. The procedure performed for definitive treatment of the principal diagnosis or the one closest to it
    Explanation
    The correct answer is "The procedure performed for definitive treatment of the principal diagnosis or the one closest to it." This answer is correct because the principal procedure refers to the main surgical or medical intervention performed to treat the primary diagnosis or the one that is most closely related to it. It is the procedure that is considered the most important in addressing the patient's condition and providing a definitive treatment.

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  • 42. 

    The purpose of payer edits is to review claim data to identify problems related to services billed, such as

    • Services that are not medically necessary

    • Charges for services that are not competitive

    • Services submitted late

    • None of the above

    Correct Answer
    A. Services that are not medically necessary
    Explanation
    Payer edits are used to review claim data and identify any problems related to the services billed. This can include services that are not medically necessary, meaning they may not be required for the patient's condition or are not supported by medical evidence. By identifying these unnecessary services, payers can ensure that they are not paying for treatments that are not beneficial to the patient's health.

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  • 43. 

    The OCE has over 60 edits used to identify claim issues involving

    • Coding and coverage

    • Incorrect completion

    • Coding system

    • None of the above

    Correct Answer
    A. Coding and coverage
    Explanation
    The OCE (Outpatient Code Editor) is a tool used to identify claim issues in outpatient coding. It has over 60 edits that are used to identify various types of claim issues. The edits include identifying problems related to coding and coverage, incorrect completion of claims, and issues with the coding system. Therefore, the correct answer is "Coding and coverage" as these are among the claim issues that the OCE identifies.

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  • 44. 

    Examples of source documents used by coders are

    • Medical and financial information obtained from the patient

    • Encounter forms, a requisition, and Emergency Department record

    • Coding references and dictionaries

    • All of the above

    Correct Answer
    A. Encounter forms, a requisition, and Emergency Department record
    Explanation
    Source documents used by coders include encounter forms, a requisition, and Emergency Department records. These documents provide essential information about the patient's medical and financial details, which are necessary for accurate coding. In addition, coders also refer to coding references and dictionaries to ensure correct coding procedures. Therefore, all of the above options are correct as they represent the various source documents used by coders in their coding process.

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  • 45. 

    The Medicare Code Editor (MCE) and Outpatient Code Editor (OCE) and used to edit claims for services as follows

    • MCE edits are for inpatient claims

    • OCE edits are for outpatient claims

    • Both a and b

    • All of the above

    Correct Answer
    A. Both a and b
    Explanation
    The correct answer is "Both a and b." The Medicare Code Editor (MCE) is used to edit claims for inpatient services, while the Outpatient Code Editor (OCE) is used to edit claims for outpatient services. Therefore, both MCE and OCE are used to edit claims for services, making option "Both a and b" the correct answer.

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  • 46. 

    HCPCS Level I and II codes describing hospital outpatient services are reported on the UB-04 in what form section

    • Section 1

    • Section 2

    • Section 3

    • Section 4

    Correct Answer
    A. Section 2
    Explanation
    HCPCS Level I and II codes describing hospital outpatient services are reported on the UB-04 in Section 2. This section of the UB-04 form is specifically designated for reporting the Healthcare Common Procedure Coding System (HCPCS) codes. HCPCS codes are used to identify specific medical procedures, services, and supplies provided in a hospital outpatient setting. By reporting these codes in Section 2, healthcare providers can accurately document and bill for the services rendered to patients in a hospital outpatient setting.

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  • 47. 

    Each item in the Charge Description Master is associated with what code

    • ICD-9-CM Volume III codes

    • HCPCS code

    • ICD-9-CM and HCPCS code

    • None of the above

    Correct Answer
    A. HCPCS code
    Explanation
    The correct answer is HCPCS code. The Charge Description Master is a list of all the items and services provided by a healthcare facility, along with the corresponding charges. Each item in the Charge Description Master is associated with a specific code, and in this case, it is the HCPCS code. HCPCS codes are used to describe medical procedures, supplies, and services provided to patients. Therefore, the items in the Charge Description Master are associated with HCPCS codes to accurately represent the services provided and their corresponding charges.

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  • 48. 

    What claim form and procedure coding system are used to submit professional charges for services rendered by a physician who is employed by the hospital

    • UB-04 and ICD-9-CM Volume III

    • HCPCS and UB-04

    • CMS-1500 and HCPCS

    • All of the above

    Correct Answer
    A. CMS-1500 and HCPCS
    Explanation
    The correct answer is CMS-1500 and HCPCS. CMS-1500 is the claim form used to submit professional charges for services rendered by a physician, while HCPCS (Healthcare Common Procedure Coding System) is the coding system used to identify and report specific medical services and procedures. This combination of claim form and coding system is commonly used for submitting professional charges for services provided by a physician employed by a hospital. The other options, UB-04 and ICD-9-CM Volume III, are not applicable in this scenario.

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  • 49. 

    ICD-9-CM diagnosis coding guidelines vary for services performed in which of the following categories

    • Inpatient and non-patient

    • Outpatient and inpatient

    • Home care and non-patient

    • None of the above

    Correct Answer
    A. Outpatient and inpatient
    Explanation
    The correct answer is Outpatient and inpatient. ICD-9-CM diagnosis coding guidelines vary for services performed in outpatient and inpatient settings. These guidelines provide specific instructions on how to assign codes for different types of encounters, such as outpatient visits, emergency room visits, and inpatient admissions. The coding guidelines for outpatient services may differ from those for inpatient services due to the nature of the care provided and the documentation requirements. It is important for medical coders to be familiar with these guidelines to ensure accurate and consistent coding.

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Quiz Review Timeline (Updated): Feb 5, 2024 +

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  • Current Version
  • Feb 05, 2024
    Quiz Edited by
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  • Mar 06, 2012
    Quiz Created by
    Lindsaystippel

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