MA Chapter 19: Procedural Coding Flashcards


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1

To ensure reimbursement at the highest allowed level, CPT codes must?

INCLUDE CODES AND MODIFIERS THAT REFLECT THE SERVICES PERFORMED

2

The most frequently used CPT codes are?

EVALUATION AND MANAGEMENT CODES

3

For reporting an evaluation and management code, CPT considers a patient to be "new" if the patient has not received professional services from any provider in the medical practice within the last ? years?

THREE

4

When unbundling is done intentionally to receive more payment than is allowed, the claim is likely to be considered?

FRAUDULENT

5

The healthcare common procedure coding system (HCPCS) was originally developed for use in coding services, such as durable medical equipment for?

MEDICARE PATIENTS

6

Analysis of the connection between the diagnostic and procedural information on a claim is called?

CODE LINKAGE

7

An act of deception used to take advantage of another person or entity is called?

FRAUD

8

A healthcare provider who practices under false qualifications or credentials is guilty of?>

FRAUD`

9

Medical offices usually have a(n) ? to help minimize the risk of fraud by discovering and correcting coding and billing problems?

COMPLIANCE PLAN

10

Having a medical practice compliance plan in place?

SHOWS A "GOOD-FAITH" EFFORT TO BE COMPLIANT WITH CODING REGULATIONS

11

A medical provider bills separately for a comprehensive metabolic panel and a quantitative glucose test, which is normally included in the metabolic panel. This is an example of which of the following fraudulent coding and billing practices?

BILLING SEPERATLEY FOR SERVICES THAT ARE BUNDLED IN A SINGLE PROCEDURE CODE

12

When a patient has no symptoms of a disease and the provider performs the tests for that disease at the patients request, the provider has committed which of these fraudulent coding and billing practices?

PERFORMING PROCEDURES NOT RELATED TO THE PATIENTS CONDITION

13

Billing for a moderate level evaluation and management service when only a simple BP check and injection were carried out it and example of?

REPORTING SERVICES AT A HIGHER LEVEL THAN PERFORMED

14

There is a question concerning a claim for a procedure submitted last year. Where will you look to double-check the codes in question?

LAST YEARS CPT CODES

15

A plus sign (+) is used to indicate?

ADD-ON CODES

16

Modifiers to CPT codes indicate?

THAT SOME SPECIAL CIRCUMSTANCE APPLIES TO THE SERVICE

17

National codes issued by CMS that cover many supplies and durable medical equipment are?

HCPCS LEVEL II CODES

18

Inaccuracy in linking diagnostic codes will result in all of the following except?

INTERNAL CODING AUDITS

19

The CPT is updated and new codes are provided for use beginning?

ANNUALLY JANUARY 1

20

Which of the following is NOT one of the 6 main sections in the CPT manual?

PHYSICAL THERAPY

21

In order to find information regarding prefixes and suffixes used in the CPT coding manual, you would look in the?

INTRODUCTION TO THE MANUAL

22

Which of the following best describes the CPT code format?

5-DIGIT NUMERIC CODES

23

To complete the description for a CPT code that has an indented description you should?

REFER TO THE DESCRIPTION FOR THE PREVIOUS CPT CODE TO COMPLETE THE DESCRIPTION

24

When coding CPT procedures, an add-on code will describe?

OTHER PROCEDURES DONE IN ADDITION TO A MAIN PROCEDURE

25

If a code description has changed since the last revision of the CPT manual, what symbol is placed next to the CPT code?

BLUE TRIANGLE

26

What symbol next to a CPT code tells you that moderate sedation is included in the procedure?

BULL'S-EYE

27

What symbol appears next to codes that are new since the last CPT revision?

RED DOT

28

What symbol appears next to a code that appears out of numerical sequence?

POUND (#) SIGN

29

A modifier indicates?

SPECIAL CIRCUMSTANCES APPLY TO THE PROCEDURE

30

Where in the CPT manual will information about the proper use of modifiers be found?

APPENDIX A

31

Where in the CPT manual can you find a complete listing of all add-on codes?`

APPENDIX D

32

Dr. Moore is scheduled to perform a routine removal of a mole from Ralph's left shoulder under local anesthesia. Dr. Moore has injected the local anesthetic and is about to begin the procedure when Ralph suddenly has a panic attack and states, "I just cant handle this!" Dr. Moore halts the procedure. When you code for this procedure what modifier will you use?

52: REDUCED SERVICES

33

Dr. is scheduled to perform a cyst removal on Haley's right hand. After he begins the procedure, he notices that the cyst is much larger than anticipated and is involved with nerves and ligaments in the right thumb. Complete cyst removal takes 30 minutes longer than expected. Which modifier do you use?

22: INCREASED PROCEDURAL SERVICES

34

An example of a Category II code is used for?

WEIGHT REDUCTION COUNSELING

35

Which of the following items is NOT required for a service to be considered a consultation?

REVISION OF THE INITAL DIAGNOSIS

36

Counseling codes are only used if?

A COMPLETE HISTORY AND PHYSICAL EXAM DOES NOT OCCUR

37

Which of the following is NOT a potential reason for downcoding?

THE INSURANCE CARRIER DOES NOT COVER THE SERVICES INCLUDED ON THE CLAIM

38

For coding purposes, which of the following is NOT a level of patient history?

EXPANDED DETAILED

39

For coding purposes, which of the following is NOT a complexity leer for medical decision making?

GENERAL-PURPOSE MDM

40

Nathan is in the medical office today complaining of a sore throat and fever. After ruling out strep throat, the practitioner diagnoses a common cold and tells Nathan to take OTC medications for symptom relief. In which category does Nathan's CC fall?

SELF-LIMITED COMPLAINT

41

Which of the following statements about surgical coding for the musculoskeletal system is NOT true?

MUSCULOSKELETAL SUBHEADINGS BEGIN WITH THE FOOT AND TOES AND WORK THEIR WAY UP TO THE HEAD

42

Which subsection of the surgery section include procedures on the spleen and bone marrow?

HEMIC/LYMPHATIC SYSTEMS

43

How many codes are required for giving a patient an injection of a vaccine?

TWO

44

When coding a surgical code, where should you look to be sure you find the correct code?

USE THE ALPHABETIC LISTING OF PROCEDURES AT THE BACK OF THE CPT MANUAL

45

You have consulted the index in the CPT and discovered that a dressing for a burn is found in the procedure codes 16010-16030. To correctly code the dressing you should?

CHECK EACH CODE IN THE RANGE TO CHOOSE THE CORRECT ONE

46

After you decide on the appropriate CPT code(S) for a procedure you should?

CONSULT APPENDIX A, IN THE CPT TO CHECK FOR APPLICABLE MODIFIERS`

47

Which of the following best describes HCPCS level II codes?

THE CODES HAVE FIVE CHARACTERS: NUMBERS, LETTERS OR A COMBINATION OF BOTH