Section 1

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Explain how the RBRVS calculates how a provider gets reimbursed. Make sure to include the terms "relative value" and "conversion factor" in your explanation.

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Cards (98)

Section 1

(50 cards)

Explain how the RBRVS calculates how a provider gets reimbursed. Make sure to include the terms "relative value" and "conversion factor" in your explanation.

Front

relative value by geographical region x conversion factor = $

Back

Matt has chronic back pain from an old motor vehicle accident. He came to the office to see his provider because he is experiencing acute back pain after having a bowel movement. Acute back pain would be the first-listed condition coded and then chronic back pain would be coded.

Front

True

Back

The most common forms of Medicare Fraud include

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BIling for services not furnished, misrepresenting a diagnosis, unbundling, up coding

Back

The largest third-party payer in the United States is

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Medicare Program

Back

The two coding systems that will be taught in this class are _______ and_________

Front

ICD -10-CM and CPT

Back

ICD-10-CM provides codes to deal with encounters for ___________________other than a disease or injury. These codes begin with the letter _______.

Front

cirumstances; Z

Back

The World Health Organization (WHO) is responsible for maintaining ICD-10-CM

Front

Back

The patient was last seen in the office two years ago, so this patient is considered a (n):

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established patient

Back

MEANS: must follow this information

Front

See

Back

CPT codes that end with the numbers "99" are considered

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unlisted procedure codes

Back

CPT codes that begin with the numbers "99" are considered

Front

Evaluation and Management

Back

You completed and documented the vitals of a patient who came in the office short of breath. You saw that the provider went into the examination room and exited within two minutes. Your provider gave you a fee ticket (super bill) that documented 99205 E/M visit with a diagnosis of congestive heart failure (CHF). After reviewing this patient's medical record you notice the provider documented that they spent 60 minutes in counseling and/or coordination of care. What would you do in this situation?

Front

Do not submit the fee ticket, and query the provider

Back

The best modifier to use when a provider does an E/M visit on a postoperative patient for a condition not related to the operation would be

Front

-24

Back

Codes assigned in chapter 16 of the ICD-10-CM code book pertain to ________________patients

Front

certain conditions origination in the perinatal period

Back

Subjective information, like a patient stating "my arm hurts bad", is considered objective:

Front

false

Back

A subsequent nursing home visit E/M level 99307 states the history and examination are problem-focused, and the medical decision making as____________________. If the provider spent more than 50% of their time counseling and/or coordinating care of the patient, the provider has to document at least ____________minutes.

Front

straight forward; 10 mins

Back

According to the E/M coding guidelines when the nature of presenting problem is this type, it does not require the presence of a physician, but service is provided under the physician's supervision.

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minimal

Back

Volume 1, Arranged with the first character always a letter and then numerically

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tabular

Back

Volume 2, Arranged alphabetically

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Index

Back

Solid Rock was seen in the office today and the provider performed a low-level E/M visit. However, the provider placed a comprehensive high level E/M visit for reimbursement. You educate your provider that this is called _________and is considered fraud.

Front

upcoding

Back

According to chapter 19 specific coding guidelines fractures are coded using the appropriate 7th character extension for _______________care for encounters after the patient has completed active treatment of the fracture and is receiving _____________care for the fracture during the healing or recovery phase.

Front

subsequent; routine

Back

what is the largest 3rd party payer?

Front

Medicare Program

Back

If the medical assistant is responsible for filing Medicare claims then it is important that they validate that the services being billed were provided by consulting the medical record or physician.

Front

True

Back

If you, the medical assistant, is asked by your provider to assign codes for the practice, whose responsibility is it to assign codes accurately and completely to maximize reimbursement?

Front

the medial assistant

Back

Stacy went to see her provider because her nose would not stop bleeding after she picked it with her new fake nails. The provider noticed a small laceration in her nostril and applied pressure with a gauze which eventually stopped the bleeding. Which would be the first-listed diagnosis?

Front

laceration

Back

According to chapter 1 specific coding guidelines only confirmed cases of HIV can be coded.

Front

True

Back

The ICD-10-CM alphabetic index and tabular are used in outpatient settings to substantiate

Front

Back

Patient came in with a cough and provider asked the patient if they are experiencing any chest pain as well. The patient denied any chest pain. This information would be found under

Front

review of systems ( ROS)

Back

The ICD-10 is designed for the classification of patient mortality and

Front

Back

For outpatient encounters it is appropriate to assign codes that the provider has documented as "probable", "rule-out", "versus", or otherwise uncertain.

Front

False

Back

List the six reasons codes are used today

Front

Back

The elements of the key history component are, chief complaint (CC), history of present illness (HPI), _______________________________________________, and past, family, social history (PFSH).

Front

review of systems (ROS)

Back

A new patient consultation in an office setting with a detailed history, detailed examination, and low complexity medical decision making would be assigned E/M CPT code _______________.

Front

99243

Back

the organization developed and maintains the ICD - 10- CM

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NCHS

Back

A three character code is to be used only if it is not further subdivided

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true

Back

MEANS: non- essential modifer

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( parenthesis)

Back

MEANS; a more specific code does not exist

Front

(NEC)- not elsewere classified

Back

Additions, deletions, and revised CPT codes can be found in appendix______of the CPT Official code book

Front

B

Back

Transforming verbal or narrative descriptions of diseases, injuries, conditions, and procedures into alphanumeric designations is a complex activity and should not be undertaken without proper training.

Front

Back

ICD-10-CM stands for

Front

international classification of diseases 10th revision clinical modifications

Back

The insurance claim form (paper type) used in physician office clinics for reimbursement is called

Front

CMS 1500 claim form

Back

MEANS: not included here, if the condition is present that code can be included

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Exclude 2

Back

Patient information located in the medical record is referred to as

Front

documentation

Back

Codes that describe symptoms and signs, as opposed to diagnoses, are ________________for reporting purposes when a related definitive diagnosis has not been established (confirmed) by the provider.

Front

acceptable

Back

For a new patient, what key components must meet or exceed the stated requirements to qualify for a particular evaluation and management (E/M) level

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History Component Physical Component Medical Decision Making Component

Back

the organization developed and maintains the ICD-10

Front

WHO

Back

The symbol that indicates a product is pending FDA approval is the

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lighting bolt

Back

The best modifier to use when during an E/M visit the provider decides that surgery needs to be performed would be

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-57

Back

Medicare Part _______ pays for physician office visits

Front

B

Back

One of the reasons coding systems are used in a physician office or medical clinic is because codes directly relate to how a provider will be reimbursed.

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TRUE

Back

Section 2

(48 cards)

One of the reasons coding systems are used in a physician office or medical clinic is because codes directly relate to how a provider will be reimbursed

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true

Back

10. The type of service where a patient is admitted to the hospital is called

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admission

Back

A patient presented to the office with cough, frequent urination, and runny nose. An upper respiratory infection was the first listed diagnosis. What other additional diagnoses can be assigned to this case

Front

Frequent urination

Back

always verify the codes in the Tabular to assure accurate coding

Front

true

Back

the current revision for CPT is revision four (4)

Front

true

Back

the following maintain the CPT code book

Front

american medical association (AMA)

Back

There are 18 chapters in the United States ICD-10-CM Official code book.

Front

false, 19

Back

Daisy Flower was seen in the office today for her post-operative evaluation. You notice that the provider assigned an E/M visit for reimbursement. You know that this E/M visit is considered a global package and should not be billed separately. You educate your provider that this is called _________and is considered fraud

Front

unbundling

Back

The CPT code 49451 represents:

Front

CPT category I codes

Back

The elements of the key medical decision making component are, number of diagnoses, amount of data reviewed, and

Front

risk

Back

The ICD-10 is designed for classification of patient mortality and ______

Front

Mobility

Back

All ICD-10-CM and CPT codes must be supported by

Front

Physician documentation in the medical record

Back

When assigning a diagnosis, always verify the code in the Tabular to assure accurate coding.

Front

true

Back

In the Alphabetic Index of Volume 2, ICD-10-CM, nonessential modifiers are:

Front

Terms enclosed in parentheses that have no effect on the selection of the code listed for the main term

Back

The patient was last seen in the office four years ago, so this patient is considered a (n):

Front

new patient. (3yrs)

Back

The acronym ICD-10-CM means:

Front

International Classification of Diseases, 10th Revision, Clinical Modification

Back

a coder cant not code directly from the index

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true

Back

It is important to follow any cross-reference instructions, such as "see

Front

true

Back

In the outpatient setting, the term "first-listed condition" is used to identify the reason for the encounter.

Front

true

Back

Just like ICD-10-CM, it is NOT acceptable to assign CPT codes by referring to the index only.

Front

true

Back

In the outpatient setting, a diagnosis that is documented as "versus" should be coded as if it exists.

Front

false

Back

In CPT, the description of a code prior to the semicolon (;) is considered:

Front

stand-alone code

Back

Additions, deletions, and revised CPT codes can be found in appendix____of the CPT Official code book.

Front

B

Back

Most codes in Chapter 13, Diseases of the Musculoskeletal System and Connective Tissue, have these designations

Front

site and laterality

Back

According to the E/M coding guidelines when the nature of presenting problem is this type, it means there is a high risk of morbidity without treatment.

Front

high severity

Back

The CPT code that has four digits and ends with the letter "T" are considered:

Front

CPT category III codes

Back

Z codes are used to report:

Front

Factors influencing health status and contact with health services

Back

All ICD-10-CM codes require a minimum of four digits

Front

false

Back

When separate codes exist to identify acute and chronic conditions, and both conditions are documented, the chronic code is sequenced first

Front

false acute first

Back

In the CPT index codes listed as 21552-21558 are considered

Front

code ranges

Back

It is acceptable to use codes that describe signs or symptoms when a definitive diagnosis has not been established by the provider

Front

true

Back

a bullet symbol indicates the CPT code is

Front

New

Back

Solid Rock was seen in the office today and the provider performed a low-level E/M visit. However, the provider placed a comprehensive high level E/M visit for reimbursement. You educate your provider that this is called _________and is considered fraud.

Front

up-coding

Back

the instructional note in the Tabular o f the ICD-10-CM directs the coder on sequncing

Front

Code First

Back

CPT modifiers can be used to communicate to insurance payers that an unusual circumstance has occurred:

Front

true

Back

main terms in the alphabetic index are in bold type and subterms are indented under the main term

Front

true

Back

ICD-10-CM codes are used to translate verbal or narrative descriptions into 3-7 alphanumeric codes.

Front

true

Back

The codes in the ICD-10-CM are alphanumeric

Front

true

Back

The Chapter 16, Certain Conditions Origination in the Perinatal Period, codes are only used in this medical record

Front

newborn

Back

if there is a required 7th charcter to assign for an ICD-10-cm code but there ist a 6th letter what would you use for the 6th letter?

Front

X

Back

patient information located in the medical record is referred to as

Front

documentation

Back

Patient came in with a cough and provider asked the patient if they are experiencing any chest pain as well. The patient denied any chest pain. This information would be found under:

Front

review of systems

Back

The alphabetic index in ICD-10-CM is considered volume_

Front

2

Back

A patient being seen at their primary doctor's office is considered an outpatient

Front

true

Back

According to the chapter specific coding guidelines for Diseases of the Musculoskeletal System and Connective Tissue, if the provider does not document whether a traumatic fracture is open or closed, the default is to assume it is an open fracture.

Front

false

Back

The best CPT modifier to use when a provider does an E/M visit on a postoperative patient for a condition not related to the operation would be

Front

-24

Back

The Healthcare Common Procedural System (HCPCS) level II codes are called:

Front

national codes

Back

A patient had a bilateral herniorrhaphy and the CPT code description didn't include laterality. The modifier used to indicate a bilateral procedure was done would be:

Front

-50

Back