Coding/Billing
What is the CPT code range for Evaluation and Management services?
99202–99499
What system enables providers to electronically share patient health information?
Health Information Exchange (HIE).
Which setting allows you to code “suspected” diagnoses?
Inpatient
What documentation red flag could trigger an audit when repeated across multiple patient records?
Cloned notes or copy-paste verbiage with no patient-specific content.
What’s the first thing most coders do when they can’t find a code?
Google it. 😂
What is the CMS-1500 form?
This form is used to submit claims to Medicare and Medicaid for professional services.
How long must legal medical records be retained under federal law?
At least 6 years (may vary by state or policy).
In ICD-10-PCS, what does the first character represent?
The section (e.g., medical/surgical = 0).
What entity oversees false claims, kickbacks, and improper billing in federal healthcare programs?
The Office of Inspector General (OIG).
Finish the phrase: “When in doubt, always check the __________.”
Guidelines
What are the two types of edits under the National Correct Coding Initiative (NCCI)?
Column 1/Column 2 edits and Medically Unlikely Edits (MUEs).
What is CDI in the context of health record documentation?
Clinical Documentation Integrity.
What type of conditions are captured under "Present on Admission (POA)" indicators?
Conditions documented as existing at the time of inpatient admission.
What does the acronym CERT stand for in Medicare auditing?
Comprehensive Error Rate Testing.
What do coders joke they need after reading 40 operative reports in a day?
A coffee IV drip. ☕💉
According to outpatient ICD-10-CM guidelines, when should a historical condition not be coded?
When the condition is no longer active and is not documented as impacting care during the visit.
What is Natural Language Processing (NLP) used for in health records?
To analyze and extract data from free-text documentation in EHRs.
What is the root operation for a total hip replacement in ICD-10-PCS?
Replacement (replacing a body part with a synthetic substitute).
What federal act governs patient privacy and documentation security?
HIPAA – the Health Insurance Portability and Accountability Act.
Which superhero works as a radiologist by day and fights crime by night?
Doctor Strange.
What are the three components of medical decision making used to determine E/M levels?
Number and complexity of problems, amount/complexity of data, and risk of complications.
What does HIM stand for in healthcare?
Health Information Management.
If a patient is admitted for chemotherapy but also has anemia due to malignancy, what’s the principal diagnosis?
Encounter for chemotherapy (Z51.11), per sequencing guidelines.
What’s the difference between a leading and non-leading query?
A leading query suggests a diagnosis; non-leading queries are open-ended or multiple-choice with objective support.
What is the golden rule for coders?
If it’s not documented, it didn’t happen.