Business of Medicine
Medical Terminology
Positional & Directional Terms
A&P
Modifiers
ICD-10
Anesthesia
Integumentary
Musculoskeletal
100
THE MEDICARE PROGRAM IS MADE UP OF SEVERAL PARTS. WHICH PART IS MOST SIGNIFICANT TO CODERS WORKING IN PHYSICIAN OFFICES AND PHYSICIAN FEES WITHOUT THE USE OF A PRIVATE INSURER?
MEDICARE PART B HELPS TO COVER MEDICALLY-NECESSARY DOCTORS SERVICES NOT COVERED UNDER MEDICARE PART A.
RATIONALE: MEDICARE B IS AN OPTIONAL BENEFIT FOR WHICH THE PATIENT MUST PAY A PREMIUM AND WHICH REQUIRES A YEARLY CO-PAY. MEDICARE PART B IS THE MOST SIGNIFICANT PORTION OF THE MEDICARE PROGRAM FOR CODERS WORKING PHYSICIAN OFFICES.
100
Using medical terminology break down the following word: ambidextrous
Ambi - both
dextrous -having skills with hands
100
(DAILY DOUBLE)
Giving the directional or positional term what is the meaning of: Abduction
Meaning: away from
100
Name the 3 layers of the skin in order from top to bottom?
Epidermis, Dermis, Subcutaneous tissue
100
WHEN IS MODIFIER 32 USED?
IT IS USED FOR GOVERNMENTAL LEGISLATIVE OR REGULATORY REQUIRED PROCEDURES SUCH AS DNA TEST, PATERNITY, BLOOD OR URINE TESTS.
EXAMPLE: IF THE JUDGE MANDATES THAT A PERSON HAS TO UNDERGO A DRUG TEST, WE WOULD BILL THAT DRUG TEST WITH A MODIFIER 32
100
When a patient a has condition that is both acute and chronic and there are separate entries for both, how is it reported?
Code Both, either use the code that states Acute on Chronic for that condition -OR- code separately, sequencing acute first
RATIONALE: According to the ICD-10-CM Section 1.B.8 coding guidelines, if the same condition is described as both acute (subacute) and chronic, and separate entries exist in the Alphabetic Index at the same indentation level, code both and sequence the acute (subacute) first
100
A 50-year-old female had a left subcutaneous mastectomy for cancer. She now returns for reconstruction which is done with a single TRAM flap. Right mastopexy is done for asymmetry. Code the anesthesia for this procedure.
ANSWER: 00402
100
An 11-year old female presents to the doctor’s office with two dark lesions and a skin tag on her back. The two lesions on her right upper back are punch biopsied. The skin tag on her back is removed by electrocauterization. How is this coded?
ANsWER: 11100, 11101, 11200-59
100
When coding a fracture, if the doctor doesn’t specify what kind of treatment was used, how would you code the fracture?
ANSWER: Closed Treatment
RATIONALE: If the doctor doesn’t document in the notes the specifics of a treatment, you should code for the lowest level of service.
200
(DAILY DOUBLE)
IF AN NCD DOESN’T EXIST FOR A PARTICULAR SERVICE/PROCEDURE PERFORMED ON A MEDICARE PATIENT, WHO DETERMINES COVERAGE?
IF AN NCD DOESN’T EXIST FOR A PARTICULAR ITEM, IT’S UP TO THE MAC TO DETERMINE COVERAGE.
RATIONALE: ACCORDING TO CMS GUIDELINES, WHERE COVERAGE OF AN ITEM OR SERVICE IS PROVIDE FOR SPECIFIED INDICATIONS OR CIRCUMSTANCES BUT IS NOT EXPLICITLY EXCLUDED FOR OTHER, OR WHERE THE ITEM OR SERVICE IS NOT MENTIONED AT ALL IN THE CMS MANUAL SYSTEM, THE MEDICARE CONTRACTOR IS TO MAKE THE COVERAGE DECISION, IN CONSULTATION WITH IT‘S MEDICAL STAFF, AND WITH CMS WHEN APPROPRIATE, BASED ON THE LAW, REGULATIONS, RULINGS AND GENERAL PROGRAM
200
Using medical terminology break down the following word: megalocardia
Megalo - large
cardia - heart
200
Giving the directional or positional term what is the meaning of: Sagittal
Meaning: vertical body plane, divides the body into equal right and left sides
200
WHICH LUNG HAS 3 LOBES?
200
WHEN IS A MODIFIER 91 USED?
A MOD 91 IS USED WHEN A REPEAT CLINICAL LAB TEST IS PERFORMED
EXAMPLE: INFLUENZA 87804, 87804-91
200
A patient has melanoma of the lip, nose, and neck. How do we code this?
ANSWER: C43.0, C43.31, C43.4
200
A 56-year-old receives general anesthesia for an open pleura biopsy. An anesthesiologist medically directing two other cases, and medically directs a CRNA on this case. What are the appropriate codes for both providers?
ANSWER: 00540-QK (Anesthesiologist)
00540-QX (CRNA)
200
(DAILY DOUBLE)
When lesions are excised from multiple sites are the measurements added together, then coded -OR- coded separately?
ANSWER: Code each lesion separately.
200
If a physician amputates an arm and put an implant in its place, how is this procedure coded?
ANSWER: 24931
300
NATIONAL COVERAGE DETERMINATION SERVE WHAT PURPOSE?
NATIONAL COVERAGE DETERMINATION HELPS TO SPELL OUT CMS POLICIES ON WHEN MEDICARE WILL PAY FOR ITEMS OR SERVICES
300
(DAILY DOUBLE)
Using medical terminology break down the following word: Appendectomy
Append - appendix
ectomy - surgical removal
300
Giving the directional or positional term what is the meaning of: Transverse
Meaning: horizontal body plane, divides the body into top and bottom sections
300
What‘s the longest bone in your arm and what are the 2 short bones in your arm?
Humerus - longest bone
radius connected to thumb
ulna connected to pinky finger
300
(DAILY DOUBLE)
WHEN A PATIENT IS SEEN BY A PROVIDER IN A DOCTORS OFFICE AND GIVEN AN INJECTION WHAT MODIFIER SHOULD YOU USE?
25 MODIFIER
SIGNIFY, SEPARATELY IDENTIFIABLE E&M SERVICE BY THE SAME PHYSICIAN/PROVIDER
300
A healthcare worker is exposed to blood from a Hepatitis C positive patient after a vial is broken and a piece of glass touched the worker’s exposed arm. How would the Dx be billed?
ANSWER: Z77.21
300
(DAILY DOUBLE)
How many units of anesthesia is billed for 355 minutes of time?
ANSWER: 23 units
(355 divided by 15 = 345) Throw the remaining 10 minutes away since it does not divide into 15 evenly.
RATIONALE: 1 unit of Anesthesia time is 15 minutes.
300
A patient present with a palpable lump in the left breast. The surgeon dissects down to the mass and removes it entirely. The procedure is described as “Biopsy of mass of left breast”. How is this coded?
ANSWER: 19120-LT
300
When it comes to coding a spinal bone graft procedures, which modifier cannot be used?
ANSWER: Modifier 62
400
WHEN ARE PROVIDERS RESPONSIBLE FOR OBTAINING AN ABN FOR A SERVICE NOT CONSIDERED MEDICALLY NECESSARY?
PRIOR TO PROVIDING A SERVICE OR ITEM TO A BENEFICIARY
400
Using medical terminology break down the following word: Rhinoplasty
Rhino- nose
plasty- surgical repair
400
Giving the directional or positional term what is the meaning of: Proximal
Meaning: near the center of the body
400
(DAILY DOUBLE)
There are 4 sinus cavities, what are they?
Frontal, Ethmoid, Sphenoid and Maxillary
400
SURGEON REPAIRS ROTATOR CUFF ON BOTH SHOULDERS, WHAT MODIFIER SHOULD BE USED?
MODIFIER 50 OR
MODIFIER LT/RT
400
(DAILY DOUBLE)
A patient has been diagnosed with Scurvy after he has complained of bruising easily, weakness, and fatigue. How would this be coded?
ANSWER: E54
400
What is the Anesthesia guideline when multiple procedures are performed?
ANSWER: When multiple surgical procedures are performed during a single anesthetic administration, only the anesthesia code representing most complex procedure is listed.
400
A wound repair that involves layered closure of one or more of the deeper layers of subcutaneous tissue and superficial (non-muscle) fascia or extensive cleaning of heavily contaminated wounds is what complexity of repair.
ANSWER: Intermediate
400
(DAILY DOUBLE)
A patient is given Xylocaine, a local anesthetic, by injection into the thigh above the site to be biopsied. A small muscle biopsy is then introduced through the skin into the muscle, about 3 inches deep, and a muscle biopsy is taken. How is this procedure coded?
ANSWER: 20206
500
EVALUATION AND MANAGEMENT SERVICES ARE OFTEN PROVIDED IN A STANDARD FORMAT SUCH AS SOAP. WHAT DOES THE ACRONYM SOAP STAND FOR?
SUBJECT, OBJECTIVE, ASSESSMENT AND PLAN
500
Using medical terminology break down the following word: neuralgia
Neur- nerve
algia-pain
500
Giving the directional or positional term what is the meaning of: Supine
Meaning: face up/ palm up
500
How are muscles attached to bones?
They are attached by tendons
500
IF A SURGEON PERFORMS A PROCEDURE AND DOCUMENTS THAT IT LASTED LONGER THAN USUAL. WHAT MODIFIER IS USED?
MODIFIER 22 - INCREASED PROCEDURAL SERVICES
500
(ICD-10) What does the acronym ICD-10-CM stand for?
ANSWER: International Classification of Diseases, 10th Revision, Clinical Modification
500
What is the Anesthesia guideline when calculating time for multiple procedures?
ANSWER: The time reported is the combined total for all procedures.
500
Excision of 2-cm squamous cell carcinoma from left chest with repair of resultant 8-cm2 defect using V-Y plasty. How is this coded?
ANSWER: 14000
500
Name the 5 regions of the spine and now many vertebrae are in each.
ANSWER: Cervical - 7
Thoracic - 12
Lumber - 5
Sacrum - 5 (fused)
Coccyx - 4 ( fused)