Oranges
When records are reviewed by third-party payers, if a procedure is not documented, it
The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) remained in use in the United States until September 30th of what year?
2015
What are HCPCS Level I codes are known as (or the same as)
Current Procedural Terminology (CPT)
Where in the CPT manual would you find information about modifiers?
Appendix A
The AMA defines medical necessity as services or procedures that a prudent physician would provide to a patient in order to prevent, diagnose, or treat an illness, injury, or disease or the associated symptoms in a manner that is (which is true):
a.in accordance with the generally accepted standard of medical practice.
b. clinically appropriate in terms of frequency, type, extent, site, and duration.
c. not for the intended economic benefit of the health plan or purchaser or the convenience of the patient, physician, or other health care provider.
All are true
Which of the following would not be a required step in utilizing medical necessity guidelines?
a. Review of the family history section of the progress note
b. Review of the narrative diagnostic finding(s) indicated
c. Review the order from provider
d. Looking over the entire encounter form and progress note to make sure that all procedures and services and diagnoses are identified
Review of the family history section of the progress note
When coding, the primary reason for the office visit is listed first, and other reasons are listed in what order?
Order of importance
Services performed in the office are generally marked on a patient’s encounter form (or superbill) by the
provider
Which of the following can happen to anyone knowingly submitting a false claim or creating a false record or statement to receive payment from the federal government:
1. be fined a civil penalty of not less than $10,781 and not more than $21,563 per false claim submitted.
2. be imprisoned and face other penalties.
3. be guilty of violations of the Federal False Claims Act.
All of these
As a result of the Medicare Modernization Act of 2004, new, revised, and deleted HCPCS/CPT codes must be implemented every year on which date?
January 1st
The main rule to remember of the ICD coding rules, which says that the reason for the patient visit (encounter) is coded first is known as the:
Upcoding can result in
serious fines and penalties
A payer practice in which a reported evaluation and management service is reduced to a lower level based strictly on the diagnosis code reported is known as
downcoding
Who publishes Current Procedural Terminology (CPT)?
World Health Organization (WHO)
The CPT manual uses symbols to indicate specific information about code numbers. For example, the + symbol stands for:
add-on code
Which level of the Healthcare Common Procedural Coding System (HCPCS) includes codes that identify products, supplies, and services not included in CPT?
Level II
Which of the following is false:
a. ICD-10-CM helps reduce coding errors.
b. ICD-10-CM provides greater coding accuracy and specificity.
c. The United States is the only nation using the ICD-10-CM coding system.
d. ICD-10-CM results in improved efficiency of care and lower costs.
The United States is the only nation using the ICD-10-CM coding system.
When coding procedures and diagnoses, you isolate the main term from the provider’s statement assessment or description for the service provided and then look it up in the:
Index
Assigning a diagnosis code that does not match patient documentation for the purpose or increasing reimbursement through the DRG system is known as:
Upcoding
ICD codes are descriptive of the
Presenting disease or condition
Which HCPCS Level II codes are temporary codes for procedures, services, and supplies?
G Codes
Which of the following statements is true regarding HCPCS Level II codes?
1. Level II codes were developed to identify products and supplies for which there are no CPT codes.
2. Level II codes are composed of one alpha and four numeric characters.
3. Level II G codes are temporary codes for procedures/professional services.
All are true
Which of the following statements is not true when using HCPCS Level II codes?
1. The search for the correct HCPCS code begins in the Index.
2. The search for the correct HCPCS code begins in the Tabular List.
3. When appropriate, the correct HCPCS modifier should be appended to provide additional information.
4. Both CPT and HCPCS Level II codes can be reported on the same claim.
The search for the correct HCPCS code begins in the Tabular List.
A _____ is used to inform third-party payers that circumstances for a particular code have been altered
Modifier
How many characters may there be in an ICD-10 code?
3 to 7