Medical coding and practice quizzes

week 14

International Classification of Diseases (ICD-10)

established to track disease and death rates, maintained by World Health Organization (WHO) (starts with letters than numbers)

Tabular list

a structured list of codes that correspond to specific medical conditions or procedures and serves as the primary source for choosing the final code for a medical condition or procedure

ICD-10-Z

used to identify specific health related circumstance or problem which is not necessarily an injury or illness

Current Procedural Terminology (CPT)

usually 5 digit numeral used to document procedures and services in out patient setting (billing purposes for insurance)

Modifiers

helps further describe a procedure code without changing its definition

Evaluation and management codes

99202-99499

Anesthesiology codes

00100-01999, 99100-99140

Surgery codes

10021-69990

Pathology and laboratory codes

80048-39356

Medicine codes

90281-99500-99602

Evaluation and Management codes (E&M codes)

use of CPT codes from the range 99202 to 99499 and represent services provided by a physician or other qualified healthcare professional

Healthcare common procedure coding (HCPCS)

represent non-physician services such as ambulance rides, wheelchairs, walkers, and other equipment and services

Downcoding

reimbursement on lower code level than submitted (lack of documentation most common cause)

Upcoding

reimbursement on higher code level than submitted for a higher fee (fraudulent)

The National Provider Identifiers (NPI)

unique identification numbers for covered health care providers (must be used during cleaning house)

code 99214

CPT code for physician services/office visit

99213

E/M code for an established patient, expanded, problem focused

Routing or encounter form

superbill

for which reason should a MA enter an bookkeeping adjustment on a patients account

insurance disallowance, which the provider pays the difference for

(This is the difference between the actual amount of the procedure and the amount agreed upon by the insurance company and the provider)

Which area on the medical records content areas includes a patient’s demographic data

Subjective

shingling

method of filing paper medical records by placing newer reports on top of older reports

Nitroglycerin

can be used for myocardial infarction and should be placed under the patient’s tongue

If a provider request sterile solution

place a sterile container on the field and pour a small amount of sterile solution into the container

Signs for cerebrovascular accident (stroke)

slurring speech and developing slight drooping of one side of mouth

Epistaxis and taking Warfarin

is a top priority

this is a nose bleed and the patient has taken a blood thinner that stops blood from clotting

A patient should be placed in which position for an examination of the dorsal cavity

Prone

During an ear irrigation a patient can report dizziness if

the temperature of the water is too cold

Hemoglobin levels

Adult Men: 13.5 to 18.0 g/dL

Adult Women: 12.0 to 15.0 g/dL (non-pregnant)

Nonadherent dressing

should be used on a partial thickness burn

Lithotomy

pelvis examination

Potassium levels

between 3.5 and 5.0 millimoles per liter (mmol/L)

if patient has had a previous thromboses the MA should

perform a capillary collection rather than a venipuncture for blood tests

Sims position

used for enema

Testing hearing using Weber test

ask the patient if they hear the vibration louder in one ear than the other

High risk of developing artery disease

smoking

High risk of experience a cerebrovascular accident (CVA)

sleep apnea

intermittent oxygen deprivation during sleep (hypoxia), increased blood pressure and heart strain, and potential for atrial fibrillation (A-fib)

Hiatal hernia

characterized by the top portion of the stomach protruding through the diaphragm

Clinical purpose of contrast media in diagnostic imaging

highlights the inner contours of body structures

Swelling of the right arm may happen because of

right-sided radical mastectomy and lymphadenectomy

Chronic hypertension may cause

congestive heart failure (CHF)

Colorectal cancer may happen because of

a low-fiber, high-fat diet

Rheumatologist

a doctor specializing in diagnosing and treating diseases that affect the joints, muscles, and bones

Fibromyalgia

a condition that causes pain in muscles and soft tissues all over the body

Syncope symptoms can be

chills, nausea, and dizziness

diagnostic tests for a patient’s liver and pancreas is for which system

digestive

Tuberculin skin test (TB)

intradermal

Transdermal is used for

slow release of medication into the blood stream

focused on evidence-based patient care and shared decision making is a feature part of

the patient-centered medical home (PCMH) model of care

Patient navigator

patients needs and barriers, coordination care, and identifying resources

A medical assistant is part of a team that is caring for a patient who is being discharged from the hospital. What action would contribute to a successful transition of care

the provider discontinues all medication started in the hospital and relays the information to the rest of the team

purpose of patients discharge summary in a providers office

to document information necessary for continuity of care