Chapter 46 - medical coding

which organization complied the first disease classification system in the united states?

american medical association

How does a classification system become a coding system?

names are replaced by numbers and letters

For which reason(s) are procedure codes used?

-to classify the type of care given to patients

-to identify and/or justify medical services a patient received

-to collect statistics about frequency and effectiveness of procedures

-to determine how frequently certain diseases, occur in the population

How often should the medical office purchase new code books or computer code sets?

annually

Who publishes the CPT manual for procedure codes?

American Medical Association

What do CPT Category II and Category III codes consist of?

four digits and one letter

What coding system is used by the Centers for Medicare and Medicaid Services for services and equipment that are not usually covered by ordinary health insurance?

HCPCS Level II

What is the first section of the CPT manual?

evaluation and management

What is the format of most CPT codes?

Five-digit code

What would be added to a code for a procedure that was extensive or unusual or that required an assistant?

a two digit modifier

in the index of the cpt manual, for which of the following might the medical assistant find a modifying term?

anatomic location

dr barry manning is an internist. in which section of the CPT manual would the codes for his office visits be found?

evaluation and management

which of the following is a key factor determining the level of service for an E/M code?

the extent of the medical history

Which of the following types of history focuses mainly on the chief complaint?

problem focused history

If the patient has multiple problems and is seriously ill, what type of medical decision making is probably necessary?

high complexity

in which section of the cpt manual is there an attempt to link reimbursement to the completeness of the examination and the amount of skill required to manage the patients problems?

evaluation and management

How is an established patient defined?

a patient who has been seen in the past 3 years

Which type of anesthesia does not receive a separate code?

local anesthesia administered by infiltration

Which factor is used to calculate payment for anesthesia services?

the base value of the anesthesia code

In an anesthesiologist's practice, which type of modifiers indicate the patient's condition at the time of the administration of the anesthesia?

physical status modifiers

What is included in the code for a surgery?

Local or topical anesthesia

Which of the following diagnostic tests is/are included in the radiology section of the CPT manual?

standard angiography, computed tomography, magnetic resonance imaging, standard radiologic procedures

What is a panel related to CPT coding?

A group of laboratory tests that are done together

When procedure codes are used to bill an insurance company, which of the following is an example of upcoding?

a medical office uses a separate code for each lab test in a panel when all tests in the panel were performed

During a routine examination, the physician decides to have an electrocardiogram (ECG) performed on the patient. How should this be coded?

as a separate procedure

What problems with CPT codes may cause insurance claims to be rejected?

the service is not backed up with documentation in the patient record

If the medical assistant is coding for the removal of a lesion, what might influence selection of the proper code?

type of lesion

size of lesion

location of the lesion

method of removal of the lesion

What is the format of HCPCS Level II codes?

One letter followed by four digits

Which of the following is most likely to require a HCPCS Level II code?

metal crutches

Why was diagnostic coding originally developed?

-to track disease processes

-to classify the cause of disease

-to collect data for medical disease

-to evaluate hospital service utilization

What organization first published and continues to manage the International Classification of Diseases?

the world health organization

What is the meaning of the "10" in the abbreviation ICD-10-CM?

10th edition

Which of the following is an addition in the ICD-10 compared to the ICD-9?

greater number of codes

expansion of injury codes

additional digits and letters

more information related to ambulatory care

How are most diseases or conditions arranged in the tabular section of the ICD-10 manual?

by classification of disease or body system affected

What is the format of the first three characters of an ICD-10 code?

one letter followed by two digits

In which chapter of the ICD-10 manual would you expect to find the diagnosis code for an adolescent who comes to the office for a physical examination before enrolling in a school sports program?

the last chapter

How do insurance companies use diagnosis codes?

To decide whether the care given corresponds to the patient's disease

In the ICD-10 code M84.50xA, what is the function of the "x"?

it is a placeholder for information that is not specified

What is the purpose of external cause codes in the ICD-10?

they are used to gather statistics about causes and severity of injury

If a diagnosis is listed by the physician as "wedge compression fracture of the fifth lumbar vertebra," which word should be referenced in the alphabetic index of the ICD-10 manual?

fracture

Which of the following abbreviations or punctuation indicates that a more specific ICD-9 or ICD-10 code cannot be identified?

NOS

In the ICD-10, which term indicates that a condition is not coded here, and the patient cannot have this condition in addition to the condition listed above it?

excludes 1

Why is it important for a medical assistant to be aware of guidelines for medical necessity?

to link procedure codes to correct diagnosis codes

If an office has a pattern of downcoding, what is the effect on insurance payments?

insurance payments will tend to be lower than average for the services

What is the penalty (if any) if a medical office is found to have a practice of upcoding?

the practice must pay a large fine

HCPCS level 1 codes include the current CPT codes (T/F)

true

Category II CPT codes represent services that represent emerging technology (T/F)

false

The section of the CPT manual that contains the most codes is the evaluation and management section (T/F)

false

The CPT manual, a code that provides only text to replace the words after a semicolon in the code above is called an indented code (T/F)

true

if the evaluation and management code on an insurance claim is for a lower level of care than is reflected in the patients medical record, the claim is an example of upcoding (T/F)

false

the medical assistant must look up CPT codes for most office visits and office procedures when billing insurance campanies for patient services (T/F)

false

the standards of electronic transmission and require code sets had to be changed in order to accommodate ICD-10 codes (T/F)

true

when coding the diagnosis "tachycardia, R/O angina pectoris," the medical assistant should look up the code in the index under "angina" (T/F)

false

For ICD-10 codes, the instruction "code first" tells the coder to use another code as the first code because it identifies the underlying cause or condition (T/F)

true

the term "upcoding" can be defined as using codes incorrectly in order to obtain more reimbursement (T/F)

true