Study for your Medical Coding certification with this comprehensive guide. This study resource covers ICD-10-CM guidelines, CPT coding rules, anatomy basics, and common procedures.
Q: UB04 form is used for
Answer: Hospice, Ambulatory Surgery Centers, Home Health Care
Q: patient confidentiality
Answer: treating patient’s medical information as private and not for publication
Q: signing an Acknowledgement of Notice of Privacy Practice is accepting what
Answer: HIPAA
Q: form to authorize sharing of medical information
Answer: medical release form
Q: standard form used for medical billing
Answer: CMS-1500
Q: must appear on CMS 1500 form prior to submission
Answer: birth date in 8 digit format, all caps
Q: encounter form
Answer: financial record source document to record treated diagnosis and services rendered to the patient during the current encounter. also called the superbill
Q: where non allowed charges are recorded
Answer: adjustment column
Q: 10 digit numeric identifier required in box 33A of CMS 1500
Answer: National Provider Identifier (NPI)
Q: CLIA – Clinical Laboratory Improvement Act
Answer: quality standards for lab tests
Q: most common reason for claim rejection
Answer: incorrect or incomplete information
Q: PICA pitch 10
Answer: written CMS 1500 form
Q: PICA pitch 12
Answer: electronic CMS 1500 form
Q: delinquent claim
Answer: not paid within a certain amount of time
Q: implied contract
Answer: patient scheduling an appointment with a new provider
Q: bullet/solid circle
Answer: symbol used to indicate a new CPT code
Q: plus sign (+)
Answer: add on CPT code symbol
Q: triangle
Answer: new/revised code in HCPCS level 1
Q: multiple, varying wound sizes
Answer: add the sizes together
Q: dependents of military personnel
Answer: required to have military ID for TriCare insurance
Q: used as first-listed diagnosis to indicate family history
Answer: V-Code
Q: diagnostic category code
Answer: three digit code that covers a single disease or relative condition
Q: standard medical code sets
Answer: ICD-9-CM, HCPCS, CPT, HCPCS Level II
Q: insurance claim register
Answer: diary or ledger of submitted claims
Q: appeal
Answer: explains why claim should be re-considered for payment
Q: offer Medigap
Answer: private commercial insurance companies
Q: hemodialysis
Answer: found in medicine secion of CPT manual
Q: payer of last resort
Answer: Medicaid
Q: Medicare Administrative Contractor (MAC)
Answer: Third party that contracts with CMS (Centers for Medicare and Madicaid Services) to process claims and perform integrity tasks – accepts electronic claims
Q: pending
Answer: submitted for review not yet paid
Q: co-payment
Answer: cost sharing requirement for the insured to pay at the time of service
Q: steps for coding 1st, 2nd, and 3rd degree burns
Answer: depth, extent, agent (e-code). 3rd degree first
Q: privacy officer
Answer: protects patient health information
Q: ICD-9 principle
Answer: code signs and symptoms in absence of established diagnosis
Q: classifications of neoplasms in table of neoplasms
Answer: malignant, benighn, uncertain, un-specified, specific, in-situ (6)
Q: form needed for medicare patient when services for diagnostic tests are not covered
Answer: ABN (Advanced Beneficiary Notice)
Q: valid ICD-9 principle
Answer: code to the full number of digits required for that code or it is invalid
Q: claim control number
Answer: claim ID or DCN (document control number) assigned to each claim
Q: time reporting
Answer: guideline for anesthesiology, 24G on CMS 1500
Q: developed and updates the CPT manual
Answer: AMA (American Medical Association)
Q: patient ledger account
Answer: permanent record of all financial transactions between the practice and the patient
Q: bull’s eye
Answer: CPT symbol for conscious moderate sedation