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Theory 160 wk1

theory exam

Question	Answer
The same coding guidelines apply to both inpatient and outpatient settings	False
In the outpatient setting the term first-listed diagnosis is used instead of principal diagnosis	True
The first-listed diagnosis is the diagnosis that the physician lists first	False
In the outpatient setting a diagnosis that is documented as rule-out should be coded as if it exists	False
V codes can be assigned as first-listed or secondary diagnoses	True
In the outpatient setting the term first-listed diagnosis is used in lieu of princiapl diagnosis	True
If a patient is admitted for observation for a medical condition a code is assigned for the medical condition as the first-listed diagnosis	True
It is acceptable to use codes that describe signs or symptons when a definitive diagnosis has not been established by the provider	True
If the pre and postoperative diagnosis are different the preoperative diagnosis should be coded	False
In times past physicians in private billed indemnity insurance plans and professional services were reimbursed on a fee-for-service basis	True
Ross-Loos Medical Group america's oldest privately owned prepaid medical group started in Texas	False
The health maintenance organization act of 1973 required most employers to offer HMO coverage to their employess as an alternative to traditional health insurance	True
Medicare-eligible patients are not involved with HMO's or prepaid health plans	False
In a staff model HMO physicians are hired directly by the health plan that pays their salary	True
Exclusive provider organizations (EPO) are regulated by the federal government	False
The difference between an IPA and a PPG is that a PPG may not be owned by its member physicians whereas an IPA is physician owned	False
In a point of service(POS) program members may choose to use a nonprogram provider at any time	True
The term turfing means to transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer	True
If a primary care physician sends a patient to a specialist for consultatiion and the specialist is not in the managed care plan, the specialist may bill the primary care physician for payment	True
In certain managed care plans there is an incentive for the gatekeeper to limit patient referrals to specialists	True
Managed care plans allow laboratory tests to be performed at any facility the patient chooses	False
Managed care plans never require a CMS-1500 claim form to be completed and submitted	False
Usually there are no deductibles for managed care plans	True
A copayment in a managed care plan is usually a fixed dollar amount	True
Radiology codes designated as a separate procedure should be reported in addition to the code for the total procedure or service	False
There are four subheadings in the radiology section	False
The phrase with contrast represents contrast material administered intravasculary intra articularly or intrathecally	True
It is acceptable for the radiologist to communicate his/ or her opinion via telephone instead of a written report	False
Personal history of peptic ulcer	V12.71
Screening for sickle cell	V78.2
Long term use of high risk medication	V58.69
Preoperative evaluation for elective cholecystectomy due to gallstones. Patient is seen by pulmonologist because of COPD	V72.82, 574.20, 496
Initial office visit for patient with diarrhea Physician documented gastroentritis	Gastroenteritis
An established patient is seen for amenorrhea and galactorrhea to rule out pituitary tumor	Amenorrhea, galactorrhea
The abbreviation MCO stands for	Managed Care Organization
A primary care physician who controls patient access to specialists is called a/an	Gatekeeper
Benefits under the HMO Act fall under two categories__health services and supplemental health servfices	Basic
The process called___is an evaluation of the quality and efficiency of services rendered by a practicing physician or physicians within the speciality group	Quality Improvement
UR is the abbreviation for___which is necessary to control costs in the health care setting	Utilization Review
When a managed care plan requires the primary care physician to seek approval before referring a patient to a specialist it is called obtaining	Pre authorization
When a certain percentage of the monthly capitation payment is held out of the premium fund to pay for operating an IPA, its known as a/an	Withhold
In clinical brachytherapy the superviaion of radio elements and dose interpretation are performed by the therapeutic	Radiologist
Two dimensional ultrasonic scanning procedure with a two dimendiagnostic ultrasoundsional display is the definition of___	B-scan
Radiologic examination nasal bones complete minimum of three views	70160
A cardiac magentic resonance imaging for morphology and function without contrast	75557
Renal venography unilateral selective supervision and interpretation	75831
An 18 MeV radiation treatment single treatment area	77404
Liver imaging with vascular flow	78202
Unlisted ultrasound procedure	76999
Two view chest x-ray film frontal and lateral	71020
Complete abdominal ultrasound using real time with image documentation	76700
X-ray shoulder arthography supervision and interpretation only	73040
Epididymography, supervision and interpretation	74440
Selective spinal angiography supervision and interpretation	75705
Saline infusion sonohysterography with color flow doppler	76831
__means lying down	Recumbent
Retroperitoneal sonogram kidneys	76770
MRI of brain with contrast	70552
america's oldest privately owned prepaid medical group is the	Ross-Loos medical Group
What plan allows members of Kaiser Permanente Medical Care Program to seek medical help from non Kaiser physicians?	Point Of Service
Kaiser Permanente's medical plan is a closed panel program which means	It limits the patient's choice of personal physicians
A significant contribution to HMO development was the	Health Maintenance Organization Act of 1973
How does an HMO receive payment for the services its physicians provide?	Prepaid health plan
When an HMO is paid a fixed amount for each patient served without considering the actual number or nature of services provided to each person this is known as	Capitation
How are physicians who work for a prepaid group practice model paid?	Salary paid by independent group
What is the name of an organization of physicians sponsored by a state or local medical association that is concerned with the development and delivery of medical services and the cost of health care?	foundation for medical care
In an independent practice association(IPA) physician's are	Not employees and are not paid salaries
An Organization that gives members freedom of choice among physician's and hospitals and provides a higher level of benefits if the providers listed on the plan are used is called a/an	Preferred provider organization(PPO)
A physician-owned business that has the flexibility to deal with all forms of contract medicine and also offers its own plans is a/an	PPG
A program that offers a combination of HMO-style cost management and PPO-style freedom of choice is a/an	Point of Service Plan (POS)
Practitioners in an HMO program may come under peer review by a professional group called a	Quality Improvement Organization
When a physician sees a patient more than is medically necessary, it is called	Churning
Referral of a patient recommended by one specialist to another specialist is known as	Tertiary Care
What is the correct procedure to collect a copayment on a managed care plan?	Collect the copayment when the patient arrives for the office visit
The modifier reported when a physician component is reported separately is	-26
A__procedure is one that is performed independently of, and not immediately related to, another service	Separate
the divisions of the Radiation Oncology section of the CPT manual are divided into subsections based on what?	Type of service
What is the standard measure of energy in radiation treatment?	MeV
What is the modifier used to identify the technical component of a radiologic procedure?	-TC
What are the radiosotopes that attach themselves to red blood cells called?	Tracer
What is the name of the high frequency sound waves in an imaging proccess that is used to diagnose patient illness?	Ultrasound
Radiation oncology codes include normal follow-up care during the course of treatment and __following its completion	Includes 3 month global period
Codes 76801 and 76802 include determination of the number of gestational sacs and fetuses, gestational sac/fetal measurements appropriate for gestation<14 weeks 0 days and;	Survey of visible fetal and placental anatomic structure, qualitive assessment of amniotic fluid/gestational sac shape, examination of the maternal uterus and adnexa
A needle with a suture attached is passed through an incision into the stomach the needle is snared and removed via the mouth a gastrostomy tube is connected to the suture and passed through the mouth into the stomach and out the abdominal wall cpt code?	None Of The Above
The procedure is a percutaneous transhepatic dilation of biliary duct stricture with or without placement of a stent. How would radiological supervision and interpretation be coded?	74363

Created by: moviegrl

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