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TPA Questions

Questions from Practice Exam

How should one look up "closed reduction, percutaneous pin fixation of right fourth metacarpal fracture?" Look under reduction OR metacarpal.
What is vascular stenting? It involves the placement of a small wire mesh tube called a stent in the newly opened artery. Often performed at the same time as an angioplasty.
For an existing patient, if the "Review of Systems" is blank, can you count the E&M encounter? Yes, but only for a low level of E&M visit.
What would be the most likely compliance, ancillary coding publications, in addition to the CPT, ICD-9, and HCPCS manuals? Coding Clinic and CPT Assistant
What is the main authoritative document for ICD-9 code sequencing? AHA Coding Guideline (published each year) and the Coding Clinic.
For certain diagnoses, specified payments by CMS are paid to hospitals at: A lower payment amount if the specified diagnoses were acquired in the hospital.
What is RAC audit? What does it mean? Medicare Recovery Audit Contractor. RAC is a nationwide auditing program focusing on improper payments for "duplicate" payments, fiscal intermediaries' mistakes, Medicare necessity and coding.
The "principal procedure" describes the: Definitive Treatment
An E code ______ be a ______ diagnosis. An E code can never be a principal (first-listed) diagnosis.
Patients with this condition commonly experience pelvic pain, dysmenorrhea, and heavier menses. Adenomyosis
Trichomonas vaginalis is caused by a ______; Code for the detection by immunoassay with direct optical observation: Tiny parasite; CPT Code:87808
CPT code 95811 also includes: CPAP (continuous positive airway pressure)
What code should a pharmacist report for drug interaction counseling services? Specific Level 1 CPT codes.
In 2010, the "office consultation" codes: Were not deleted in CPT, but are no longer recognized by Medicare.
Under the PPS (Prospective Payment System), charges for services are established: In advance.
How are skin grafts measured? In square centimeters.
Which type of hysterectomy removes the cervix as well as the uterus? Total
What is not included in a LCD (Local Coverage Determination)? CPT to ICD-9 procedural codes Crosswalk.
A one-week-old male has a circumcision. What would be the appropriate DRG assignment? 343 12 SURG CIRCUMCISION AGE 0-17
What is IPPS and what does it mean? Known as the Inpatient Prospective Payment System, under the IPPS, each case is categorized into a diagnosis-related group (DRG).
What is the difference between an EMR, EHR and Computerized Medical records? None, they all refer to the same thing.
Epitheliomas are? A rare, malignant, cutaneous neoplasm. They are also occasionally referred to as sebaceous adenomas or basal cell tumors.
Which is not one of the seven compliance components recommended by the OIG? ERISA (Employee Retirement Income Security Act of 1974)
Code for the removal of a 2-cm vascular malformation of the soft issue of the left thumb. CPT Code: 26111-FA
Which components are part of Medicare Part B? CPT codes, CMS-1500, ICD-9
The "Privacy Rule" specifies how many circumstances in which the parent is not the "personal representative" with respect to certain health information about his or her minor child? Three (3)
Under HIPAA, which of the choices is not one of the three circumstances in which the parent is not the "personal representative"? If the parent is a convicted felon or sex offender.
Who would investigate HIPAA complaints? The Office of Civil Rights (OCR) and the Department of Health and Human Services (HHS).
There are two broad categories of HIPAA Implementation. They are: The Insurance Reform Provision of HIPAA and the Administrative Simplification Provisions
Under HIPAA, the "Data Use Agreement" must: Establish the permitted uses of protected information, and the appropriate safeguards to protect, and limit who can use or receive the data.
The parasympathetic nervous system is part of the nervous system that serves to: Slow the heart rate, increase the intestinal and gland activity, and relax the sphincter muscle.
The rotator cuff is: A group of flat tendons that fuse together and surround the front, back and top of the shoulder joint like a cuff on a shirt sleeve.
Code for a trans-anal approach for the excision of a partial thickness rectal tumor. CPT Code: 45171
Hospital Discharge Codes 99238 and 99239 include: Only those E&M services performed by the discharging physician.
For radiological code 71022, the type is ____, the number of views is _____, and the views are _____. The type is radiologic or X-ray The number of views is 4 The views are AP (anteroposterior) or frontal, lateral and oblique or right and left angled.
The surgeon deftly entered through the middle fossa and removed a tumor from the temporal bone from the patient's left ear. The correct procedure code is: CPT Code: 69970-LT
Code the V code for a traumatic fracture: ICD-9 Code: V15.51
The principal procedure is one that was: Performed for definitive treatment.
Revenue codes are used on: Only the UB-04 form.
Which code involves the manipulation of the TMJ (temporomandibular joint), therapeutic, requiring an anesthesia service? CPT Code: 21073
Autosomal deletion syndromes are associated with? Deletions of certain portions of a chromosome.
What is SNOMED and what is it used for? Systematized Nomenclature of Medicine, a systematically organized computerized collection of medical terminology that is accessible for research. It covers clinical areas such as diseases, findings, procedures, microorganisms & pharmaceuticals.
What is a common term for software that reviews claims for errors? Claim scrubber.
Which medical specialties would most likely require a specialized EMR (Electronic Management System)? Neurology, Psychiatry, Ophthalmology.
Medicare Part A health insurance companies are currently called? Fiscal Intermediaries.
CPT code 93503 is used only to describe the: Placement of a flow-directed catheter, such as a Swanz-Ganz.
CPT codes 49000-49010 are ______ and codes 49320-49329 are _____? CPT codes 49000-49010 are Laparotomy codes while 49320-49329 are laparoscopy codes.
Which modifier would you consider the opposite of Modifier -22, Increased Procedural Services? CPT Modifier -52, Reduced Services.
Under HIPAA, is "consent" considered the same as "authorization"? No - they are not considered as meaning the same thing.
Code for pathologic plica, left knee: ICD-9 Codes: 727.83, Plica syndrome/plica knee
Dr. Avery performed a bilateral breast reconstruction, immediate, with subsequent tissue expansion (using a tissue expander). Code for the procedure. CPT Code: 19357-50
Carcinoma in axillary lymph nodes and lung metastatic from breast. ICD-9 Code: ICD-9 Codes: 174.9, 196.3, 197.0
The diagnosis code for a malignant tumor of the breast in a male patient is? ICD-9 Code: 175.9
In the medical chart, any loose notes or documentation are: Considered part of the medical record, even if it is not clasped or affixed.
A "principal diagnosis" (Dx) is found in _____ and the "first-listed" diagnosis (dx) is found in ______? A principal diagnosis is found in an inpatient chart, Medicare Part A, and the UB-04 form. A first-listed diagnosis is found in an outpatient chart, Medicare Part B, and the CMS-1500 form.
Which "central venous access device" code would be correct for the insertion of a PICC line, for a child less than five years of age, non-tunneled, without a pump or port? While the correct answer, per the CPT book is 36555, for the purposes of this test the correct answer is CPT Code: 36568
Cushing's Syndrome due to malignant pheochromocytoma is coded to: ICD-9 Code: 194.0, 255.0
When adding multiple repair sites: Add only the same type, same anatomical site grouping (per CPT codes)
A patient presents to the clinic seeking AIDS testing since a former partner has been diagnosed with AIDS and the patient has been exposed. What diagnosis code should be reported? ICD-9 Code: V01.7
A living will, personal directive, advance directive, or advance decision are all examples of what? An Advance Health Care Directive
Code for malignant hypertensive nephropathy with uremia: ICD-9 Code: 403.01
Reporting the wrong CPT code but getting paid means: You should always match your documentation to the codes you report. The wrong CPT code is never a good thing.
Code for Diverticular disease of the sigmoid colon and appendix, with resolving diverticulitis of the sigmoid colon: ICD-9 Code: 543.9, 562.11
What is an example of an orthotic device? Orthotics is a specialty within the medical field concerned with the design, manufacture & application of orthoses. An orthotic is "an externally applied device to modify structural & functional characteristics of the neuromuscular & skeletal system."
Code for: aseptic meningitis due to AIDS: ICD-9 Code: 042; 047.8
Code for the insertion of an implant outside the muscular cone, after evisceration of the ocular contents: CPT Code: 67550
Charging for services that are not medically necessary, do not conform to professionally recognized standards, or are unfairly priced is known as: Abuse
What is a "Cross-Coder" most likely used for? ICD-9 Procedure Codes to CPT Codes.
Code for the destruction of hemorrhoids by cryosurgery. Use unlisted CPT Code: 46999
The surgeon performed arthrodesis of the vertebral bodies, L1, L2 and L3 (total 3), using a lateral extracavitary approach technique of L1 (lumbar). A minimal diskectomy was performed to prepare the interspace. CPT Codes: 22533, (+Add-on code) 22534x2
Under HIPAA, what is needed to justify access to the entire medical record? The covered entity's policies and procedures must state so explicitly and include a justification.
In an inpatient setting, when no procedure is performed, the coder takes into account: The patient's age; any secondary codes for any comorbidities and complications; discharge status and applies these to the MDC.
Code for Cushing's Syndrome due to malignant pheochromocytoma: ICD-9 Codes: 194.0; 255.0 We are coding the malignant neoplasm followed by the manifestation, in this case, Cushing's Disease.
Code for head and neck carcinoma with metastases of the tonsils. ICD-9 Code: 196.0
Carcinoma in axillary lymph nodes and lung metastatic from breast. ICD-9 Codes: 174.9; 196.3; 197.0 Code the breast cancer first as primary followed by the secondary sites of lymph nodes and lung.
Volume 3 ICD-9 procedure codes are: About the same level of difficulty as CPT codes to learn. (?)
The False Claims Statute: Makes it illegal for any health care provider to submit to Medicare or Medicaid bills that contain charges for items or services furnished substantially in excess of its "usual charges."
Code the removal and replacement of a permanent pacemaker, pulse generator, single chamber, atrial. CPT Codes: 33233, 33212-51
What is an example of hardware integrity? Raid Hard Disk Drive, Diesel Generator, Remove services in another city.
What is not allowed in the medical record? Erasures, adding notes at a later date, without properly noting the change, and post-it notes.
Which components below are part of Medicare Part B? CMS-1500, CPT Codes, ICD-9 codes.
What is an electronic clearinghouse? An organization that routes electronic claims to the appropriate insurance company.
What is considered an exception to the business associate standard? Disclosures by a covered entity to a health care provider for treatment of the individual.
A 35-year-old female undergoes an excision of a 3.0-cm tumor of her forehead. An incision is made through the skin & subcutaneous tissue. The tumor is dissected free of surrounding structures. The wound is closed in layers & interrupted sutures. CPT Codes: 21012, 12052
What is the correct CPT code assignment for hysteroscopy with lysis of intrauterine adhesions? CPT Code: 58559
What coding system is used for physician inpatient or outpatient procedures? CPT: Current Procedural Terminology
Patient had a laparoscopic incisional herniorrhaphy for a recurrent reducible hernia. The repair included insertion of mesh. What is the correct code assignment? CPT Code: 49656
Identify the correct ICD-9 diagnosis codes for metastatic carcinoma of the colon to the lung. ICD-9 Codes: 153.9, 197.0
With the "prospective payment system"
Code for head and neck carcinoma with metastases of the tonsils: ICD-9 Code: 196.0 (?)
Code for a fracture of the right fibula due to osteogenesis imperfecta: ICD-9 Codes: 733.16, 756.51
Created by: Laura Duncan



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