Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Procedure Book
HIPAA/Privacy Rules
| Question | Answer |
|---|---|
| The Complete Procedure Coding Book: Chapter 1:Legal & Ethical Issues According to HIPAA, covered entities include: | 1. Health care providers 2. Health plans 3. Health care clearinghouses |
| HIPAA's Privacy Rule is all about the: | use and disclosure of protected health information |
| An example of protected health information is: | patient's social security number |
| HIPAA states that all covered entities must comply with the Privacy Rule as of: | April 14, 2003 |
| Most state laws mandate that when a health care professional suspects abuse of any kind he or she must: | call the appropriate authorities |
| The intent of HIPAA's Privacy Rule is to: | 1. Protect an individual's privacy 2. Not interfere with the flow of information necessary for care |
| All covered entities must create and implement written: | Privacy practices notices |
| Protected health information (PHI) is: | any health information that can be connected to a specific individual |
| Taking authorization for the release of protected health information over the phone from an individual is: | Never acceptable |
| The term "use" per HIPAA's Privacy Rule refers to the exchange of information between health care personnel: | within the same office |
| The term "disclosure" per HIPAA's Privacy Rule refers to the exchange of information between health care personnel: | and health care personnel in other covered entities |
| Ensuring that patients' privacy is protected is the responsibility of: | all staff members |
| HIPAA is a ________ law: | Federal |
| The Privacy Rule says physician permitted by not mandated if abuse suspected. State law says physician must report it. What should the physician do? | call the police immediately |
| Manager of local Walgreen's offers to pay for a copy of patient names and addresses taking medications. You should: | Explain that this would be against the law under HIPAA's Privacy Rule |
| According to HIPAA's rules and regulations, a covered entity's workforce includes: | volunteers, trainees, and employees, part- time and full-time |
| HIPAA;s Privacy Rule has been carefully crafted to: | a) Protect a patient's health care history b) Protect a patient's current medical issues c) Protect a patient's future health considerations |
| A written form to release PHI should include: | a) specific identification of the person who will be receiving the information b) the specific information to be released c) an expiration date |
| There can be ____ ____ _____ penalties for any violation of HIPAA's rules. | both civil and criminal |
| Those who are permitted to file an official complaint with HHS are: | any individual |
| Penalties for violating any portion of HIPAA apply to: | all covered entities |
| If you disclose PHI improperly and under false pretenses, you can: | be fined $100,000 and get up to 5 years in prison. |
| HHS stands for: | Department of Health and Human Services |
| Changing a code from one that is mo9st accurate to one you know the insurance company will pay for is called: | coding for coverage |
| Unbundling is an illegal practice in which coders: | bill using several individual codes instead of one combination code |
| Upcoding is an illegal practice in which coders: | Bill using a code for a higher level of service than what was actually provided |
| Medicare's CCI investigates claims that include: | a) unbundling b) the improper use of mutually exclusive codes c) unacceptable reporting of CPT codes |
| Coding improperly on a claim form can cause that claim to be: | a) rejected b) reviewed c) suspended |
| Chapter 2:Intro to Coding & CPT The most important factor in coding is: | accuracy of codes |
| When you find unclear or missing information in the physician's notes, you should: | query the physician |
| Diagnosis codes identify: | why the patient saw the provider |
| Procedure codes identify: | what the provider did for the patient |
| Coding from Superbills instead of physician's notes can cause the facility to: | a) lose time b) lose money by undercoding c) lose money by delaying payments received |
| CPT guidelines | can be found in the front of every CPT section |
| An example of a CPT guideline is a description of: | the proper use of add-on codes |
| A CPT code has: | five numbers |
| HCPCS Level II codes may be used to report: | durable medical equipment |
| ICD stands for: | International Classification of Diseases |
| CPT stands for: | Current Procedural Terminology |
| ICD-9-CM, volume 3 procedure codes are used to report: | procedures done for inpatients |
| A superbill is: | a form pre-printed with the most often used codes in a facility |
| The plus symbol ( + ) identifies: | an add-on code |
| The circle with a dot in the center symbol identifies: | a code that includes conscious sedation |
| A patient is considered an outpatient at any of these facilities: | a) Doctor's office b) Emergency room c) Same-day surgery center |
| CPT codes are used for: | a) Reimbursement from third-party payers b) Government agencies for funding allotment c) Foundations for research directions |
| The term "procedure" can also mean: | a) treatment b) counseling c) surgery |
| The CPT book is revised and in effect beginning each year on: | January 1st. |
| Chapter 3:Intro to CPT Modifiers A modifier explains: | an unusual circumstance |
| Modifiers are attached to: | procedure codes |
| A modifier is a code made up of: | a) two numbers b) two letters c) one number and one letter |
| A physical status modifier may only be attached to: | anesthesia codes |
| An example of a HCPCS Level II modifier is: | E2 |
| An example of a personnel modifier is: | 81 |
| If a third-party payer limits your use of multiple modifiers, you should use: | Modifier 99 |
| P5 is an example of a: | Physical status modifier |
| When appending both a CPT modifier and a HCPCS modifier to a procedure code: | The CPT modifier comes first. |
| A supplemental report is ______ when using a modifier: | sometimes required |
| Chapter 4: E/M Codes Part 1 E/M codes enable the physician to be reimbursed for al of these services: | a) talking with the patient and his or her family b) consulting with other health care professionals c) reviewing data such as test results |
| Often, finding the correct E/M code begins with knowing: | where the patient met with the physician |
| A patient who has not seen a particular physician in the last three years is categorized as: | a new patient |
| The three key components of many E/M codes include all of these: | a) history b) exam c) Medical Decision Making (MDM) |
| Levels of patient history include: | a) problem-focused b) expanded problem-focuses c) detailed d) comprehensive |
| Body areas that might be included in a physical examination include: | each extremity |
| When services are provided at different levels, the guidelines state you should code to a level of: | all key components are met or exceeded |
| If ______ of the time with the patient is spent counseling, you should use time rather than key components to determine the level of service code: | 51% or more |
| A consultation is expected to be a(n) _______ relationship with the patient. | temporary |
| A patient seen in the office and then admitted to the hospital the same day should be coded with E/M codes from subsection: | Initial hospital care only |
| Chapter 5: E/M Codes Part 2 A preventive medical E/M encounter may include any of these services: | a) counseling b) anticipatory guidance c) risk factor reduction intervention |
| If the physician finds a healthy concern during a preventive medicine examination requiring additional E/M services, you should code this: | separately and additionally (pg. 115) |
| E/M services provided to a patient in an assisted living facility are reported from the subsection: | Domiciliary, Rest Homes,and Custodial Care Settings |
| If a patient is discharged from the hospital and admitted into an SNF on the same day by the same physician, report the E/M services with: | A hospital discharge code and an admission to the nursing facility code. |
| After Dr. does full history, exam, & comprehensive MDM, pt. admitted into a psychiatric residential treatment center. You will code E/M services with: | An admission to a nursing facility code |
| Critical care codes are determined by: | length of time |
| Conferencing with other health care professionals regarding management and/or treatment of a patient is: | Coded from 99366-99368 |
| A modifier explains: | an unusual circumstance |
| Chapter 6: Anesthesia Health care professionals permitted to administer anesthetics include: | a) anesthesiologists b) certified registered nurse anesthetists c) surgeons |
| The categories of anesthesia include: | a) topical/local b) regional c) general |
| Topical anesthesia is administered | to the skin |
| MAC is an acronym that stands for: | monitored anesthesia care |
| Conscious sedation is provided in order to: | reduce anxiety |
| When the same physician performing the procedure administers regional or general anesthesia, modifier 47 should be appended to: | the correct procedure code |
| The anesthesia code package includes: | a) preoperative visits b) postoperative visits c) usual monitoring services |
| Qualifying circumstances are conditions that might require more work on the part of the anesthesiologist, including: | a) extreme age b) emergency conditions c) total body hypothermia |
| A physician status modifier describes issues that may increase the complexity of delivering anesthetic services, including: | mild systemic disease |
| Chapter 7: Surgery Coding, Part 1 The global surgical package includes: | a) Pre-procedural evaluation and management b) The procedure c) follow-up care |
| The global period is determined by: | The standard of care |
| The following is an example of a diagnostic test not included in the global package: | biopsy |
| When a procedure is planned as a series of procedures, each service after the first should be appended with the modifier: | 58 |
| When a surgeon does not provide preoperative or postoperative care to the patient upon whom he or she operates, the procedure code should be appended with modifier: | 54 |
| Excision of lesions are reported: | with each lesion coded separately |
| The code for the excision includes this type of repair: | simple |
| If the surgeon performs a re-excision of a lesion during a later encounter with the patient, append the procedure code with the modifier: | 58 |
| If multiple wounds located on the same anatomical site are repaired with the same complexity, report this procedure by: | adding all the lengths together and coding the total |
| The elements of determining the most accurate code for a skin graft include: | a) the size of the recipient area b) the location of the recipient area c) the type of graft |
| Chapter 8: Surgery Coding, Part 2 Codes within the musculoskeletal subsection include: | casts |
| Arthrodesis is performed: | a) alone b) in combination with other procedures |
| An open treatment of a fracture is performed: | surgically |
| Backbench work during a transplant process is: | the preparation of the organ |
| The cardiovascular system includes all except: | lungs |
| Venous grafts harvested from the saphenous vein: | are included in the graft code |
| The code for an endovascular repair of an iliac aneurysm includes: | a) introduction of graft b) stent deployment c) balloon angioplasty |
| An enterectomy is the harvesting of a donor's: | intestine |
| A pancreatic donor must be: | deceased |
| A physician who only interprets the results of a urodynamic procedure must be coded with: | Modifier 26 |
| Chapter 9: Radiology The professional component of radiologic services includes: | interpretation of the imaging |
| Interventional radiologic services are provided with the intent of: | a) diagnosing a condition b) preventing the spread of a disease c) measuring the progress of a disease |
| Sonograms use ______ to record images: | sound waves |
| The term "with contrast" means that the technician or radiologist: | administered a substance to enhance the image |
| If the code description includes the term "two views" and the radiology reports show that only one view was taken, you should code the service: | with that code plus the modifier 52 |
| Angiography is the imaging of: | blood vessels |
| RPO stands for: | right posterior oblique |
| Radiation for the treatment of a malignant neoplasm is most often used for: | therapeutic purposes |
| MRI stands for: | magnetic resonance imaging |
| Chapter 10: Pathology & Laboratory Laboratory tests can be performed: | a) in a free-standing lab b) in a hospital c) at a physician's office |
| Most often, the coding specialist responsible for reporting the lab work works for: | the facility that performs the tests |
| A specimen can be: | a) blood b) urine c) sputum |
| When not all of the tests listed in a panel are performed, you should: | code the tests individually |
| When more tests are performed, including all those listed in a panel, you should: | code the panel, plus the additional tests performed |
| Genetic testing code modifiers are used when reporting: | molecular diagnostics |
| CBC stands for: | complete blood count |
| Surgical pathology may include: | gross examination |
| Quantitative testing is: | the measurement of an element |
| Chapter 11: Medicine Coding When an immunization is given, you will need: | Two codes: one for the administration and one for the drug |
| Vaccinations and immunizations can be administered: | a) percutaneously b) intradermally c) subcutaneously |
| When a patient receives infusion therapy via more than one site, code: | all appropriate sites |
| Psychotherapy services are coded first by: | location |
| Dialysis codes are reported: | a) by patient age b) number of days treated c) location of treatment (inpatient or outpatient) |
| An An optometrist is qualified to: | supply glasses and contact lenses |
| An otorhinolaryngologist treats: | ears, nose, throat |
| Duplex scans are: | a) ultrasonic b) noninvasive c) records of blood patterns and flow |
| Acupuncture codes are determined by: | a) age of the patient b) time spent face to face with patient |
| Chiropractic treatment codes are chosen by: | the number of regions treated |
| Chapter 12: Category II & Category III Coding Category I codes are also known as: | CPT codes |
| Category II codes are used for reporting: | performance measurement |
| When coding Category II codes, you have to also reference: | performance measures |
| The modifiers 1P and 2P are used with: | Category II codes |
| An example of a Category II code is: | 1111F |
| Category III codes should be used: | Only if no Category I codes are appropriate |
| An unlisted code should only be used when: | a) an accurate Category I code is not available b) an accurate Category III code is not available |
| Category III codes are updated: | twice a year |
| The use of Category II codes is: | optional |
| Coding for reimbursement properly may include: | a) CPT codes b) Category III codes c) HCPCS Level II codes |
| Chapter 13: HCPCS Level II Coding The symbol of a circle with a line through it means: | a service not covered under the skilled nursing facility payment system. |
| The little box with a check mark in it indicates a code description that: | includes a quantity measurement |
| The J codes are used to bill insurance carriers for: | drugs administered by a health care professional by means other than oral |
| HCPCS Level II codes are used, most often, to report: | a) drugs used for treatment of a patient b) equipment provided to a patient c) dental services |
| The acronym DME stands for: | durable medical equipment |
| HCPCS Level II codes are presented as: | One letter followed by four numbers |
| HCPCS is an acronym that stands for: | Healthcare Common Procedure Coding System |
| The code D1110 is an example of a: | HCPCS Level II code |
| The D0000-D9999 codes are created and maintained by the: | American Dental Association |
| Gauze used by a physician as a surgical dressing is: | not coded separately because it is included in the professional service |
| The E codes shown in the HCPCS Level II book are: | used to identify DME provided to a patient |
| An example of DME is: | a three-pronged cane |
| A deleted code in the HCPCS Level II book means: | The code is no longer available to represent the service or item |
| Alcohol intervention treatment ight be code from: | H0001-H2037 |
| Chapter 14: Coding Medical Supplies An example of a medical supply reported by HCPCS Level II codes is: | vascular catheter |
| Incontinence supplies, reported with HCPCS Level II codes, are used: | by the patient for personal at-home use |
| DME stands for | durable medical equipment |
| Medicare uses all of the following qualifiers to determine an item as DME: | a) the item can withstand repeat use b) the item is used in the patient's home c) the item is primarily used for medical purposes |
| An example of DME is: | pacemaker monitor |
| A method of administering drugs in which the medication is inserted into the patient's muscle is represented by the abbreviation: | IM |
| HCPCS Level II codes identify certain pharmaceuticals by brand name and/or generic name in: | The table of drugs |
| The J codes report drugs administered by: | a health care professional |
| Coding transportation services includes specifics about: | a) the type of vehicle used b) the type of service provided c) whether extra personnel were required |
| The codes used for reporting transportation of a patient may only be used: | whenever medically necessary |
| Chapter 15: ICD-9-CM Volume 3 Procedure Codes ICD-9-CM volume 3 codes are used only by: | Hospitals |
| Volume 3 includes codes for: | a) surgical procedures b) radiology c) injections |
| Dr. Gerard goes to see his patient who has been admitted into the hospital. You will code his visit from which book? | CPT |
| NOS has the same meaning as: | Unspecified |
| Terms shown in (parentheses) in the tabular listing are: | Optional |
| An adjunct code in volume 3 is the same as a CPT: | Add-on code |
| A small box with the letters NC next to a code means: | Not covered my Medicare |
| You are required to code to the highest specificity. This means if a four-digit code is correct and available: | Use is mandatory |
| An example of a volume 3 code is: | 36.09 |
| Chapter 16: ICD-10-PCS Review In ICD-10-PCS, the initials PCS stands for: | Procedure Coding System |
| Of the fur objectives for ICD-10-PCS, the one that relates to the meanings of the words and terms used is titled: | Standardized terminology |
| The descriptions for procedures identified in ICD-10-PCS: | Do not include diagnostic information |
| The structure of ICD-10-PCS codes includes: | Seven characters |
| ICD-10-PCS codes include: | One letter followed by numbers |
Created by:
Laura Duncan