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FINAL EXAM

QuestionAnswer
1. HOW MANY DIAGNOSIS CAN BE LISTED ON THE UB-04 CLAIM FORM? 10
2. WHAT IS LISTED ON A CHARGE DESCRIPTION MASTER? Procedure Codes, procedure or service description, charges
3. WHAT ARE REVENUE CODES? Codes that identify the department or unit that supplies the services.
4. WHAT IS AMBULATORY SURGICAL UNIT? A department in a hospital that provides outpatient surgery services
5. DEFINE COST OUTLIER A case that cannot be assigned an appropriate DRG (Diagnosis Related Group) because of an atypical situation
6. WHAT IS THE SOFTWARE PROGRAM THAT ALLOWS A FACILITY TO CALCULATE ITS DIAGNOSIS RELATED GROUP (DRG) PAYMENT GROUP? Grouper
7. WHO MAINTAINS THE AMBULATORY PAYMENT CLASSIFICATION (APC) LIST? Centers of Medicare and Medicaid Services (CMS)
8. AMBULATORY PAYMENT CLASSIFICATION (APC) SYSTEM BASE PAYMENT ON Procedures
9. WHAT IS PROSPECTIVE PAYMENT SYSTEM? Established payment rates to hospitals prospectively, which means before services are rendered
10. HOW OFTEN IS A PATIENT CONTROL NUMBER (PCN) ASSIGNED TO A PATIENT IN THE HOSPITAL? The patient control number (PCN) is provided at each hospital admission
11. DEFINE COMORBIDITY A preexisting condition that, because of its effects on the specific principal diagnosis, results in more intensive therapy or a longer stay
12. THE TYPE OF FACILITY THAT WOULD USE UB-4 CLAIM FORM INCLUDES? Hospitals, institutional facilities, inpatient care, hospice and skilled nursing
13. MAJORITY OF HOSPITAL REIMBURSEMENT COMES FROM? Insurance Companies
14. WHEN WILL A HOSPITAL BILL FOR PATIENT SERVICES? After the discharge paperwork is completed and signed by the physician.
15. THE METHOD OF REIMBURSEMENT THAT PAYS HOSPITALS A FIXED RATE PER DAY FOR ALL SERVICES PROVIDED? Per diem
16. WHAT DOES OPPS STAND FOR? Outpatient Prospective Payment System
17. DIAGNOSIS RELATED GROUP (DRG) SYSTEM IS A TYPE OF? Prospective payment system
18. THE PHYSICIAN WHO IS PRIMARILY RESPONSIBLE FOR A PATIENT'S CARE WHILE IN THE HOSPITAL IS REFERRED TO AS THE? Attending Physician
19.WHEN REFERRING TO DIAGNOSIS RELATED GROUP (DRG), THE ABBREVIATION CC IS USED TO INDICATE? Complication or comorbidities
20. IF THE TIME THAT THE PATIENT WAS ADMITTED TO THE HOSPITAL IS UNKNOWN, WHICH CODE WOULD BE ENTERED ON THE FORM (ON LOCATOR 13(? Code 99
21. ON THE CMS-1500 CLAIM FORM, THE ABBREVIATION EIN REFERS TO? Employer Identification Number
22. ON THE CMS-1500 CLAIM FORM, THE ABBREVIATION NPI INDICATES THAT? The National Provider Identifier must be entered
23. ON THE CMS-1500 CLAIM FORM, THE ABBREVIATION EMG INDICATES THAT It must be noted if emergency services were provided
24. ACCORDING TO HIPAA, COVERED ENTITIES FOR COMPLIANCE ISSUES INCLUDE? Health plans, clearing house, billing service, and providers
25. THE SUBSECTION OF HIPAA THAT REGULATES ELECTRONIC BILLING IS KNOWN AS THE? Administrative Simplification
26. A CMS-1500 CLAIM FORM USED BY PHYSICIAN OFFICES WAS DEVELOPED BY? The Centers for Medicare and Medicaid Services (CMS)
27.A LIMITED INSURANCE POLICY PURCHASED TO COVER PART OF THE PATIENT'S EXPENSES, NOT COVERED BY THE PRIMARY INSURANCE POLICY Supplemental Insurance
28. IF A PATIENT HAS MORE THAN ONE INSURANCE PLAN, THE DETERMINATION OF HOW MUCH WILL BE PAID BY EACH IS KNOWN AS? Coordination of Benefits
29. ACCORDING TO THE BIRTHDAY RULE, IF BOTH PARENTS COVER DEPENDENT CHILDREN UNDER THEIR INSURANCE POLICIES, THE PRIMARY INSURANCE IS THE POLICY Of the parent whose date of birth occurs earliest in the year
30. THE EMPLOYER IDENTIFICATION NUMBER (EIN) OR FEDERAL TAX ID NUMBER IS ISSUED BY? The internal Revenue Service (IRS)
31. THE IDENTIFICATION NUMBER ISSUED TO PHYSICIANS WHO ARE AUTHORIZED TO PRACTICE MEDICINE IN A GIVEN STATE IS THE? State License Number
32. IF NEEDED INFORMATION IS MISSING FROM A CLAIM WHEN IT IS SUBMITTED TO AN INSURANCE CARRIER, IT IS REFERRED TO AS? A dirty Claim
33. SCRAMBLING ELECTRONIC INFORMATION DURING TRANSMISSION TO PREVENT IT FROM BEING INTERCEPTED OR READ BY UNAUTHORIZED USERS IS A PROCESS KNOWN AS? Encryption
34. A COMPANY THAT RECEIVES CLAIMS FROM PROVIDERS, AUDITS THEM, AND FORWARDS THEM ON TO INSURANCE CARRIERS IS? Clearinghouse
35. AN AUDIT/EDIT REPORT FROM A CLEARINGHOUSE WILL SHOW ALL OF THE FOLLOWING Claims that need corrections, claims that are missing information, claims forwarded to the insurance carrier
36. IF A PATIENT WISHES INSURANCE PAYMENTS TO BE MADE DIRECTLY TO THE PROVIDER, THE PATIENT MUST SIGN WHICH TYPE OF FORM? Assignment of benefits form
37. A CLAIM CAN ONLY BE SUBMITTED TO AN INSURANCE CARRIER ON THE PATIENT'S BEHALF IF THE PATIENT SIGNED A? Release of information form
38. THE POLICY IN MOST MEDICAL OFFICES IS TO REQUEST THAT THE PATIENT SIGN AND UPDATE A RELEASE OF INFORMATION FORM Once a year
39. THE PERSON WHO IS ULTIMATELY RESPONSIBLE FOR PAYMENT TO THE MEDICAL OFFICE IS CALLED THE Guarantor
40. AS IT PERTAINS TO THE CMS-1500 FORM, THE ACRONYM OCR REFERS TO? Optical character recognition
41. WHICH OF THE FOLLOWING IS NOT A FRACTURE TREATMENT? OPEN, CLOSED, PERCUTANEOUS, REPLANTATION. Replantation
42. WHICH OF THE FOLLOWING FLAPS DESCRIBES A BONE GRAFT THAT IS TAKEN ALONG WITH THE SKIN AND TISSUE THAT OVERLIES THE BONE? MYOCUTANEOUS, DERMIS/EPIDERMIS, FREE, FREE OSTEOCUTANEOUS. Free osteocutaneous
43. FRACTURE CODES ARE BASED ON? Treatment type
44. THE RESTORATION OF A FRACTURE OR DISLOCATION TO ITS NORMAL ANATOMIC ALIGNMENT BY THE APPLICATION OF MANUALLY APPLIED FORCE IS KNOWN AS? Manipulation
45. A HIP REPLACEMENT IS CODED BASED ON THE? Medical reason for the surgery
46. OPEN TREATMENT OF A FRACTURE IS WHEN THE? Fracture site is surgically opened and visualized or opened remotely
47. SURGICAL AND FRACTURE REPAIR CODES IN THE MUSCULOSKELETAL SUBSECTION INCLUDE? The application and removal of the initial casts, splints, or strapping applied by the treating physician
48. A BUNIONECTOMY IS A HALLUX CORRECTION Valgus
49. ARTHOSCOPY IS A DESIRABLE TREATMENT CHOICE BY PHYSICIANS AND PATIENTS BECAUSE THE? Incisions are smaller, risk of infection is decreased, recovery time is quicker
50. IS A DIAGNOSTIC ARTHROSCOPY ALWAYS INCLUDED IN A SURGICAL ARTHOSCOPY? True
51. WHICH OF THE FOLLOWING IS NOT A TREATMENT METHOD FOR A DISLOCATION? APPLYING GENTLE TRACTION, ROTATING LIMB WHILE APPLYING PRESSURE, ATTACHING A WEIGHT TO THE PATIENT, EXTERNAL FIXATION. External fixation
52. DEFINE ARTHROCENTESIS An injection into a joint, an aspiration of fluid from a joint and a puncture of a joint cavity
53. THE ACRONYM ORIF STANDS FOR? Open reduction with internal fixation
54. IS THE ATTACHMENT OF A SPINAL FIXATION DEVICE AT EACH END OF THE AREA BEING REPAIRED AND AT LEAST ONE OTHER ATTACHMENT IN THE AREA BEING REPAIRED Segmental instrumentation
55. ELECTRICAL OR ULTRASOUND STIMULATION IS USED TO? Promote healing
56. DESCRIBE REDUCTION Manipulation
57. WHICH OF THE FOLLOWING TERMS DESCRIBE TRACTION BY USING STRAPPING, ELASTIC WRAPS OR TAPE? Skin
58. THE APPLICATION OF A CRANIAL HALO IS A FORM OF? External fixation
59. THIS TYPE OF GRAFT IS OFTEN TAKEN FROM THE UPPER THIGH AREA. Fascia Lata
60. INSERTION OF A DEVICE INTO THE MUSCLE TO MEASURE THE PRESSURE WITHIN THE MUSCLE IS MONITORING OF? Interstitial fluid pressure
61. THE MEDICAL WORD FOR THE SHIN BONE IS THE? Tibia
62. THE MEDICAL WORD FOR AN INDIVIDUAL FINGER OR A TOE IS PHALANX? True
63. THE MEDICAL WORD FOR THE KNEECAP IS THE OLECRANON False
64. THE ULNA IS THE? The forearm bone located along the little finger side of the lower arm
65. THE HUMERUS IS THE? Bone of the upper arm
66. WHICH IS THE MEDICAL WORD FOR THE THIGH BONE? Femur
67. THE SMALL BONES OF THE WRIST JOINT ARE KNOWN AS THE? Carpal bones
68. WHICH IS THE MEDICAL WORD FOR THE TAIL BONE? Coccyx
69. WHICH IS THE MEDICAL WORD FOR COLLARBONE? Clavicle
70. THE BONES OF THE ANKLE ARE CALLED THE CARPAL BONES? False
71. THE CERVICAL VERTEBRAE ARE IN THE? Neck
72. WHICH IS THE MEDICAL WORD FOR THE BONE ON THE THUMB SIDE OF THE FOREARM? Radius
73. A CONTUSION DUE TO A BLUNT INJURY WITH BLEEDING IN THE MUSCLE IS COMMONLY KNOWN AS? A bruise
74. THE FLEXOR HALLUCIS BREVIS MUSCLE IS A MULSCLE IN THE HAND False
75. WHAT IS THE LARGE MUSCLE IN THE BUTTOCKS? Gluteus maximus
76. THE PECTORALIS MAJOR MUSCLE IS LOCATED IN THE? Chest
77. THE LATISMUS DORSI IS A MUSCLE OF THE? Back
78. THE BRACHIORADIALIS MUSCLE IS LOCATED IN THE? Upper and lower arm
79. THE ACTION OF THE MUSCLE BENDS THE HEAD TOWARD THE STERNUM Stenocleidomastoid muscle
80. THERE ARE APPROXIMATELY HOW MANY SKELETAL MUSCLES IN THE BODY? 700
81. THE HUMAN BODY IN ANATOMICAL POSITION IS DESCRIBED AS? The body standing erect, the head looking forward, arms to the sides, palms forward, feet pointing forward
82. BODY PLANES DIVIDE THE BODY INTO? Right and left, top and bottom, back and front
83. PHYSIOLOGY IS THE STUDY OF THE STRUCTURE OF THE HUMAN BODY. False
84. TWO OF THE IMAGINARY PLANES THAT DIVIDE THE BODY DERIVE THEIR NAMES FROM? Suture lines on the skull
85. THE SAGITTAL PLANE DIVIDES THE BODY INTO? Left and right
86. WHICH STRUCTURE CAN ONLY BE SEEN THROUGH A MICROSCOPE? Cell
87. THE---------CAVITY IS A CONTINUATION OF THE CRANIAL CAVITY. Spinal
88. ANY CHANGE IN THE NORMAL STRUCTURE OF FUNCTION OF THE BODY IS? Disease
89. THE CAUSE OR ORIGIN OF A DISEASE IS THE? Etiology
90. A PATIENT WHO IS ASYMPTOMATIC. Shows no symptoms or signs
91. A PATIENT CANNOT RECOVER FROM AN ILLNESS THAT IS? Terminal
92. THE CORONAL PLANE DIVIDES THE BODY INTO? Front and back
93. WHAT HEALTHCARE SETTING IS THE MOST FREQUENTLY USED? Physician's office
94. THE PREDICTED OUTCOME OF A DISEASE IS CALLED A DIAGNOSIS? False
95. THERE ARE FOUR REGIONS OF THE ABDOMINOPELVIC AREA. False
96. THE LUNGS, HEART, ESOPHAGUS, AND TRACHEA WOULD ALL BE FOUND IN THE? Thoracic cavity
97. AN OPHTHALMOLOGIST WOULD STUDY THE? Eyes
98. THE STUDY AND TREATMENT OF CANCER IS KNOWN AS? Oncology
99. THE STUDY OF THE MEDICAL CARE OF THE ELDERLY IS KNOWN AS? Gereatrics
100. WHO ARE PHYSICIAN EXTENDERS? Nurse midwives, nurse anesthetists and physician assistants.
101. THE OFFICIAL GUIDELINES FOR CODING AND REPORTING ARE UPDATED BY CMS AND AMA. False
102. SECTION IV OF THE OFFICIAL GUIDELINES FOR CODING AND REPORTING CONTAINS INFORMATION REGARDING OUTPATIENT CODING. True
103. A LATE EFFECT IS THE RESIDUAL EFFECT AFTER ACUTE PHASE OF AN ILLNESS OR INJURY HAS PASSED. True
104. FOR BILATERAL SITES, THE FINAL CHARACTER OF THE CODES IN THE I-10 ALWAYS INDICATES LATERALITY. False
105. SYSTEMIC LUPUS ERYTHEMATOSUS WITH ASSOCIATED ENDOCARDITIS (M32.11) IS AN EXAMPLE OF DUAL CODING. False
106. MULTIPLE CODES ARE OFTEN REQUIRED FOR LATE EFFECTS, COMPLICATION CODES, AND OBSTETRIC CODES. True
107. YOU CANNOT REPORT CODES FOR OPEN WOUND EXPLORATION (20100-1013) IF THE WOUND IS SUFFICIENT IN SIZE TO ACCOMPLISH THE REPAIR AND THE WOUND DOES NOT NEED TO BE ENLARGED. True
108. USING CODES FROM THE WOUND EXPLORATION CATEGORY REQUIRES THE CODER TO ASSESS THE EXTENT OF THE PROCEDURE. True
109. 22585 IS AN ADD-ON CODE True
110. THERE ARE FOUR SUBHEADINGS IN THE RADIOLOGY SECTION False
111. WHICH TREATMENT OF FRACTURE REQUIRES THE FRACTURE TO BE EXPOSED TO VIEW OR OPENED AT A REMOTE SITE FOR NAILING ACROSS THE FRACTURE. Open
112. TERMS THAT DESCRIBES TRACTION BY USE OF STRAPPING, ELASTIC WRAPS, OR TAPE. Skin
113. WOUND EXPLORATION CODES HAVE WHAT SERVICES BUNDLED INTO THE CODES. Exploration, including enlargement; debridement, removal of foreign body (ies), minor vessel ligation, repair.
114. THE APPLICATION OF A CRANIAL HALO IS A FORM OF: External fixation
115. THIS TYPE OF GRAFT IS OFTEN TAKEN FROM THE UPPER THIGH AREA. Fascia Lata
116. INSERTION OF A DEVICE INTO THE MUSCLE TO MEASURE THE PRESSURE WITHIN THE MUSCLE IS MONITORING OF: Interstitial Fluid Pressure
117. FAST BECOMING THE TREATMENT OF CHOICE FOR MANY ORTHOPEDIC SURGICAL PROCEDURES IS Endoscopy/arthroscopy
118. NOT CONSIDERED A FRACTURE TREATMENT Replantaion
119. DESCRIBES A BONE GRAFT THAT IS TAKEN ALONG WITH THE SKIN AND TISSUE THAT OVERLIES THE BONE Free Osteocutaneous
120. FRACTURE CODES ARE BASED ON Treatment type
121. THE RESTORATION OF A FRACTURE OR DISLOCATION TO ITS NORMAL ANATOMIC ALIGNMENT BY THE APPLICATION OF MANUALLY APPLIED FORCE IS KNOWN AS Manipulation
122. A HIP REPLACEMENT IS CODED BASED ON THE Medical reasons for the surgery
123. OPEN TREATMENT OF A FRACTURE IS WHEN THE: Fracture site is surgically opened and visualized or opened remotely.
124. WHERE IS THE BIMALLEOLAR BONE LOCATED? Wrist
125. NOT A TREATMENT METHOD FOR A DISLOCATION: External Fixation
126. THE DIFFERENCE BETWEEN THE CODE FOR A SOFT TISSUE ABSCESS IN THE MUSCULOSKELETAL SYSTEM SECTION & THE CODES FOR ABSCESS IN THE INTEGUMENTARY SYSTEM SUBSECTION. The code in the Musculoskeletal System subsection is associated with deep tissue possibly to the bone.
127. ARTHROCENTESIS IS; An injection into the joint, an aspiration of fluid from the joint, a puncture of a joint cavity.
128. THE ACRONIM ORIF STANDS FOR: Open reduction with internal fixation
129. ELECTRICAL OR ULTRASOUND STIMULATION IS USED TO: Promote healing
130. A BUNIONECTOMY IS A HALLUX ------CORRECTION. Valgus
131. ARTHROSCOPY IS A DESIRABLE TREATMENT CHOICE BY PHYSICIANS AND PATIENTS BECAUSE. The incisions are smaller, risk of infection is decreased, recovery time is quicker.
132. A------ARTHROSCOPY IS ALWAYS INCLUDED IN A SURGICAL ARTHROSCOPY. Diagnostic
133. THIS IS NOT A TYPE OF BUNIONECTOMY. Mumbord
134. BONE GRAFTS FOR SPINAL SURGERY ARE OFTEN CODED IN CONJUNCTION WITH A SURGICAL PROCEDURE. WHAT IS THE APPROPRIATE MODIFIER FOR THE BONE GRAFT CODE. No modifier
135. A--------PROCEDURE IS ONE THAT IS PERFORMED INDEPENDENTLY OF, AND NOT IMMEDIATELY RELATED TO ANOTHER SERVICE. Separate
136. THE DIVISION OF THE RADIATION ONCOLOGY SECTION OF THE CPT MANUAL ARE DIVIDED INTO SUBSECTIONS BASED ON WHAT. Type of service
137. WHAT IS THE MODIFIER USED TO IDENTIFY THE TECHNICAL COMPONENT OF A RADIOLOGIC PROCEDURE. TC
138. WHAT ARE THE RADIOISOTOPES THAT ATTACH THEMSELVES TO RED BLOOD CELLS CALLED? Tracer
139. WHAT IS THE NAME OF THE HIGH-FREQUENCY SOUND WAVES IN AN IMAGING PROCESS THAT IS USED TO DIAGNOSE PATIENT ILLNESS? Ultrasound
140. ACCORDING TO CPT GUIDELINES, RADIATION ONCOLOGY CODES INCLUDE NORMAL FOLLOW-UP CARE DURING THE COURSE OF TREATMENT AND ----FOLLOWING ITS COMPLETION. Includes 3 month global period
141. 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, qualitative assessment of amniotic fluid/gestational sac shape, examination of the maternal uterus and adnexa.
142. USE OF A NEEDLE AND SYRINGE TO WITHDRAW FLUID. Aspiration, centesis
143. FIVE GRAFT TYPES REPRESENTED IN THE MUSCULOSKELETAL SUBSECTION. Bone graft, tissue graft, fascia lata graft, cartilage graft, tendon graft.
144. NONINVASIVE DIAGNOSTIC TECHNIQUE THAT PRODUCES A CROSS-SECTIONAL IMAGE OF ORGANS AND OTHER INTERNAL BODY STRUCTURES. Magnetic resonance
145. X-RAY OF THE BILE DUCTS USING RADIOPAQUE CONTRAST. Cholangiography
146. X-RAY OF THE BLOOD VESSELS FOLLOWING INJECTION OF RADIOPAQUE SUBSTANCE. Angiography
147. ALSO KNOWN AS A PET SCAN, IT MEASURES METABOLIC OR BIOCHEMICAL ACTIVITY OF THE BRAIN AND OTHER ORGANS BY TRACKING ITS MOVEMENT AND CONCENTRATION. Tomography
148. X-RAY PHOTOGRAPH OF THE SPINAL CORD FOLLOWING ADMINISTRATION OF RADIOPAQUE SUBSTANCE INTO THE SUBARACHNOID SPACE. Myelogram
149. THE APPLICATION OF ULTRASONIC WAVES FOR DIAGNOSTIC IMAGING OF INTERNAL STRUCTURES Ultrasound
150. X-RAY OF THE VEIN OR VEINS FOLLOWING INJECTION OF A RADIOPAQUE SUBSTANCE. Venography
151. MEASUREMENT OF THE DIAMETERS OF THE FEMALE PELVIS, ESP. THE BIRTH CANAL Pelvimetry
152. ALSO KNOWN AS A CAT SCAN, THIS TECHNIQUE ALLOWS SAFE, PAINLESS, AND RAPID DIAGNOSIS IN PREVIOUSLY INACCESSIBLE AREAS OF THE BODY. Computed tomography
153. X-RAY VISUALIZATION OF LYMPH VESSELS AND NODES FOLLOWING INJECTION OF A CONTRAST MATERIAL. Lymphangiography
154. ANTERIOR (VENTRAL) In front of
155. POSTERIOR (DORSAL) In back of
156. SUPERIOR Toward the head or the upper part of the body; also known as cephalad or cephalic
157. INFERIOR Away from the head or the lower part of the body; also known as caudad or caudal
158. MEDIAL Toward the middle of the body
159. LATERAL Away from the midline of the body (to the side)
Created by: Lizbeth Romo