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Mod 150 Unit 3 Revie


A person can live without a spleen True
The mediastinum is located between the lungs True
The stem cell harvesting in 38205 is the collection of stem cells from the bone marrow False
The upper jugular group of lymph nodes are located in the groin False
The diaphragm is a wall of muscle that separates the thoracic and abdonimal cavities True
There is more chance for advancement working in a hospital facility than in a private physician's office True
Because of the divrsity in reimbursement methods; it is very important that the insurance billing specialist have basic knowledge if insurance programs True
When a managed care patient is admitted for a nonemergency to a hospital without a managed care contract, the managed care program needs to be notified by the hospital within 48 hours False
Emergency department charges are billed along with the inpatient stay on the CMS-1500 claim form False
When admitted as a worker's compensation case, the patient will not have an insurance card True
The physician's office uses ICD-9-CM Volumes 1,2 and 3 to code diagnoses and procedures False
Surgical procedures performed in the hospital operating room are billed by the hospital billing department False
Elective surgeries are deferrable True
A patient has a right to request an itemized bill from a hospital stay with no cost to the patient True
On the UB-40 claim form, the patient's date of birth should be entered using 6 digits in block 14 False
On the UB-04 claim form in Field 17, code 20 (expired) is used to indicate the patient's discharge status True
Information such as "condition is employed related" (Code 02), listed in Fields 18 through 28 the UB-04 claim form, is called condition code True
The DRG is assigned using an automated system called the DRG selector False
The purpose of the DRG-based system is to hold down rising health care costs True
The grouper differentiates between chronic and acute conditions False
The ambulatory payment classifications (APCs) are based on diagnoses False
Th --- manufactures most blood cells bone marrow
The spleen is composed of this material that also surrounds veins and arteries lymph tissue
---- is a malignant disease of the bone marrow in which excessive white blood cells are produced Leukemia
Mediastinum codes are identified by which factor surgical approach
This type of lymphadenectomy is the removal of the lymph nodes, glands, and surrounding tissues radical
The lymph node excision category codes are based on what two things method and location
How many categories are located in the Mediastinum subheading 4
A diaphragmatic hernia is also known as a(n) esophageal hiatal hernia
This bone marrow is taken from a close relative, so there is a genetic similarity allogenic
This bone marrow is collected from the patient and later transplanted or reinfused back into the patient from whom it came autologenic
What word describes a lymphadenectomy in which only the lymph nodes are removed limited
What is it called when the diaphragm is out of normal position and has moved up farther into the thoracic cavity eventration
Confidential information about patients should never be discussed with any of the above
When criteria are used by the review agency for admission screening, this is referred to as AEPs
One criterion that needs to be met to certify severity of illness (SI) in an admission is active, uncontrolled bleeding
One criterion that needs to be met for intensity of service (IS) in an admission is administration and monitoring of intravenous medications
A patient is considered an inpatient to the hospital on admission for an overnight stay
When a patient who has managed care contract is admitted to a hospital for an emergency, the managed care program needs to be notified within 48 hours
The rule stating that when a patient receives outpatient services within 72 hoursof admission, then all outpatient services are combined with inpatient services and become part of the diagnostic-related group rate for admission, is called the 72 hour rule
What organization is responsible for admission review, readmission review, procedure review, day and cost outlier review, DRG validation, and transfer review QIO
Readmission review occurs if the patient is readmitted within 7 days of discharge
The significant reason for which a patient is admitted to the hospital is coded using the principal diagnosis
Classifications of surgical and nonsurgical procedures and miscellaneous therapeutic and diagnostice procedures are found in ICD-9-CM Volume 3
ICD-9-CM procedure codes contain Both A and C
The codebook used to list procedures on outpatient hospital claims is CPT
The person who interviews the patient and obtains personal and insurance information and the admittin diagnosis is a/an admitting clerk
Daily progress notes are entered on the patient's medical record by a/an nurse
The claim form transmitted to the insurance carrier for reimbursement for inpatient hospital services is a called a UB-04
The form that accompanies the billing claim form for inpatient hospital services is called a detail statement
The hospital insurance claim form must always be reviewed by the insurance billing editor
Professional services billed by the physician include All of the above
If a patient is being admitted to a hospital and refuses all preadmission testing but a bill is sent to the insurance carrier for these anway, this ia called phantom charges
A tentative DRG is based on admission diagnosis, scheduled procedures, age and secondary diagnosis
How many major diagnostice categories (MDCs) are there in the DRG-based system 25
On the UB-04 claim form, code 6 (transfer from another health care facility) in Field 15 is used to indicate source of admission
The claim form used for outpatient hospital services is UB-04
Laparoscopic splenectomy 38120
Bone marrow biopsy by needle aspiration 38221
Biopsy of a lymph node by fine needle aspiration without image guidance 10021
Excision of a mediastinal tumor 39220
The mediastinum category code range is 39000-39499
Suprahyoid lymphadenectomy 38700
The physician performs a complete axillary lymphadenectomy 38745
Imbrication of the diaphragm for eventration, transabdomina, nonparalytic 39545
The physician repairs a large laceration of the diaphragm that occurred during a car accident from the seat belt the patient was wearing though a transabdominal approach 39501
The physician performs an extensive drainage of a lymph node abscess 38305
PAT is an abbreviation for Pre-admission testing
The hospital department that conducts an admission and concurrent review on all cases and prepares a discharge plan to determine whether admissions are justified is called the ---- department Utilization review
The --- coding system is used to list procedural codes for Medicare patients on hospital insurance claims that are not in the CPT book HCPCS
The --- is the clinical resume for final progress note discharge summary
The Uniform Bill claim form is considered a --- statement summary
Medicare provides stop loss called --- in its regulations outliers
The abbreviation of the phrase that indicates when claims are submitted electronically is --- EDI
On the UB-04 claim form, the second digit of the four-digit bill code in Field 4 indicates the type of facility
On the UB-04 claim form, 1553 listed as the hour of admission indicates that the patient was admitted at --- 3:53 pm
A four-digit code corresponding to each narrative description or standard abbreviation that identifies a specific accomodation, ancillary service, or billing calculation related to services billed is called a/an ---- code revenue
The DRG-based system changed hospital reimbursement from a fee-for-service to a lump sum, fixed-fee payment based on the --- rather than on time or services rendered. diagnosis
Cases that cannot be assigned an appropriate DRG because of atypical situations are called ---- cost outliers
An unethical practice of upcoding a patient's DRG category for a more severe diagnosis to increase reimbursement is called --- DRG creep
---- is a preexisting condition that will, because of its effect on the specific principal diagnosis, require more extensive therapy or cause an increase in length of stay by at least 1 day in approximately 75% of cases Comorbidity
Created by: bgarneau