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Theory 160 wk1

theory exam

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