theory exam
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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| The same coding guidelines apply to both inpatient and outpatient settings | False
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| In the outpatient setting the term first-listed diagnosis is used instead of principal diagnosis | True
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| The first-listed diagnosis is the diagnosis that the physician lists first | False
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| In the outpatient setting a diagnosis that is documented as rule-out should be coded as if it exists | False
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| V codes can be assigned as first-listed or secondary diagnoses | True
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| In the outpatient setting the term first-listed diagnosis is used in lieu of princiapl diagnosis | True
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| 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
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| It is acceptable to use codes that describe signs or symptons when a definitive diagnosis has not been established by the provider | True
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| If the pre and postoperative diagnosis are different the preoperative diagnosis should be coded | False
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| In times past physicians in private billed indemnity insurance plans and professional services were reimbursed on a fee-for-service basis | True
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| Ross-Loos Medical Group america's oldest privately owned prepaid medical group started in Texas | False
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| 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
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| Medicare-eligible patients are not involved with HMO's or prepaid health plans | False
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| In a staff model HMO physicians are hired directly by the health plan that pays their salary | True
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| Exclusive provider organizations (EPO) are regulated by the federal government | False
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| 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
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| In a point of service(POS) program members may choose to use a nonprogram provider at any time | True
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| The term turfing means to transfer the sickest high-cost patients to other physicians so that the provider appears as a low utilizer | True
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| 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
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| In certain managed care plans there is an incentive for the gatekeeper to limit patient referrals to specialists | True
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| Managed care plans allow laboratory tests to be performed at any facility the patient chooses | False
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| Managed care plans never require a CMS-1500 claim form to be completed and submitted | False
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| Usually there are no deductibles for managed care plans | True
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| A copayment in a managed care plan is usually a fixed dollar amount | True
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| Radiology codes designated as a separate procedure should be reported in addition to the code for the total procedure or service | False
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| There are four subheadings in the radiology section | False
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| The phrase with contrast represents contrast material administered intravasculary intra articularly or intrathecally | True
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| It is acceptable for the radiologist to communicate his/ or her opinion via telephone instead of a written report | False
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| Personal history of peptic ulcer | V12.71
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| Screening for sickle cell | V78.2
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| Long term use of high risk medication | V58.69
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| Preoperative evaluation for elective cholecystectomy due to gallstones. Patient is seen by pulmonologist because of COPD | V72.82, 574.20, 496
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| Initial office visit for patient with diarrhea Physician documented gastroentritis | Gastroenteritis
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| An established patient is seen for amenorrhea and galactorrhea to rule out pituitary tumor | Amenorrhea, galactorrhea
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| The abbreviation MCO stands for | Managed Care Organization
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| A primary care physician who controls patient access to specialists is called a/an | Gatekeeper
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| Benefits under the HMO Act fall under two categories__health services and supplemental health servfices | Basic
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| 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
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| UR is the abbreviation for___which is necessary to control costs in the health care setting | Utilization Review
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| 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
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| 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
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| In clinical brachytherapy the superviaion of radio elements and dose interpretation are performed by the therapeutic | Radiologist
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| Two dimensional ultrasonic scanning procedure with a two dimendiagnostic ultrasoundsional display is the definition of___ | B-scan
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| Radiologic examination nasal bones complete minimum of three views | 70160
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| A cardiac magentic resonance imaging for morphology and function without contrast | 75557
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| Renal venography unilateral selective supervision and interpretation | 75831
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| An 18 MeV radiation treatment single treatment area | 77404
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| Liver imaging with vascular flow | 78202
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| Unlisted ultrasound procedure | 76999
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| Two view chest x-ray film frontal and lateral | 71020
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| Complete abdominal ultrasound using real time with image documentation | 76700
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| X-ray shoulder arthography supervision and interpretation only | 73040
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| Epididymography, supervision and interpretation | 74440
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| Selective spinal angiography supervision and interpretation | 75705
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| Saline infusion sonohysterography with color flow doppler | 76831
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| __means lying down | Recumbent
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| Retroperitoneal sonogram kidneys | 76770
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| MRI of brain with contrast | 70552
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| america's oldest privately owned prepaid medical group is the | Ross-Loos medical Group
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| What plan allows members of Kaiser Permanente Medical Care Program to seek medical help from non Kaiser physicians? | Point Of Service
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| Kaiser Permanente's medical plan is a closed panel program which means | It limits the patient's choice of personal physicians
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| A significant contribution to HMO development was the | Health Maintenance Organization Act of 1973
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| How does an HMO receive payment for the services its physicians provide? | Prepaid health plan
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| 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
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| How are physicians who work for a prepaid group practice model paid? | Salary paid by independent group
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| 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
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| In an independent practice association(IPA) physician's are | Not employees and are not paid salaries
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| 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)
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| 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
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| 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)
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| Practitioners in an HMO program may come under peer review by a professional group called a | Quality Improvement Organization
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| When a physician sees a patient more than is medically necessary, it is called | Churning
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| Referral of a patient recommended by one specialist to another specialist is known as | Tertiary Care
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| 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
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| The modifier reported when a physician component is reported separately is | -26
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| A__procedure is one that is performed independently of, and not immediately related to, another service | Separate
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| the divisions of the Radiation Oncology section of the CPT manual are divided into subsections based on what? | Type of service
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| What is the standard measure of energy in radiation treatment? | MeV
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| What is the modifier used to identify the technical component of a radiologic procedure? | -TC
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| What are the radiosotopes that attach themselves to red blood cells called? | Tracer
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| What is the name of the high frequency sound waves in an imaging proccess that is used to diagnose patient illness? | Ultrasound
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| Radiation oncology codes include normal follow-up care during the course of treatment and __following its completion | Includes 3 month global period
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| 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
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| 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
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| 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
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