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37 Cards in this Set
- Front
- Back
Which level of healthcare common procedural coding system includes codes that identify products, supplies and services not included in CPT |
Level 2 |
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Upcoding can result in |
Serious fines and penalties |
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Assigning a diagnosis code that does not match patient documentation for the purpose of increasing reimbursement through the DRG system |
Upcoding |
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All of these statement are true about IDC-10-CM except |
The United States will be the only nation using the ICD-10-CM |
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Which of the following would not be a required step in utilizing medical necessity guidelines? |
Review the family history section of the progress note |
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Which of the following statements is not true when using HCPCS Level 2 codes |
The search for the correct HCPCS code begins night tabular list |
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The ICD-9-CM remained in use in the US until Sep 30th of what year |
2015 |
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Which HCPCS Level 2 codes are temporary codes for procedures, services and supplies |
G codes |
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HCPCS Level 1 codes are know as |
Current procedural terminology |
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Where in the CPT manual would you find information about modifiers |
Appendix A |
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A payer practice in which a reported evaluation and management service is reduced to a lower level based strictly on the diagnosis code reported |
Down coding |
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Which of the following statements is true regarding HCPCS Level 2 codes |
All of the above |
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Level of history obtained |
Key component |
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Counseling |
Contributory factor |
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Coordination of care |
Contributory factor |
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Level of examination performed |
Key component |
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Degree of medical decision making involved |
Key component |
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Nature of the presenting problem |
Key component |
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Always at least three characters |
ICD 9 PCS |
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Each character can be alphanumeric |
ICD 10 PCS |
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No decimal is used |
ICD 10 PCS |
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Alpha characters are no case sensitive |
ICD 10 PCS |
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Identify the main term in the index |
Both |
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Code each problem to the highest level of specificity available in the classification |
ICD |
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Analyze the providers statement or description for the service provided and isolate the main term |
CPT |
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Never code directly from the index |
Both |
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Code the minimum number of diagnoses that fully describe the patients care received on that visit |
ICD |
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Sequence codes correctly so that it is possible to understand chronology of events |
ICD |
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The reason for the patients visit is coded first |
ICD |
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Check for any relevant subterms under the main term |
Both |
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Review all descriptions of codes listed for main terms and subterms to be sure the correct code is selected |
Both |
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Code correctly and completely and diagnosis or procedure that affects the care, influences the health status, or is a reason for treatment on that visit |
Both |
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When both spouses have health insurance, the policy provision that limits benefits to 100% of the cost: also known as dual coverage |
Coordination of benefits |
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A type of managed care operation that is typically set up as a for profit corporation with salaries employees |
Health maintenance organization |
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Determining whether a service is covered and considered medically necessary under a patient's insurance plan |
Preauthorization |
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Discoery of whether a treatment is covered under a patient's insurance contract |
Precertification |
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Identifies limited situations where paper claim forms may be submitted for payment |
Administrative simplification compliance act |