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CBCS BILLING AND CODING EXAM
400+QUESTIONS AND CORRECT DETAILED
ANSWERS|ALREADY GRADED A+
Medical Billing & Coding as a Career - ANSWER>>*Claims assistant professional or claims manager, *Coding Specialist, * Collection Manager, *Electronic Claims Processor, *Insurance Billing Specialist, * Insurance Coordinator, *Insurance Counselor, *Medical Biller, *Medical & Financial Records Manager, * Billing & Coding Specialist
What are Medical Ethics? - ANSWER>>Standards of conduct based on moral principle. They are generally accepted as a guide for behavior towards pt's, dr's, co-workers, the gov, and ins co's.
What does acting within ethical behavior boundaries mean? - ANSWER>>carrying out one's responsibilities w/ integrity, dignity, respect, honesty, competence, fairness, & trust.
Compliance regulations: - ANSWER>>Most billing-related cases are based on HIPPA and False Claims Act
Health Insurance Portability & Accountability Act (HIPAA) - ANSWER>>Enacted in 1996, created by the Health Care Fraud & Abuse Control Program-enacted to check for fraud and abuse in the Medicare/Medicaid Programs and private payers
What are the 2 provisions of HIPPA? - ANSWER>>Title I: Insurance Reform Title II: Administrative Simplification
What is Title I of HIPPA? - ANSWER>>Insurance Reform-primary purpose is to provide continuous ins coverage for worker & their dependents when they change or lose jobs. Also *Limits the use of preexisting conditions exclusions *Prohibits discrimination from past or present poor health *Guarantees certain employees/indv the right to purchase new health ins coverage after losing job *Allows renewal of health ins cov regardless of an indv's health cond. that is covered under the particular policy.
What is Title II of HIPPA? - ANSWER>>Administrative Simplification-goal is to focus on the health care practice setting to reduce administrative cost & burdens. Has 2 parts- 1) development and implementation of standardized health-related financial & administrative
activities electronically 2) Implementation of privacy & security procedures to prevent the misuse of health info by ensuring confidentiality
What is the False Claims Act (FCA)? - ANSWER>>Federal law that prohibits submitting a fraudulent claim or making a false statement or representation in connection w/ a claim. Also protects & rewards whistle-blowers.
What is the National Correct Coding Initiative (NCCI)? - ANSWER>>Developed by CMS to promote the national correct coding methodologies & to control improper coding that lead to inappropriate payment of Part B health ins claims.
How many edits does NCCI include? - ANSWER>>2: 1)Column 1/Column 2 (prev called Comprehensive/Component) Edits
Column 1/Column 2 edits (NCCI) - ANSWER>>Identifies code pairs that should not be billed together b/c 1 code (Column 1) includes all the services described by another code (Column 2)
Mutually Exclusive Edits (NCCI) - ANSWER>>ID's code pairs that, for clinical reasons, are unlikely to be performed on the same pt on the same day
What are the possible consequences of inaccurate coding and incorrect billing? - ANSWER>>*delayed processing & payment of claims *reduced payments, denied claims *fine and/or imprisonment *exclusion from payer's programs, loss of dr's license to practice med
Who has the task of investigate and prosecuting health care fraud & abuse? - ANSWER>>The Office of Inspector General (OIG)
Fraud - ANSWER>>knowingly & intentionally deceiving or misrepresenting info that may result in unauthorized benefits. It is a felony and can result in fines and/or prison.
Who audits claims? - ANSWER>>State & federal agencies as well as private ins co's
What are common forms of fraud? - ANSWER>>billing for services not furnished, unbundling, & misrepresenting diagnosis to justify payment
Abuse - ANSWER>>incidences or practices, not usually considered fraudulent, that are inconsistent w/ the accepted medical business or fiscal practices in the industry.
report form. IT IS THIS RECORD THAT PROVIDES INFO NEEDED TO COMPLETE THE INS CLAIM FORM.
Reasons for Documentation - ANSWER>>Important that every pt seen by dr has comprehensive legible documentation about pt's illness, treatment, & plans for following reasons:
Retention Of Medical Records - ANSWER>>Is governed by state & local laws & may vary from state-to-state. Most dr are required to retain records indefinitely, deceased pt records should be kept for @ least 5 years
- algia - ANSWER>>pain
- emia - ANSWER>>blood condition
- itis - ANSWER>>inflammation
- megaly - ANSWER>>enlargement
- meter - ANSWER>>measure
- oma - ANSWER>>tumor, mass
- osis - ANSWER>>abnormal condition
- pathy - ANSWER>>disease condition
- rrhagia - ANSWER>>bursting forth of blood
- rrhea - ANSWER>>discharge, flow
- sclerosis - ANSWER>>hardening
- scopy - ANSWER>>to view
- centesis - ANSWER>>surgical puncture
- ectomy - ANSWER>>removal, resection, excision
- gram - ANSWER>>record
- graphy - ANSWER>>process of recording
- lysis - ANSWER>>separation, breakdown, destruction
- pexy - ANSWER>>surgical fixation
- plasty - ANSWER>>surgical repair
- rrhapy - ANSWER>>suture
- scopy - ANSWER>>visual examination
- stomy - ANSWER>>opening
- therapy - ANSWER>>treatment
- tomy - ANSWER>>incision, to cut into
a, an - ANSWER>>without
ante - ANSWER>>before
anti - ANSWER>>against
brady - ANSWER>>slow
dys - ANSWER>>painful, difficult
endo - ANSWER>>inside, within
epi - ANSWER>>upon, above
ex - ANSWER>>out, out of
hemi - ANSWER>>half, partial
colp - ANSWER>>vagina
derm - ANSWER>>skim
enter - ANSWER>>intestine
episi - ANSWER>>vulva
gastro - ANSWER>>stomach
gloss - ANSWER>>tongue
hepato - ANSWER>>liver
hyster - ANSWER>>uterus
lapar - ANSWER>>abdomen
lact - ANSWER>>milk
lith - ANSWER>>stone
mast - ANSWER>>breast
myo - ANSWER>>muscle
nat - ANSWER>>birth
oophor - ANSWER>>ovary
oste - ANSWER>>bone
pneum - ANSWER>>lung
rhin - ANSWER>>nose
salping - ANSWER>>fallopian tubes
stomat - ANSWER>>mouth
Anterior, Ventral - ANSWER>>front surface of the body
Posterior, Dorsal - ANSWER>>back side of the body
Superior - ANSWER>>above another structure
Inferior - ANSWER>>below another structure
Proximal - ANSWER>>near the point of attachment to the trunk
Distal - ANSWER>>far from the point of attachment to the trunk
Medial - ANSWER>>pertaining to the middle of the body
Lateral - ANSWER>>pertaining to the side
Frontal, Coronal - ANSWER>>Vertical plane dividing the body into anterior & posterior portions
Sagittal - ANSWER>>vertical plane dividing the body into right & left sides
Transverse, Cross-sectional - ANSWER>>Horizontal plane dividing the body into upper & lower portions
Anatomy & Physiology - ANSWER>>A professional medical coder must have knowledge of anatomy & physiology so that coding assignment is quick & accurate.
What is the 1st body system for which medical procedures are described in the CPT manual? - ANSWER>>The Integumentary System (the skin and it's accessory organs) Integument means covering. It is a complex system of specialized tissues containing glands, nerves and blood vessels.
How much area does the skin cover? - ANSWER>>an area of 22 sq ft (an average adult). It is the largest organ of the body
- apocrine sweat glands (secrete orderless sweat)
What organ secretes hormones? - ANSWER>>the adrenal glands, they secrete epinephrine & steriods
Albino - ANSWER>>deficient in pigment (melanin)
Collagen - ANSWER>>structural protein found in the skin & connective tissue
Melanin - ANSWER>>major skin pigment
Lipocyte - ANSWER>>a fat cell
Macule - ANSWER>>discolored, flat lesion (freckles,, tattoo marks)
Polyp - ANSWER>>benign growth extending from the surface of the mucous membrane
Fissure- - ANSWER>>groove or crack like sore
Nodule - ANSWER>>solid, round or oval elevated lesion more than 1 cm in diameter
Ulcer - ANSWER>>open sore on the skin or mucous membrane
Vesicle - ANSWER>>small collection of clear fluid; blister
Wheal - ANSWER>>Smooth, slightly elevated, edematous (swollen) area that is redder or paler than the surrounding skin
Alopecia - ANSWER>>absence of hair form areas where it normally grows
Gangrene - ANSWER>>death of tissue associated w/ the loss of blood supply
Impetigo - ANSWER>>bacterial inflammatory skin disease characterized by lesion, pustules, and vesicles
Multigravida - ANSWER>>a pregnant woman who has had at least one previous pregnancy
The Musculoskeletal System - ANSWER>>includes bones, muscles & joints. Acts as a framework for the organs, protects many of those organs, and also provides the body w/ the ability to move
What are bones connected to one another by? - ANSWER>>by fibrous bands of tissues called LIGAMENTS
What are muscles attached to the bone by? - ANSWER>>tendons
What is the fibrous covering of muscles called? - ANSWER>>the fascia and the aricular cartilage, covers the end of many bones and serves as a protective function.
Bones - ANSWER>>complete organs made up of connective tissue called OSSEOUS. Inner core of bones is comprised of HEMATOPOIETIC tissue. This is where the red bone marrow manufactures blood cells. Other parts of the bones are storage areas for minerals necessary for growth, ie; calcium and phosphorous
How are bones categorized? - ANSWER>>as belonging to either the AXIAL SKELETON or the APPENDICULAR SKELETON.
Axial Skeleton - ANSWER>>consist of the skull, rib cage & spine
Appendicular Skeleton - ANSWER>>made up of the shoulder, collar, pelvic, arm & legs
Long Bones - ANSWER>>typically very strong, are broad at the ends and have large surfaces for muscle attachment. IE: HUMERUS & FEMUR.
Short Bones - ANSWER>>are small w/ irregular shapes, they are found in wrist and ankle
Flat Bones - ANSWER>>are found covering the soft body parts, IE; SHOULDER BLADES, RIBS AND PELVIC BONES
Sesamoid Bones - ANSWER>>small, rounded bones that resemble a sesame seed. they are found near joints and increase the efficiency of muscles near a joint. IE, KNEE CAP
Skull - ANSWER>>made up of 2 parts, the cranium and the facial bone
Cranium - ANSWER>>includes following bones
Upper Appendicular Skeleton - ANSWER>>includes the shoulder girdle which is made up of the SCAPULA, CLAVICLE, & UPPER EXTREMITIES
Scapula - ANSWER>>or shoulder blades are flat bones that help support the arms
Clavicle - ANSWER>>or collarbone, is curved horizontal bones that attach to the upper sternum at one end, these bones help stabilize the shoulder
Humerus - ANSWER>>upper arm bone
Ulna - ANSWER>>lower medial arm bone
Radius - ANSWER>>lateral lower arm bone (in line w/ the thumb)
Carpals - ANSWER>>Wrist bones, there are 2 rows of 4 bones in the wrist
Metacarpals - ANSWER>>the 5 radiating bones in the fingers. These are the bones in the palm of the hand.
Phalanges - ANSWER>>finger bones, each finger has 3 phalanges, except for the thumb. The 3 phalanges are the proximal, middle and a distal phalanx. The thumb has a proximal and distal
Lower Appendicular - ANSWER>>can be divided into the pelvis and the lower extremities
Pelvis - ANSWER>>superior & widest bone
Ischium - ANSWER>>lower portion of the pelvic bone
Pubic Bone - ANSWER>>lower anterior part of the bone
Femur - ANSWER>>thighbone
Patella - ANSWER>>kneecap
Tibia - ANSWER>>shin
Fibula - ANSWER>>smaller, lateral leg bone
Malleolus - ANSWER>>ankle
Tarsal - ANSWER>>hind foot bone
Metatarsal - ANSWER>>midfoot bone
Phalanx - ANSWER>>toe bones, 14 in all (2 in great toe, 3 in each of the other toes)
Joints - ANSWER>>parts of the body where 2 or more bones of the skeleton join. Different joints have different ROM (range of motion), ranging from no movement at all to full range of movement
No ROM - ANSWER>>most synarthroses are immovable joints held together by fibrous tissue
Limited ROM - ANSWER>>amphiathroses are joints joined together by cartilage that is slightly moveable, such as the vertebrae of the spine or the pubic bone
Full ROM - ANSWER>>diathroses are joints that have free movement, Ball-and-socket joints (hip) and hinge joints (knees) are common diathroses joints (synovial joints)
Synovial Joints - ANSWER>>free moving joints, are surrounded by joint capsules. Many of the synovial joints have BURSAE-SACS OF FLUID THAT ARE LOCATED BETWEEN THE BONES OF THE JOINT AND THE TENDONS THAT HOLD THE MUSCLES IN PLACE.
Muscles - ANSWER>>Muscle is tissue comprised of cells. Have the ability to contract & relax.
What are the 3 different functions of the human muscles? - ANSWER>>1) allow the skeleton to move
- responsible for movement of organs
- to pump blood to the circulatory cystem
How are muscles attached to bones? - ANSWER>>by strong, fibrous bands of connective tissues called tendons.
Extension - ANSWER>>to increase the angle of the joint
Flexion - ANSWER>>to decrease the angle of the joint
Hairline Fracture - ANSWER>>a minor fracture appears as a thin line on x-ray; and may not extend completely through the bone
Greenstick Fracture - ANSWER>>the bone is partially bent & partially broken, this is a common fracture in children b/c their bones are still soft
Pathologic Fracture - ANSWER>>any fracture occurring spontaneously as a result of disease
Salter-Harris Fracture - ANSWER>>a fracture of the epiphyseal plate in children
Sprains, strains and dislocation/subluxation - ANSWER>>SPRAIN is a traumatic injury to the joint involving the soft tissue, soft tissue includes the muscles, ligaments and tendons.
Strain - ANSWER>>lesser injury, usually this is a result of overuse or overstretching
Dislocation - ANSWER>>is when the bone is completely out of place
Subluxation - ANSWER>>bone is partially out of joint
Evaluations & Management Review - ANSWER>>The E&M section include codes that pertain to the nature of the physicians work. Codes depend on type of service, pt status, and place where service was rendured. The E&M section is divided into broad categories such as office visit, hospital visits, and consultations
Basic Format of the levels of E&M services - ANSWER>>1) a unique code # is listed
- the place & type of service is specified
- the content of the service is defined
- the nature of the presenting problem(s) usually associated w/ a given level is (are) described
- time is typically specified in the descriptor of the code
New Patient - ANSWER>>defined as one who has not received medical services w/in the last 3 years
Established Patient - ANSWER>>defined as someone who has recieved medical services w/in the last 3 years from the physician or another physician of the same specialty who belongs to the same group practice
Chief Complaint - ANSWER>>brief statement describing the symptom, problem, diagnosis, or condition that is the reason the pt seeks medical care
How many Volumes to ICD manual? - ANSWER>>3; *Volume 1- Disease: Tabular List *Volume 2- Disease: Alphabetic Index *Volume 3- Procedures: Tabular list and Alphabetic Index
Volume 1-Index to Diseases, Tabular List - ANSWER>>contains the disease and condition codes and the descriptions, also contains the V codes and E codes
Volume 2-Index to Diseases, Alphabetic Index - ANSWER>>the is the alphabetic index of Volume 1; use this first then volume 1 to confirm codes
Volume 3-Procedures - ANSWER>>contains codes for surgical, therapeutic, and diagnosis procedures, used primarily in hospitals
Which volume(s) are used in the inpatient and outpatient settings (physician office)? - ANSWER>>Volume's 1 & 2
How to ensure you have chosen the correct code? - ANSWER>>First locate the code in the alphabetic index (Volume 2) then cross-reference this code in the Tabular List (Volume 1)
What are V codes? - ANSWER>>Supplementary Classification of Factors Influencing Health Status and Contact of Health Services-supplementary classification code used to identify health care encounters that occur for reasons other that illness or injury or to indentify pt's whose illness is influenced by special circumstances or problems. Can be found in both Volume 1 & Volume 2
What are circumstances when V codes are used? - ANSWER>>*When a person who is not currently sick encounters health services for some specific reason such as to act as an organ donor or receive a vaccination. (IE; V59.3 is the code for donor of bone marrow) *When a person w/ a resolving disease or chronic condition presents for specific treatment of that disease or condition. (IE; V56.0 is used for extracorporeal dialysis) *When a circumstance may influence the pt's health status but is not a current illness (IE; V16. is used for family history of coronary artery disease) *To indicate the birth status of a newborn (IE; V30.0 is uused for a newborn male born in the hospital by c-section)
Sequencing the diagnosis - ANSWER>>the diagnosis, condition, or other reason for the encounter or visit shown in the medical record to be chiefly responsible for the services provided is listed first. Coexisting conditions that were treated or medically managed or influenced by the pt during the encounter are listed as additional codes. (Conditions that were previously treated and no longer exist are not coded.) If personal history or family history has an impact on current care or influence treatment, history code may be assigned as a secondary code
Alphabetic Index (Volume 2) - ANSWER>>Everything in the Index is listed by condition-that is, diagnosis, signs, symptoms, and conditions such as pregnancy or admission
Nonessential Modifers - ANSWER>>the main term may be followed by these in paranthesis, their presence or absences does not have an effect on the the selection of the code listed for the main term
Essential Modifiers - ANSWER>>Terms indented two spaces to the right below the main term called subterms. Are essential modifiers b/c they have bearing on the right selection of the code.
Hypertension table - ANSWER>>found in the Index under the main term "Hypertension" and it contains a list of conditions that are due to or associated with hypertension. The Table classifies the conditions as: -Malignant; an accelerated sever form of hypertension w/ vascular damage and a diastolic pressure of 130mmHg> -Benign; Mild or controlled hypertension & no damage to the vascular system or organs -Unspecified; This is not specified as benign or malignant in the diagnosis or medical record
Neoplasm Table - ANSWER>>this is located in the Index under the main term "Neoplasm" and is organized by anatomic site. Each site has 6 columns w/ 6 possible codes determined by whether the neoplasm is malignant, benign, of uncertain behavior or of unspecified nature
Malignant - ANSWER>>further classified as to primary, secondary or carcinoma in situ
Primary Malignancy - ANSWER>>the original cancer site. Malignant tumors are considered primary unless documented as secondary or mastastic
Secondary Malignancy - ANSWER>>cancer that has metastasized (spread) to a secondary site either adjacent or remote region of the body
Carcinoma (Ca) in Situ - ANSWER>>cancer that is localized and has not spread to adjacent tissues or distant parts of the body
Benign - ANSWER>>noninvasive, non-spreading, nonmalignant
Uncertain Behavior - ANSWER>>uncertain whether benign or malignant, borderline malignancy
Unspecified Nature - ANSWER>>a neoplasm is identified; however, no nature of the tumor is documented in the diagnosis of the medical record
Choose the code that represents the current status of the neoplasm - ANSWER>>a neoplasm code is assigned if the tumor has been removed and pt is still receiving chemotherapy tx or radiation. A V code is assigned if the tumor is no longer present or if the patient is not receiving treatment, but is returning for follow-up care
3 sections to Alphabetic Index - ANSWER>>Section 1) Index to diseases Section 2) Table of drugs and chemical Section 3) Index to External Cause of Injury (E Codes)
Section 1: Index to diseases - ANSWER>>each term is followed by the code or codes that apply to that term
Section 2: Table of Drugs and Chemicals - ANSWER>>contains a list of drugs & chemicals w/ the corresponding poisoning code and E codes. The E codes are used to explain the circumstances surrounding the poisoning which may be: -Accident: Poisoning was due to accidental overdose, wrong substance taken, accidents in use of drugs and biologicals, external causes of poisoning classifiable to 980- -Therapeutic Use: instances when a correct substance properly taken is the cause of an adverse effect -Suicide Attempt: the poisoning was self-inflicted -Assault: poisoning was inflicted by another person w/ intent to kill or injury -Understand: poisoning cannot be determined whether intentional or accidental
Section 3: Index to External Cause of Injury (E codes) - ANSWER>>this is the index for the E codes. It classifies in alphabetical order, environment events and other conditions as the cause of injury and other adverse effects.
