Medical Terminology Final Exam Questions, Exams of Nursing

Download Medical Terminology Final Exam Questions and more Exams Nursing in PDF only on Docsity! 1 [Date] COC 2023 - FINAL EXAM QUESTIONS Latest Update BY AN EXPERT 2 [Date] WITH ASSURED SUCCESS% 1. A choledochal cyst is a cyst originating from which structure? Common bile duct 2. A character's position can be understood as which type of classification that allows different 5 [Date] 7. A dacryocystectomy describes: Excision of the lacrimal sac 8. A deficiency of cells in the blood is defined as: Cytopenia 9. A facility coder: Must understand the complete revenue cycle process. Rationale: A facility coder must understand the complete revenue cycle process and the impact the coder's role in the overall success. 6 [Date] 10. A gonioscopy is an examination of what part of the eye:Anterior chamber of the eye 11. A hospital CDM contains the following information: Department number, CPT®/HCPCS Level II code(s), charge, revenue code, inventory number, description of service Rationale: Typically, a CDM includes the department number/internal control/inventory number, description of services, revenue center (UB revenue code), CPT ®/HCPCS Level II 7 [Date] (procedure codes), and charge for service. 12. A hospital has an obligation to provide emergency services to a patient under what federal act? Emergency Medical Treatment and Active Labor Act 13. A Medicare patient is scheduled for a procedure Medicare deemed as statutorily excluded. The facility asks the patient to sign the ABN, but the patient refuses. The facility bills the patient for 10 [Date] 15. A Medicare secondary payer ensures: Medicare payment for items or services is prohibited if payment can be paid by another payer under certain conditions. 16. A meningioma is defined as: Tumor of the meninges 17. A part of the male genital system sitting below the urinary bladder and surrounding the urethra is called the: Prostate 11 [Date] 18. A patient arrives at the ED after being involved in an automobile accident. She has multiple lacerations, a contusion on her head, and a sprained ankle. The laceration repair and a level 3 ED visit are reported. Is a modifier necessary? If yes, why? Yes. Modifier 25 is required on the ED visit to indicate it was separately identifiable from the laceration repair. 19. A patient presented to the hospital outpatient pulmonary clinic for asthma follow-up. During the encounter, the 12 [Date] physician performed an expanded problem focused history and exam with moderate decision making for this established patient. The documentation supported a low-level E/M for the facility. Later in the evening, the patient suffered an acute asthma attack and went to the ER in the same hospital for treatment. What modifier is used to indicate multiple E/M services occurred on the same date? 27 20. A patient presents to the hospital- based clinic in her 15th week of 15 [Date] forearm and a cast was applied to provide support until th ePt could be seen by an orthopedic surgeon for potential surgery. The CPT code reported was 29075 (APC assignment of 5102 with a status indicator of T). How will the procedures be reimbursed under the OPPS? 29075 (status indicator T) will be reimbursed 100%, 23620 (status indictor T) will be reduced by 50%) 23. A patient was seen in the physician's office and was directly referred to Observation with atrial fibrillation. 16 [Date] Decision was made to perform cardioversion (92960 status indicator S), but minutes before defibrillation, the patient went into normal sinus rhythm. After 3 hours in Observation the decision was then made to admit the patient for 2 days for monitoring to test the effectiveness of a new oral medication for atrial fibrillation. Report the CPT ® code(s) and ICD-10-CM code for the outpatient facility. No outpatient facility charges are filed 17 [Date] 24. A pregnant patient presents to the ED with bleeding, cramping, and concerns of loss of tissue and material vaginally. On examination, the physician discovers an open cervical (os) with no products of conception seen. He tells the patient she has had an abortion. What type of abortion has occurred? Spontaneous 25. A procedure requiring the physician to cut down to the superficial fascia is documented as cutting down into the: Hypodermis 20 [Date] and then a statement is mailed to the patient for the amount determined to be patient responsibility. 31. A status indicator of S indicates: The procedure is paid under OPPS and is not discounted. 32. A surgeon performed a radical mastectomy on the right breast for a 42- year-old woman. The patient requested a permanent prosthesis in the recovery room. The surgeon decided to take the patient back to the operating room later 21 [Date] that day and the prosthesis was inserted in the right breast. What modifier should the facility use? 58 33. A surgeon places a self-retaining indwelling ureteral stent following a cystourethroscopic procedure. Later in the evening, due to complications, the patient returns to the OR for removal of the stent by the same surgeon. Select the appropriate modifier for the stent removal. 78 22 [Date] 34. A surgical procedure creating an opening into the jejunum is defined as a: Jejunostomy 35. A teaching physician's participation in the patient's care can be documented in the patient's medical chart by: The physician, resident, or the nurse 36. A type A emergency department includes: Answer: 24-hours per day, seven days a week access for patient requiring immediate or urgent care Rationale: Type A Emergency 25 [Date] 41. According to the Conditions of Participation (CoP), medical records must be retained in their original or legally reproduced form for a period of at least: Five years 42. According to the ICD-10-CM guidelines, how is bilateral glaucoma of the same type and stage reported? A bilateral code can be used to report the type of glaucoma and the stage of glaucoma. 26 [Date] 43. According to The Joint Commission's dangerous abbreviation list, which abbreviation is considered to be a dangerous abbreviation and why? U; can be mistaken for cc. 44. Acoustic Responsible for hearing and balance (vestibulocochlear nerve) 45. Additional requirements to be certified as a CAH can be found on the: Answer:CMS website Rationale: Additional requirements to be certified as a CAH can be found on the CMS 27 [Date] website (www.cms.gov/CertificationandComplia nc/04_CAHs.asp). 46. Adrenal glands • On top of each kidney 47. Adrenal medulla The main function of this gland is the secretion of adrenaline (epinephrine). It acts by raising blood glucose levels; increases blood pressure, heart rate, sweating, respiratory rate and other activities 30 [Date] 52. Ambulatory surgical centers include: Answer: An independent ASC Rationale: Independent ASCs offer ambulatory surgical services or same- day surgeries to patients who only require services with immediate postoperative care. When the ASC is owned by the hospital, it is generally considered to be an extension of the physical hospital and the same as any other outpatient department. In general, an independent ASC must be financially independent from the hospital, not be included on the hospital's cost reports. 31 [Date] 53. Amputation: the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger. 54. An ABN rendered in a timely manner is important for the facility to receive payment when Medicare does not cover the service, because the diagnosis does not support medical necessity. The facility may: Have the patient sign the ABN after administration of anesthesia. 32 [Date] 55. An ABN was presented to a 68-year- old Medicare patient for services that might not be covered. The services facing denial were specified on the ABN. The ABN did not specify the reason Medicare might likely deny the claim. The patient signed the ABN and the claim was denied. The patient received a bill from the facility and insists she did not understand the ABN or what she was signing. Is the patient responsible for payment? The ABN did not specify the reason Medicare might 35 [Date] 59. An operative report for a major surgical procedure should include:Pre- and post-op diagnosis, title of the procedure, surgeon(s), anesthesiologist/CRNA as well as type of anesthesia used, a detailed report of the procedure and instruments and equipment used, postoperative condition, complications and additional information, such as blood loss, drains, catheters, etc. 36 [Date] 60. An orthopedist reduces a fracture and places a cast to maintain the position of the bone during healing. What root operative procedure(s) should be reported? Reposition 61. An RW of 2.0000 means: The average costs of providing care to an inPt assigned to that DRG are twice the average costs of prividing car to all inPts 62. Anemia and polycythemia are disorders related to which blood cell? Erythrocytes 37 [Date] 63. Another term for qui tam relator is: Whistleblower 64. Annual changes to MS-DRG go into effect: Annually on Oct 1st 65. AP / Anteroposterior: the X-ray beam enters the front of body (anterior) and exits back of body (posterior) 66. APCs are based on: Grouping of outpatient services that are similar clinically and require similar resources 40 [Date] Approximately 75 percent of outpatient services are driven by the CDM. 71. ASC payment indicator N1 indicates the procedure is: A packaged service/item; no separate payment is made 72. Avulsion The forceful tearing away of part of body 73. Based on word parts, what is the definition of a glossectomy? Surgical removal of the tongue. 41 [Date] 74. Based on word parts, what is the definition of a salpingo-oophorectomy? Surgical removal of an ovary and tube. 75. Based on word parts, what is the definition of a tracheostomy? Creation of a hole in the trachea. 76. Based on word parts, what structure does paronychia refer to? Nail 42 [Date] 77. Benefits a an effective compliance plan include: • Faster, more accurate payment of claims • Faster billing mistakes • Diminished chance of a payer audit • Last chance of running afoul of self-referral and anti-kickback statutes 78. Billing incident-to in the physician's office means: Under certain circumstances the physician bills for the services performed by qualified employees as though the physician performed the services. Rationale: Incident-to for the physician's office, 45 [Date] which is referred to as the Medicare Severity Diagnosis Related Groups (MS- DRGs). 83. By what payment method is the inPt hospital facility reimbursed by Medicare? IPPS/MS-DRG 84. CAHs have: Answer: No more than 25 inpatient beds used for either inpatients or swing bed services Rationale: CAHs can have no more than 25 inpatient beds used for either inpatient or swing bed services. 46 [Date] 85. Calculate the reimbursement for MS- DRG 813, Coagulations Disorders, with a relative weight of 1.6115. The hospital base rate is $3,201.00. $5,158.41 86. Cauda equinaThe end of the spinal cord, including the nerve roots of those nerves below the first lumbar nerve 87. Cauterize The use of heat or chemicals to burn or cut 47 [Date] 88. Chondroplasty: a surgical procedure used to smooth damaged cartilage in the knee. The goal of the surgery is to lessen friction in the joint, allowing the knee to move freely and without pain. The knee joint is covered in articular cartilage, which is a smooth tissue that allows the joint to move without friction. 89. Circumduction: a conical movement of a body part, such as a ball and socket joint or the eye. Circumduction is a combination of flexion, extension, adduction and abduction. 50 [Date] Programs. The standards include guidelines for documentation and apply to both hospitals and ambulatory surgery centers. 94. CPT ® code 36215 is for selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family. What appendix can help you determine the order of vascular families? Appendix L 95. CPT Critical Care guidelines provide a list of codes considered inclusive to 51 [Date] critical care services. How should these codes be reported by the Facility on the UB-04? All services performed in conjunction with critical care should be reported, even if they are considered inclusive to the critical care codes by CPT® definition 96. Critical care is: A condition, not a location. 97. Cryosurgery A procedure using low temperatures for lesion removal 52 [Date] 98. Cytopathology is the study of: Cells 99. Debridement is best described as: Removal of dead or damaged tissue as from a wound 100. Decompression Removal of pressure