Download WGU D521 Intro to Medical Coding Study Guide and more Exams Medical Physics in PDF only on Docsity!
WGU D521-lNTRODUCTlON TO MEDICAL CODING
EXAM QUESTIONS AND
ANSWERS GRADED A+ 2026
1. Diagnosis: identification of a disease by a licensed provider
- Morbidity: Refers to ill health in an individual and the levels of ill health in a population or group.
- Mortality: the state of being subject to death
- Comorbidity: a secondary condition that is present on admission and causes an increase in length of stay (LOS)
- Complication: a secondary condition that arises during hospitalization and causes an increase in length of stay (LOS) 1 /
- Principal diagnosis: that condition established after study, which is found to be primarily responsible for admission of the patient to the hospital
2/
- What is a characteristic of ICD-6?: The first version of ICD used for both death classification and disease indexing
- What was the first 'CD revision for which an alternate was made due to disagreements? : The United States developed its own version of ICD-8 based on disagreements over the circulatory section.
- Which characteristic of 'CD-I O-PCS represents a difference from ICD-9- CM?: No diagnostic information is included.
- American Health Information Management Association (AHIMA): a professional organization for health information management (HIM) professionals
1 1. American Hospital Association (AHA): Non profit group or alliance of member hospitals and health care organizations that promote the interests of hospitals. It is an advocacy group for health care organizations, particularly hospitals
- World Health Organization (WHO): A group within the United Nations responSible for human health, including combating the spread of infectious diseases and health issues related to natural disasters.
- History of Present Illness (HPI): eight categories that constitute a chronological description of an illness.
- History of Present Illness (HPI) eight categories: How long have you had the sore throat? (duration)
What part of your throat hurts? (location)
Is the pain continuous? Does it become better or worse? (timing)
How does it compare to other sore throats you have had? (severity)
4/
How would you describe the pain? (quality)
What have you done to obtain relief? Did it work? (modifying factors)
- Common Diagnosis coding process errors: Illegible physician handwriting
Illogical physician diagnosis documentation
Lack of physician documentation
Transcription errors by typist or voice-recognition systems
Content of the rest of the patient's medical record does not support the diagnosis documented
Lack of specificity
- Hybrid Record: A combination of paper and electronic records; a health record that includes both paper and electronic elements
- Integrated health record: A system of health record organization in which all the paper forms are arranged in strict chronological order and mixed with forms created by different departments
- The Joint Commission: an independent organization that accredits healthcare organizations in the United States based on performance standards
- Longitudinal health record: a single complete health record that combines data from a variety of sources within a healthcare system
5/
Source-oriented health record: a system of health record organization where information is organized according to the patient care department that provided the care
ICD-IO-PCS: ICD-10-PCS is a system of medical classification used for procedural coding. It is a US system that is used in hospital settings to report inpatient procedures. ICD-10-PCS codes support data collection, payment and electronic health records.
22. principal procedure: A procedure performed for definitive treatment, one
that is necessary for treating a certain condition. It is usually related to the primary diagnosis.
23. significant procedure: a procedure that is surgical in nature, carries a
surgical risk or anesthesia risk, and requires specialized training
24. Uniform Hospital Discharge Data Set (UHDDS): an organization that defines
data sets for reporting procedures performed
25. Current Procedural Terminology (CPT): coding system is published and
maintained by the American Medical Association (AMA). the standardized classification system for reporting medical procedures and services. It consists of five characters that report outpatient procedures, including anesthesia, surgery, radiology, pathology and laboratory, Evaluation and management, medicine services
26. evaluation and management (E&M): a section of CPT codes used to report
services provided by a physician or other qualified healthcare professional
27. modifiers: two characters appended to a CPT code to provide additional
information about the procedure without changing the meaning of the code
7/
Drainage
Extirpation
Fragmentation
35. Root operations that involve cutting or separation only: Division Release
36. Root operations that put or put back or move some or all of a body part:
Transplantation
Reattachment
Transfer
Reposition
37. Root operations that alter the diameter or route of a tubular body part:
Restriction
Occlusion
Dilation Bypass
- Root operations that always involve a device: Insertion
Replacement
Supplement
Change
Removal
Revision
39. Root operations involving examination only: Inspection Map
40. Root operations that include other repairs: Control Repair
8/
41. Root operations that include other objectives: Alteration Creation
Fusion
42. ICD-I O-CM: a standardized classification system of diagnosis codes used for
medical claim reporting in all healthcare settings. It is a set of diagnosis codes used in the United States of America, developed by a component of the U.S.
43. Inpatient Prospective Payment System ('PPS): a system of categorizing
inpatient cases into a group based on average resources used for one inclusive payment
44. Outpatient Prospective Payment System (OPPS): a system used to
determine outpatient reimbursement based on CPT codes assigned
45. revenue cycle: the process of tracking and analyzing data that includes
patient registration, medical coding, and patient billing processes for accurate reimbursement
46. fee-for-service reimbursement: Issues payments to healthcare providers
on the basis of the charges assigned to each of the separate services that
were performed for the patient
47. reasonable cost system of reimbursement: relies on an annual cost report to
compile data used to determine periodic interim payments.
- advanced beneficiary notice (ABN): a waiver of liability for the
patient to sign
if the provider deems Medicare will not pay for a service
- charge description master (CDM): a database of all billable items, revenue codes, and CPT/HCPCS codes that describe a service provided within a hospital
- discharged not final billed (DNFB): a measure of patient accounts that are held up due to either coding delays or other issues that prevent claim submission
- explanation of benefits (EOB): a statement from the payer that summarizes the costs of healthcare services billed, what is covered by the insurance plan, and how much is the patient's responsibility to pay
- National Correct Coding Initiative (NCC'): an insurance rating and data collection bureau developed by CMS to promote national coding methodologies to help reduce improper coding that may result in inappropriate payments of Medicare and Medicaid claims
11 /
