Question 1

When an insurance carrier bases reimbursement on a code level lower than the one submitted by the provider, this is called ________.

Accepted Answer

downcoding

Question 2

The extent of the patient ________ taken is a key factor in determining the level of E/M codes selected.

Accepted Answer

The answer of The extent of the patient ________ taken...

Question 3

Inaccuracy in linking diagnostic codes and procedural codes will result in all of the following except ____.

Accepted Answer

A)   exclusion from payers' programs
B)   denied claims
C)   reduced payments
D)   internal coding audits
E)   prison sentencesF) C) and D)
G) A) and B)

Question 4

For coding purposes, which of the following is not a complexity level for medical decision making?

Accepted Answer

A)   Straightforward MDM
B)   General-purpose MDM
C)   Low-complexity MDM
D)   Moderate-complexity MDM
E)   High-complexity MDMF) None of the above
G) A) and B)

Question 5

The CPT considers a patient ________ if that person has not received professional services from the physician within the last three years.

Accepted Answer

new

Question 6

Which of the following is not a potential reason for downcoding?

Accepted Answer

A)   The insurance carrier does not cover the services included on the claim.
B)   The coding system used by the insurer does not match that used by the provider.
C)   A workers' compensation carrier converts a CPT code to the lowest-paying code in the system.
D)   The payer discovers that documentation does not back up the level of code used.
E)   The provider uses a HCPCS code the insurer does not recognize.F) C) and D)
G) All of the above

Question 7

There is a question concerning a claim for a procedure submitted last year. Where will you look to double-check the codes in question?

Accepted Answer

A)   The current CPT
B)   Last year's CPT
C)   ICD-9-CM for last year
D)   ICD-9-CM for this year
E)   ICD-10-CMF) A) and B)
G) B) and C)

Question 8

In order for a service to be considered a consultation, the service must meet the 3Rs. Which of the following are the correct 3Rs?

Accepted Answer

A)   Release, record, report
B)   Request, record, report
C)   Release, request, record
D)   Request, review, report
E)   Request, review, recordF) A) and B)
G) A) and C)

Question 9

What symbol appears next to codes that are new since the last CPT revision?

Accepted Answer

A)   Red dot
B)   Pound (#)  sign
C)   Circle with diagonal line
D)   Blue triangle
E)   Bull's-eyeF) A) and E)
G) B) and C)

Question 10

Which of the following best describes HCPS Level II codes?

Accepted Answer

A)   The codes have five characters: numbers, letters, or a combination of both.
B)   The codes have six characters, including two initial letters followed by four numbers.
C)   The codes have five numeric digits.
D)   The codes have six alphabetic characters (letters) .
E)   The codes have five alphabetic characters (letters) .F) A) and D)
G) A) and E)

Question 11

Having a medical practice compliance plan in place ____.

Accepted Answer

A)   eliminates the risk of an audit
B)   ensures adherence to state regulations
C)   shows a "good-faith" effort to be compliant with coding regulations
D)   simplifies the tasks of the medical assistant
E)   replaces the insurance company's compliance checksF) B) and C)
G) A) and B)

Question 12

Counseling codes are used only if ____.

Accepted Answer

A)   counseling is provided during a complete physical examination
B)   the patient is referred to a third party for counseling
C)   a complete history and physical exam does not occur
D)   counseling is provided by a physician assistant or nurse practitioner
E)   the patient specifically requests a counseling referralF) A) and E)
G) A) and B)

Question 13

A(n) ________ plan is a strategy for finding, correcting, and preventing fraudulent medical office practices.

Accepted Answer

The answer of A(n) ________ plan is a strategy for...

Question 14

What symbol next to a CPT code tells you that moderate sedation is included in the procedure?

Accepted Answer

A)   Blue triangle
B)   Green arrows
C)   Bull's-eye
D)   Lightning bolt
E)   Red dotF) B) and E)
G) C) and D) C

Question 15

How many codes are required for giving a patient an injection of a vaccine?

Accepted Answer

A)   Depends on who is giving the injection
B)   1
C)   2
D)   3
E)   Depends on the type of vaccineF) All of the above
G) A) and B)

Question 16

HCPCS Level II codes are called ________ codes and cover supplies and DME.

Accepted Answer

The answer of HCPCS Level II codes are called ________...

Question 17

Which of the following is not one of the six main sections in the CPT manual?

Accepted Answer

A)   Anesthesiology
B)   Physical Therapy
C)   Pathology and Laboratory
D)   Surgery
E)   Evaluation and ManagementF) A) and B)
G) A) and C)

Question 18

The fraudulent practice of coding a procedure or service at a higher level than that provided to receive a higher level of reimbursement is known as code creep, overcoding, overbilling, or ________.

Accepted Answer

The answer of The fraudulent practice of coding a procedure...

Question 19

When unbundling is done intentionally to receive more payment than is allowed, the claim is likely to be considered ____.

Accepted Answer

A)   ethical
B)   invalid
C)   noncompliant
D)   fraudulent
E)   erroneousF) C) and D)
G) B) and C)

Question 20

A plus sign (+) is used for ________ codes, indicating procedures that are carried out in addition to a main procedure.

Accepted Answer

The answer of A plus sign (+) is used for...

Exam 19: Procedure Coding

When an insurance carrier bases reimbursement on a code level lower than the one submitted by the provider, this is called ________.

Correct Answerverifieddowncoding

The extent of the patient ________ taken is a key factor in determining the level of E/M codes selected.

Correct AnswerverifiedShow Answer

Inaccuracy in linking diagnostic codes and procedural codes will result in all of the following except ____.

Correct AnswerverifiedShow Answer

For coding purposes, which of the following is not a complexity level for medical decision making?

Correct AnswerverifiedShow Answer

The CPT considers a patient ________ if that person has not received professional services from the physician within the last three years.

Correct Answerverifiednew

Which of the following is not a potential reason for downcoding?

Correct AnswerverifiedShow Answer

There is a question concerning a claim for a procedure submitted last year. Where will you look to double-check the codes in question?

Correct AnswerverifiedShow Answer

In order for a service to be considered a consultation, the service must meet the 3Rs. Which of the following are the correct 3Rs?

Correct AnswerverifiedShow Answer

What symbol appears next to codes that are new since the last CPT revision?

Correct AnswerverifiedShow Answer

Which of the following best describes HCPS Level II codes?

Correct AnswerverifiedShow Answer

Having a medical practice compliance plan in place ____.

Correct AnswerverifiedShow Answer

Counseling codes are used only if ____.

Correct AnswerverifiedShow Answer

A(n) ________ plan is a strategy for finding, correcting, and preventing fraudulent medical office practices.

Correct AnswerverifiedShow Answer

What symbol next to a CPT code tells you that moderate sedation is included in the procedure?

Correct AnswerverifiedC

How many codes are required for giving a patient an injection of a vaccine?

Correct AnswerverifiedShow Answer

HCPCS Level II codes are called ________ codes and cover supplies and DME.

Correct AnswerverifiedShow Answer

Which of the following is not one of the six main sections in the CPT manual?

Correct AnswerverifiedShow Answer

The fraudulent practice of coding a procedure or service at a higher level than that provided to receive a higher level of reimbursement is known as code creep, overcoding, overbilling, or ________.

Correct AnswerverifiedShow Answer

When unbundling is done intentionally to receive more payment than is allowed, the claim is likely to be considered ____.

Correct AnswerverifiedShow Answer

A plus sign (+) is used for ________ codes, indicating procedures that are carried out in addition to a main procedure.

Correct AnswerverifiedShow Answer

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