Term
| For hemiplegia and hemiparesis and other paralytic syndromes, report the ______ side as dominant if the documentation does not specify which side is dominant. |
|
Definition
|
|
Term
| Diabetes mellitus codes are __________ codes that include the type of diabetes as well as the body system involved and complications affecting the body system. |
|
Definition
|
|
Term
| For reporting purposes, urosepsis is not considered _______. |
|
Definition
|
|
Term
| T/F - Multiple coding is when it takes more than one code to fully describe the condition, circumstance, or manifestation. |
|
Definition
|
|
Term
| SIRS is the diagnosis when all of the following are diagnosed |
|
Definition
hypothermia or fever
tachycardia
tachypnea
increased or decreased WBC |
|
|
Term
|
Definition
| single ICD-9-CM code used to identify etiology and manifestation of a disease. |
|
|
Term
| When reporting an infection that is antibiotic resistant, report the _________________ first, followed by _____, _________________________________. |
|
Definition
infection
Z16, infection with drug resistant microorganisms. |
|
|
Term
| If the medical documentation indicates the patient has 2 conditions that are both included in one diagnosis code, ____________________________________________________. |
|
Definition
| report that diagnosis code only once. |
|
|
Term
| multiple coding is also known as |
|
Definition
|
|
Term
|
Definition
| also known as dual coding, use of more than one ICD-9-CM code to identify both etiology and manifestation of a disease, as contrasted with combination coding. |
|
|
Term
| When the histological type of neoplasm is documentated, reference the __________________ _____________ first. |
|
Definition
|
|
Term
| Viral hepatitis codes are divided based on |
|
Definition
type of hepatitis
if condition is with or without hepatic coma |
|
|
Term
| If a patient is admitted with pneumonia and while hospitalized develops severe sepsis, report the __________________ first, followed by the ________________. |
|
Definition
|
|
Term
| When an encounter is for treatment of anemia due to malignancy, the first-listed diagnosis would be the _______________, followed by the ____________. |
|
Definition
|
|
Term
| When a neoplasm is not clearly benign or malignant, it is considered |
|
Definition
|
|
Term
| septic shock is considered |
|
Definition
|
|
Term
| hepatitis A was formerly known as |
|
Definition
| infectious or epidemic hepatitis |
|
|
Term
| When reporting hyptertensive chronic kidney disease, an additional code to report the type of chronic kidney disease |
|
Definition
|
|
Term
| The _______, or transmural myocardial infarction, also known as STEMI, is the most severe type of infarction. |
|
Definition
|
|
Term
| Sepsis is classified as severe sepsis when there is _____ _______ _______. |
|
Definition
| Multiple organ dysfunction (MOD). |
|
|
Term
|
Definition
| American Hospital Association |
|
|
Term
|
Definition
| American Health Information Management Association |
|
|
Term
|
Definition
Ambulatory Payment Classification
a patient classification that provides a payment system for outpatients |
|
|
Term
| Debridement techniques include: |
|
Definition
sharp and blunt dissection
curettement
scrubbing
forceful irrigation
others |
|
|
Term
| debridement of burned surface code range |
|
Definition
|
|
Term
Codes 11042-11047 are based on depth of tissue removed and surface area for wound.
How is reporting for one wound different from reporting for multiple wounds? |
|
Definition
One wound: report depth of the deepest level of the tissue removed.
Multiple wounds: sum the surface area of the wound at the same depth. Do not combine sums of different depths. |
|
|
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
The care of minor wounds, either postoperative, traumatic, or otherwise, is ___________ to other covered services. |
|
Definition
|
|
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
the only service provided is the non-surgical cleansing of the wound or ulcer with or without the application of a surgical dressing, the provider should.... |
|
Definition
| bill this service with an appropriate E/M code and not the debridement code(s). |
|
|
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
there is no necrotic, devitalized, fibrotic, or other tissue or foreign matter present, the debridement service is |
|
Definition
|
|
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
of devitalized tissue from wounds, non-selective debridement, without anesthesia, including topical application(s), is part of a |
|
Definition
| active wound care management. |
|
|
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
CPT code selected should report the level of debrided tissue, not the |
|
Definition
| extent, depth, or grade of the ulcer or wound. |
|
|
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
Select the most specific ICD-9-CM code that describes the _______________________________________ as the diagnosis on the claim |
|
Definition
| primary reason for the service, at its highest level of specificity, |
|
|
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
When the patient has required 5 or more debridement services (11043 and/or 11044), per pt, per wound, in the outpatient setting, the claim form must also include, as secondary diagnoses |
|
Definition
| ICD-(-CM codes reflecting neuropathic, vascular, metabolic, or other comorbid conditions that have resulted in in excessive frequency of service. |
|
|
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
The medical record should include an operative note for the debridement service, describing |
|
Definition
| the anatomical location treated, the instruments used, anesthesia used if required, type of tissue removed, the depth and area of the wound and the immediate post procedure care and follow-up instructions. |
|
|
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
________________ ____________ is recommended for prolonged or repetitive debridement services. |
|
Definition
| Photographic documentation |
|
|
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
Use of CPT codes 11000-11047 is not appropriate for the following services: |
|
Definition
washing bacterial or fungal debris from feet
paring or cutting of corns or calluses
incision and drainage of abscess including paronychia
trimming or debridement of nails
avulsion of nail plates
acne surgery
destruction of warts
burn debridement |
|
|
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
An E/M service may be billed on the same day as the procedure if _____________________
What modifier must be used? |
|
Definition
the E/M service represents a significant separately identifiable service.
Modifier -25 |
|
|
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
Local infiltration, metacarpal/digital block, or topical anesthesia are _________ in the reimbursement for debridement services and are not ______ ___________. |
|
Definition
included
separately payable. |
|
|
Term
| Skin Lesion excision and destruction methods: To code these procedures properly, you must know the |
|
Definition
| site, number, and size of the excised lesion (s)s, as well as whether the lesion is malignant or benign. |
|
|
Term
| The pathology report following skin lesion excision is used to identify the size of the lesion only if |
|
Definition
| no other record of the size can be documented because the solution the lesion is stored in shrinks the lesion. |
|
|
Term
| All skin lesions excised will have a ______ report |
|
Definition
|
|
Term
| Since the codes for excision of skin lesions are divided based on whether the excised lesion is ______________ or _________, the billing for the excision is not submitted to the 3rd party payer until the _______ ______ has been completed. |
|
Definition
malignant
benign
pathology report |
|
|
Term
| Why is there no pathology report for lesions that have been destroyed by laser, chemicals, electrocautery, or other methods? |
|
Definition
| Destruction of lesions destroys the lesion, leaving no available tissue for biopsy. In these cases you will have to take the type of lesion from the physician's notes only, as there is no pathology report. |
|
|
Term
| If multiple skin lesions are treated, code the ___ ___ ____ ___ first, followed by ______ using modifier _____ to indicate that multiple procedures were performed. |
|
Definition
most complex lesion procedure
others
-51 |
|
|
Term
| 3 types of closures included in the codes for lesion excision |
|
Definition
|
|
Term
| You would not report both a biopsy and an excision performed at the same time as the |
|
Definition
| biopsy is bundled into the excision service. |
|
|
Term
| When closure is required following biopsy, ______ closure is bundled into the biopsy codes. |
|
Definition
|
|
Term
| If closure of the biopsy site is more than a simple closure, you would report |
|
Definition
| the more extensive closure separately. |
|
|
Term
| On the CMS-1500 claim form, report the number of lesions treated in column |
|
Definition
|
|
Term
11100 reports a single lesion, and 11101 is an add-on code for each additional lesion.
The correct coding for 3 lesions would be |
|
Definition
11100 for lesion one and 11101X2 for lesions 2 and 3
Do not assign modifier -51 with these biopsy codes |
|
|
Term
| Do not use modifier -51 with skin tag codes, as the codes are based on the |
|
Definition
| number of lesions removed. |
|
|
Term
| If electrocautery is the main method by which the lesion was removed, you would assign codes from the |
|
Definition
Destruction, Benign or premalignant lesions category (17000-17250), not from the shaving category.
Electrosurgery used in shaving a superficial lesion burns (destroys) the lesion, so the destruction code would be reported. |
|
|
Term
Shaving of a skin lesion - Shaving codes are defined according to ___ and __ of the lesion.
If more than one lesion was removed, |
|
Definition
location, size
add modifier -51 to any codes after the first code, placing the more intensive procedure first. |
|
|
Term
| The codes in the Excision, Benign Lesions category (11400-11471) are assigned for all benign lesions, with the exception of |
|
Definition
|
|
Term
| Codes in the Excision, Malignant Lesions subheading (11600-11646) are assigned for malignant lesions that includes _____ _____and _____ ____. |
|
Definition
local anesthesia
simple closure |
|
|
Term
| Procedures included within the nails category (11719-11765) |
|
Definition
trimming of fingernails and toenails
debridement of nails
removal of nails
drainage of hematomas
biopsies of nails
repair of nails
reconstruction of the nail bed |
|
|
Term
| Do not use modifier -51 with nail removal codes, as there are 2 codes available: |
|
Definition
11730 for a single nail
11732 for each additional nail
if 3 nails removed: 11730 for first nail and 11732X2 for second and third nails. |
|
|
Term
| lesion injection codes are divided |
|
Definition
| according to the number of lesions injected (1-7 or 8+) |
|
|
Term
|
Definition
located in the introduction category
reported on the basis of square cm covered |
|
|
Term
| Codes for subcutaneous injection of filling material (11950-11954) are |
|
Definition
located in the Introduction category
are reported for services such as collagen or silicone injections
are based on amount of material injected |
|
|
Term
| Tissue expander codes (11960-11971) |
|
Definition
located in the Introduction category
not to be reported for a temporary expander used after a mastectomy. Code 19357 from reconstruction section of the Integumentary subsection |
|
|
Term
| Implantable Contraceptive capsules |
|
Definition
| found in the Introduction Category |
|
|
Term
| Subcutaneous hormone pellet implantation codes |
|
Definition
| found in the Introduction category (11980) |
|
|
Term
| A pilonidal cyst is considered complicated when it is larger than ___ cm. |
|
Definition
|
|
Term
| 3 factors to consider when reporting wound repair |
|
Definition
length of wound in cm
complexity of the repair
site of the wound repair |
|
|
Term
| wound repair is classified by |
|
Definition
the type of repair necessary to repair the wound.
three types:
simple: superficial wound repair (12001-12021) involves epidermis, dermis and subcutaneous tissue |
|
|
Term
|
Definition
superficial wound repair (12001-12021)
involves epidermis, dermis and subcutaneous tissue and requires only simple, one-layer suturing |
|
|
Term
| intermediate wound repair |
|
Definition
| requires closure of one or more layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin closure. |
|
|
Term
| you can report intermediate closure (12031-12057) |
|
Definition
| when the wound has to be extensively cleaned, even if the closure was a single-layer (simple) closure |
|
|
Term
|
Definition
| involves complicated wound closure including revision, debridement, extensive undermining, stents or retention sutures, and more than layered closure (13100-13160) |
|
|
Term
|
Definition
simple
intermediate
complex |
|
|
Term
| 3 things are considered components of wound repair and are not reported separately |
|
Definition
simple ligation: tying of small vessels
simple exploration of surrounding tissue, nerves, vessels and tendons
normal debridement |
|
|
Term
| Types of grafting procedures |
|
Definition
adjacent tissue transfers or rearrangements
skin replacement surgery and skin substitutes
flaps |
|
|
Term
| Types of adjacent tissue transfer or rearrangement (14000-14350) |
|
Definition
Z-plasty
W-plasty
V-Y plasty
rotation flaps
advancement flaps |
|
|
Term
| Adjacent tissue transfers are reported according to |
|
Definition
| size of the recipient site in square cm. |
|
|
Term
| Adjacent Tissue Transfer or Rearrangement (1400-14350) in the CPT manual is divided based on |
|
Definition
| the location of the defect and the size of the defect. |
|
|
Term
Pertaining to: Adjacent Tissue Transfer or Rearrangement (1400-14350) in the CPT manual
When skin grafting is required to cover both the primary defect and the secondary defect, the measurement s of each defect |
|
Definition
| are added together to determine the code selection for the graft. |
|
|
Term
Skin Replacement Surgery and Skin Substitutes (15002-15431).
Describe |
|
Definition
| these codes report site preparation using a variety of grafting materials and repair methods using skin or skin substitutes. |
|
|
Term
Pertaining to: Skin Replacement Surgery and Skin Substitutes (15002-15431).
The site of the defect may require surgical preparation before repair, and is reported with 15002-15005 based on |
|
Definition
| the size of the repair and site. |
|
|
Term
Pertaining to: Skin Replacement Surgery and Skin Substitutes (15002-15431).
Free skin grafts are reported by |
|
Definition
recipient site,
size of defect,
and type of repair
Size is measured in cm. |
|
|
Term
Pertaining to: Skin Replacement Surgery and Skin Substitutes (15002-15431).
Square Cm is applied to ___________
Percentage of body area is applied to _____________ |
|
Definition
adults and children over the age of 10 years
infants and children under the age of 10 years |
|
|
Term
| A split thickness skin graft is often referred to on the pt record as |
|
Definition
|
|
Term
| A full thickness skin graft is often referred to on the pt record as |
|
Definition
|
|
Term
| Epidermal autografts (15110-15116) and dermal autografts (15130-15136) are reported based on |
|
Definition
|
|
Term
| Tissue cultured epidermal autografts (15150-15157) are grafts that are |
|
Definition
| cultured from the pt's own skin cells, to reduce the chances of rejection |
|
|
Term
| Acellular dermal replacement (15170-15176) is the |
|
Definition
| use of skin replacement products based on the location and size of repair. |
|
|
Term
| Temporary allografts are reported with 15300-15321 based on |
|
Definition
| the location and size of repair |
|
|
Term
| Codes for skin graft flaps do not include _____ or ______ |
|
Definition
extensive immobilization that may be necessary, such as a large plaster cast, or
the closure of the donor site
These must be reported in addition to the flap procedure. |
|
|
Term
| How is the percentage of body area calculated in adults for reporting burns? |
|
Definition
|
|
Term
| How are burn dressing and/or debridement areas defined? |
|
Definition
Small = >5% of total body surface
Medium = whole face or whole extremity, or 5% - 10% of total body surface area
Large = more than one extremity or > 10% of total body area |
|
|
Term
| Mohs micrographic surgery requires a single physician to act in 2 integrated but separate and distinct capabilities: |
|
Definition
|
|
Term
There is no tissue remaining for pathological examination after which method has been used?
ablation
destruction
excision
Mohs |
|
Definition
|
|
Term
| What 2 items are needed to correctly code for local treatment of burns? |
|
Definition
| Percentage of body surface and depth of burn |
|
|
Term
| When an excision is being performed, the "margins" refer to the ______ ______ required to adequately excise the lesion based on the physician's judgement. |
|
Definition
|
|
Term
| Using the "Rules of Nines," one adult leg is what percentage of the human body? |
|
Definition
|
|
Term
| The removal of a lesion by transverse incision that did not require sutured closure is reported using codes from which subsection? |
|
Definition
| Shaving of Epidermal or Dermal Lesions |
|
|
Term
| The repaired wound should be measured or converted to: |
|
Definition
|
|
Term
| Incision and drainage codes are divided into subcategories according to the |
|
Definition
| condition for which the procedure is performed |
|
|
Term
| To properly code lesion excision, you must know the behavior and the narrowest margin about the lesion in addition to which of the following? |
|
Definition
|
|
Term
| Excision defined as full thickness would be through the |
|
Definition
|
|
Term
| Which of the following is a type of crosswalk to find corresponding diagnosis codes between ICD-9-CM and ICD-10-CM? |
|
Definition
|
|
Term
| The maximum number of characters in an ICD-10-CM code is |
|
Definition
|
|
Term
| T/F - Section IV of the Official Guidelines for Coding and Reporting applies to both the inpatient and outpatient settings. |
|
Definition
|
|
Term
| Z codes may be assigned as |
|
Definition
| first listed or a secondary diagnosis |
|
|
Term
| If there are separate codes for the the acute and chronic condtion, code for the _____ condition first as long as both codes are listed at the same indentation level of the Index. |
|
Definition
|
|
Term
| A ____ ____ is the residual effect after the acute phase of an illness or injury has passed. |
|
Definition
|
|
Term
| If the type of diabetes mellitus is not documented in the medical record, the default is ______ _____ diabetes mellitus. |
|
Definition
|
|
Term
| Osteoporosis is a _____ condition, meaning that all bones of the musculoskeletal system are affected. |
|
Definition
|
|
Term
| A major change took place in Medicare in ____ with the enactment of the Omnibus Budget Reconciliation Act. |
|
Definition
|
|
Term
| Who is the largest third-party payer in the nation? |
|
Definition
|
|
Term
| _________ are activities involving the transfer of health care information and _________ means the movement of electronic data between two entities and the technology that supports the transfer. |
|
Definition
|
|
Term
Which of the following models are used to deliver managed health care?
Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Individual Practice Associations (IPA)
All choices apply |
|
Definition
|
|
Term
| Fraud is an intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes knowing that the deception could result in some unauthorized benefit to himself/herself or some other person. (T/F) |
|
Definition
|
|
Term
Medicare Part B services are billed using:
RBRVS, GPCI, and RVUs.
ICD-9-CM, CPT, and HCPCS.
MS-DRGs.
APCs. |
|
Definition
|
|
Term
|
Definition
|
|
Term
If a surgeon performs more than one procedure on the same patient on the same day, and discounts were made on all subsequent procedures, Medicare would pay what percentages for the first, second, third, fourth, and fifth procedures?
100%, 100%, 100%, 100%, 100%
100%, 50%, 50%, 50%, 25%
100%, 50%, 50%, 25%, 25%
100%, 50%, 50%, 50%, 50% |
|
Definition
|
|
Term
| What edition of the Federal Register would outpatient facilities be especially interested in? |
|
| |
|
|
|
Definition
|
|
Term
| The Medicare program was established in |
|
Definition
|
|
Term
|
Definition
| International Classification of Diseases, 9th Revision, Clinical Modification |
|
|
Term
| The Table of Drugs nd Chemicals is located in |
|
Definition
|
|
Term
|
Definition
|
|
Term
| What volume of the ICD-9-CM is used by hospitals to report inpatient procedures? |
|
Definition
|
|
Term
|
Volume 3 contains _______
surgical codes and the remaining are
_______ diagnostic codes.
|
|
|
Definition
|
|
Term
| Words contained within the brackets “[ ]” provide the coder with: |
|
Definition
synonyms,
alternative wording
or
explanatory phrases |
|
|
Term
| Symbols, abbreviations, punctuation, and notations in ICD-9-CM are termed: |
|
Definition
|
|
Term
| ICD-9-CM contains ____ active appendices in the Tabular List of Volume 1. |
|
Definition
|
|
Term
The three volumes of ICD-9-CM are:
|
|
|
Definition
| Volume 1-Diseases: Tabular List, Volume 2-Diseases: Alphabetic Index, Volume 3-Procedures: Tabular List and Alphabetic Index. |
|
|
Term
If a patient presents for a routine outpatient prenatal visit
with no complications, codes V22.0 or V22.1 should be
used as the principal diagnosis. |
|
Definition
|
|
Term
| V codes can be assigned as first-listed or secondary diagnoses. |
|
Definition
|
|
Term
| If a patient is admitted for observation for a medical condition, a code is assigned for the medical condition as the first-listed diagnosis |
|
Definition
|
|
Term
| The same coding guidelines apply to both the inpatient and outpatient settings |
|
Definition
|
|
Term
| In the outpatient setting, the term first-listed diagnosis is used in lieu of principal diagnosis. |
|
Definition
|
|
Term
| If the pre- and postoperative diagnoses are different, the preoperative diagnosis should be coded. |
|
Definition
|
|
Term
| In the outpatient setting, a diagnosis that is documented as “rule out” should be coded as if it exists. |
|
Definition
|
|
Term
| The first-listed diagnosis is the diagnosis that the physician lists first. |
|
Definition
|
|
Term
| In the outpatient setting the term “first-listed diagnosis” is used instead of “principal diagnosis.” |
|
Definition
|
|
Term
| It is acceptable to use codes that describe signs or symptoms when a definitive diagnosis has not been established by the provider. |
|
Definition
|
|
Term
| It is acceptable to assign codes directly from the Alphabetic Index of the ICD-9-CM |
|
Definition
|
|
Term
| It is important to follow any cross-reference instructions, such as see also. |
|
Definition
|
|
Term
| The routinely associated signs and symptoms should not be coded in addition to a code for the particular disease or condition. |
|
Definition
|
|
Term
| Multiple coding should not be used when there is a combination code that identifies all the elements documented in the diagnosis |
|
Definition
|
|
Term
| If there are separate codes for both the acute and chronic forms of a condition, the code for the chronic condition is sequenced first |
|
Definition
|
|
Term
| Terms that may be used to describe a threatened condition include: |
|
Definition
| threatening and impending |
|
|
Term
A combination code is a single code used to classify
|
|
Definition
- 2 diseases
- a dx with an associated secondary process (manifestation)
- a dx with an associated complication
|
|
|
Term
| A late effect is the residual condition that is still present 2 months after the acute illness or injury |
|
Definition
|
|
Term
| Status asthmaticus is a term used for a very severe type of asthmatic attack. |
|
Definition
|
|
Term
ICD-9-CM presumes a cause-and-effect relationship between hypertension and heart disease.
T/F |
|
Definition
|
|
Term
HIV infection can be reported if documented as “suspected” or “possible.”
T/F |
|
Definition
|
|
Term
HIV infection can be reported if documented as “suspected” or “possible.”
T/F |
|
Definition
|
|
Term
Assignment of diabetes codes are not affected by whether the patient is on insulin
T/F |
|
Definition
|
|
Term
If a physician documents that the patient’s diabetes is poorly controlled, a fifth digit for “out of control” should be assigned
T/F
|
|
Definition
|
|
Term
A fifth digit of 3 (in remission) should be assigned to 305.0X for someone who has abused alcohol in the past but no longer drinks alcohol
T/F |
|
Definition
|
|
Term
The site to which a malignant neoplasm has spread is the primary site
T/F |
|
Definition
|
|
