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CPC Practice Exam Questions and Answers 2023
When a patient has a blood test for HIV that is inconclusive, what ICD-10-CM code is assigned a. Z21 b. R75 c. B20 d. Z11.4 b. R75 What does ... [Show More] MRSA stand for a. Methicillin Resistant Staphylococcus Aureus b. Methicillin Resistant Streptococcus Aureus c. Moderate Resistance Susceptible Aureus d. Mild Resistance Steptococcus Aureus a. Methicillin Resistant Staphylococcus Aureus What does the forth character in diabetes mellitus diabetes codes indicate? a. The condition as controlled or uncontrolled b. Any complication associated with diabetes c. Type of diabetes (type 1, or Type 2, secondary) d. If the diabetes is primary or secondary diabetes b. Any complication associated with diabetes When do you code acute respiratory failure as a secondary diagnosis a. the patient has any other condition at the same time b. When it is determined to be the cause of the shortness of breath c. Acute respiratory failure is always listed first d. When it occurs after admission d. When it occurs after admission When the type of diabetes mellitus is not documented in the medical note, what is used as the default type a. Type 2 b. Type 1 c. Can be type 1 or 2 d. Scondary diabetes a. Type 2 When is it appropriate to use history of malignancy, from category Z85 a. once the malignancy is removed form that site but the patient is still receiving chemotherapy b. When the patient cancels treatment for that site c. It has been excised, no evidence of any existing primary malignancy, and there is not further treatment directed to the site d. when 5 years has passed after surgery c. It has been excised, no evidence of any existing primary malignancy, and there is not further treatment directed to the site If a patient uses insulin, what type of diabetic does it mean the patient is a. secondary diabetes b. type 2 c. type 1 d. the use of insulin does not specify the patient is a certain type of diabetic d. the use of insulin does not specify the patient is a certain type of diabetic Pneumonia due to adenovirus. What ICD-1-CM code is reported a. B34.0 b. J12.0 c. B97.0 d. B30.1 b. J12.0 a 50 year old patient has been diagnosed with elevated blood pressure. The patient does not have a history of hypertension. The correct ICD-10-CM code to report is a. R03.0 b. I10 c. I13.0 d. I15.0 b. I10 What type of fracture is considered traumatic a. pathologic fracture b. spontaneous fracture c. stress fracture d. compound fracture d. compound frature Can Z codes be listed as a primary code? a. No; Z codes are never listed as primary codes b. No; Z codes are always reported as secondary codes c. No; Z codes are reported for external injuries and where it happened which is always listed as secondary d. Yes; Z codes can be sequenced as primary and secondary codes d. Yes; Z codes can be sequenced as primary and secondary codes Where can you find the Table of Drugs and Chemicals a. Tabular List of the ICD-10-CM codebook b. Alphabetic Index of the ICD-10-CM codebook c. Index to Procedures of the b. Alphabetic Index of the ICD-10-CM codebook d. CPT codebook b. Alphabetic Index of the ICD-10-CM codebook In which circumstances would an external cause code be reported a. Delivery of a newborn b. Causes of injury or health condition c. Chemotherapy treatment of neoplasms d. Only for the cause of motor vehicle accidents b. Causes of injury or health condition What would be considered an adverse effect a. Wound infection after surgery b. hemorrhaging after a vaginal delivery c. shortness of breath when running d. rash developing when taking penicillin d. rash developing when taking penicillin What does the root work colp/o stand for a. cervix b. vagina c. uterus d. Fallopian tubes b. vagina What does the abbreviation CKD stand for a. Chronic Kidney Dysfunction b. Congenital Kidney Disorder c. Chronic Kidney Disease c. Chronic Kidney Disease Which statement is TRUE for reporting burn codes a. burn codes are coded by the anatomical site and sequenced form top to bottom of the anatomical body b. first degree burns involve the epidermis and dermis and should always be sequenced first for multiple degrees of burns. c. Sunburns are classified with traumatic burns and should be the only burn code reported d. the highest degree of burn is reported as the primary code d. the highest degree of burn is reported as the primary code What chapter contains codes for diseases and disorders of the nails a. Chapter 13: Diseases of Musculoskeletal and Connective Tissue b. Chapter 16: Certain Conditions Originating in the Perinatal c. Chapter 14: Diseases of the Genitourinary System d. Chapter 12: Diseases of the Skin and Subcutaneous Tissue d. Chapter 12: Diseases of the Skin and Subcutaneous Tissue What does the 7th character A indicate in Chapter 19 a. Initial encounter b. Subsequent encounter c. Sequela d. Adverse effect a. Initial encounter The provider documents CKD stage 5 and ESRD. What ICD-10-CM code(s) is/are reported a. N18.4 b. N18.6, N18.4 c. N18.4, N18.6 d. N18.6 d. N18.6 What is the definition of a postpartum complication? a. any complication occurring within the six-week period prior to delivery b. b. Any complication occurring within the six-week period after delivery b. Any complication occurring within the six-week period after delivery What is NOT an example of active treatment for pathological fractures a. Surgical treatment b. Emergency department encounter c. Evaluation and treatment by a new physician d. Cast change d. Cast change According to ICD-10-CM Official Guidelines for Coding and Reporting, Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A) codes have sequencing priority over what codes a. Codes from all other chapters b. All codes including Z33.1 a. Codes from all other chapters Many coding professionals go on to find work as a. Accountants b. Consultants b. Consultants A medical record contains information on all but what areas a. Observations b. Medical or surgical interventions c. Treatment outcomes d. Financial records d. Financial records Technicians who specialize in coding are called a. coding specialists b. LPN's a. coding specialists What type of provider goes through approximately 26 1/2 months of education and is licensed to practice medicine with the oversight of a physician Physician Assistant (PA) The Medicare program is made up of several parts. Which part is most significant to coders working in physician offices and covers physician fees without the use of a private insurer? Part B The Medicare program is made up of several parts. Which part is affected by the Centers for Medicare and Medicaid -Hierarchical Condition Categories (CMS-HCC) Part C What does CMS-HCC stand for a. Centers for Medicare and Medicaid Services - Hierarchial Condition Category b. Centers for Medicare and Medicaid Services - Hospital Correct Coding Initiative a. Centers for Medicare and Medicaid Services - Hierarchial Condition Category When coding an operative report, what action would NOT be recommended a. Starting with the procedure listed b. Reading the body of the report c. Coding form the header without reading the body of the report. d. Highlighting unfamiliar words c. Coding form the header without reading the body of the report. Outpatient coders focus on learning which coding manuals CPT, HCPCS Level II, ICD-10-CM If an NCD doesn't exist for a particular service/procedure performed ona Medicare patient, who determines coverage MAC (Medicare Administrative Contractor) The ___ describes whether specific medical items, services, treatment procedures, or technologies are considered medically necessary under Medicare. a. NCD b. Medicare Physician Fee Schedule c. MS-DRG d. Internet Only Manual NCD (National Coverage Determinations Manual) NCD serve what purpose a. to provide payment options to physicians b. To spell out CMS policies on when Medicare will pay for items or services. b. To spell out CMS policies on when Medicare will pay for items or services. MAC stands for Medicare Administrative Contractor Local Coverage Determinations (LCD) are administered by Each regional MAC LCD only have jurisdiction in their ____ area regional ABN stands for Advance Beneficiary Notice When are providers responsible for obtaining an ABN for a service not considered medically necessary a. Prior to providing a service or item to a beneficiary b. After providing a service or item to a beneficiary a. Prior to providing a service or item to a beneficiary A covered entity does NOT include a. Healthcare provider b. Patient c. Clearinghouse d. Health plan b. Patient What is the definition of coding a. deciphering explanation EOB provided by an insurance carrier b. translating documentation into numerical/alphanumerical codes used to obtain reimbursement b. translating documentation into numerical/alphanumerical codes used to obtain reimbursement Who is responsible for enforcing the HIPAA security rule OCR (Office of Civil Rights) Healthcare providers are responsible for developing ___ and policies and procedures regarding privacy in their practices a. Fees b. Notice of Privacy Practices Notice of Privacy Practices A covered entity may obtain consent of the individual to use or disclose PHI to carry out all but what of the following a. healthcare operations b. for public use for public use [Show Less]
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CPC Practice Exam - 150 Questions and Answers 2023
Surgical removal The suffix -ectomy means Magnetic Resonance Imaging MRI stands for The removal of the fallopian tubes and ovaries The ter... [Show More] m "Salpingo-Oophorectomy" refers to Freezing Cryopreservation is a means of preserving something through Paracentesis Which of the following describes the removal of fluid from a body cavity Gastrotomy If a surgeon cuts into a patient's stomach he has performed a Muscle In the medical term myopathy the term pathy means disease. What is diseased? Measles, Mumps, Rubella, and Varicella The acronym MMRV stands for Outer bone located in the forearm The Radius is the Hemic and Lymphatic The spleen belongs to what organ system? The distal portion The portion of the femur bone that helps makes up the knee cap is considered what? Middle The Midsagittal plane refers to what portion of the body? Cecum Which of the following is not part of the small intestine? Teres One of the six major scapulohumeral muscles Where to esophagus joins the stomach The cardia fundus is Amputation, arm through humerus; secondary closure or scar revision The full description of CPT code 24925 is: The condition of the patient justifies the service provided Medical necessity means what? 45392 Which of the following codes allows the use of modifier 51? It helps cover outpatient charges Which of the following statements is not true regarding Medicare Part A External cause codes are only used in the initial encounter. Which of the following statements is false? Exploration, including enlargement, debridement, removal of foreign body(ies), minor vessel ligation, and repair Wound exploration codes include the following service (s) : I12.9, N18.3 What is the correct ICD-10-CM code(s) for malignant hypertension with stage III kidney disease? S51.822A, W07.XXXA, W25.XXXA, Y93.E9, Y92.030 Lucy was standing on a chair in her apartment's kitchen trying to change a light bulb when she slipped and fell. She struck the glass top stove, which shattered. She presents to the ER with a simple laceration to her left forearm that has embedded glass particles. Which is the correct code(s)? T20.30XA, T24.319A, T22.299A, T31.42, X03.0XXA Jim was at a bonfire when he tripped and fell into the flames and sustained multiple burns. He came to the emergency room via an ambulance and was treated for second and third degree burns on his face, second degree burns on his upper arms and forearms, and third degree burns on the fronts of his thighs Which is the correct code(s)? O63.0, O09.513, Z37.0 . A 35 year old woman who is pregnant in her 38th week with her first child is admitted to the hospital. She experiences a prolonged labor during the first stage and eventually births a healthy baby boy. Which is the correct code(s)? S62.632A, Y93.64, W51.XXXA, Y92.320 Henry was playing baseball at the town's sports field and slid for home base where he collided with another player. He presents to the emergency department complaining of pain in the distal portion of his right middle finger. It is swollen and deformed. The physician orders an x-ray and diagnoses Henry with a displaced tuft fracture. He splints the finger, provides narcotics for pain, and instructs Henry to follow-up with his orthopedist in two weeks. Which is the correct code(s)? F15.20, F10.20, F41.1, F43.10 A 60 year old male is admitted for detoxification and rehabilitation. He has continuously abused amphetamines to the point that he cannot voluntarily stop on his own and has become dependent upon them. He also has a long documented history of alcohol abuse and alcoholism. He experiences high levels of anxiety due to PTSD, which causes him to use and abuse substances. Which is the correct code(s)? E11.319 A patient with uncontrolled type II diabetes is experiencing blurred vision and an increase in floaters appearing in her vision. She is diagnosed with diabetic retinopathy. Which is the correct code(s)? Z21 A patient who is known to be HIV positive but who has no documented symptoms would be assigned code L55.1 A patient fell asleep on the beach and comes in with blistering on her back. She is diagnosed with second degree solar radiation burns. Which is the correct code(s)? True Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes, unless otherwise instructed by classification. A6252, A6219 A patient has a home health aide come to his home to clean and dress a burn on his lower leg. The aide uses a special absorptive, sterile dressing to cover a 20 sq. cm. area. She also covers a 15sq. cm. area with a self-adhesive sterile gauze pad. Q4010 A 12 year old arrives in his pediatrician's office after colliding with another player during a soccer game. He is complaining of pain in his right wrist. The physician orders an x-ray and diagnoses him with a hairline fracture of the distal radius. He has a short arm fiberglass cast applied and discharges him with follow up instructions. J9070 A patient with Hodgkin's disease takes Neosar as part of his chemotherapy regiment. He receives 100 mg once a week through intravenous infusion. Which is the correct code(s)? A5500-A5513 A patient with diabetes is fitted for custom molded shoes. What is the code range for such a fitting? Which is the correct code(s)? E1222 A 300lb. paraplegic needs a special sized wheelchair with fixed arm rests and elevating leg rests. Which is the correct code(s)? 99211 A patient comes into her doctor's office for her weekly blood sugar check. Her blood is drawn by the LPN on staff, the visit takes about 5 minutes total. Which is the correct code(s)? 99234 A three year old child is brought into the ER after swallowing a penny. A detailed history and exam are taken on the child and medical decision making is of moderate complexity. The child is admitted to observation for three hours and is then discharged home. Which is the correct code(s)? 99471; J80; J18.9 A 20 month old child is admitted to the hospital with pneumonia and acute respiratory distress. The physician spends 3 minutes intubating the child and spends 90 minutes of Critical Care time stabilizing the patient. Which is the correct code(s)? 99360;99465; 99460 At the request of a physician who is delivering for a high risk pregnancy, Dr. Smith, a pediatrician, is present in the delivery room to assist the infant if needed. After thirty minutes the infant is born, but is not breathing. The delivering physician hands the infant to Dr. Smith who provides chest compressions and resuscitates the infant. The pediatrician then performs the initial evaluation and management and admits the healthy newborn to the nursery. What codes should Dr. Smith submit on a claim? 99397, 99215 Mr. Johnson is a 79 year old established male patient that is seen by Dr. Anderson for his annual physical exam. During the examination Dr. Anderson notices a suspicious mole on Mr. Johnson's back. The Doctor completes the annual exam and documents a detailed history and exam and the time discussing the patient's need to quit smoking. Dr. Anderson then turns his attention to the mole and does a complete work up. He documents a comprehensive history and examination and medical decision making of moderate complexity. He also called a local dermatologist and made an appointment for Mr. Johnson to see him the next day for an evaluation and biopsy. Which is the correct code(s)? History, Exam, Medical Decision Making, Counseling, Coordination of Care, and Nature of Presenting Problem An E/M is made up of seven components six of which are used in defining the levels of E/M services. The seven components include History, Exam, Medical Decision Making, Counseling, Coordination of Care, Nature of Presenting Problem, and Time. Which six of these seven parts help define the level of the E/M service? The upper central region of the abdomen When a patient complains.of epigastric pain. Where is the pain located? 99382-25, 90471, 90710 A 2 year-old comes in for an initial WCE, Morn doesn't have the child's immunization record. She states the child's last shot was when he was 5 months old. Medical review and documentation of a new patient supports one element of HPI, five-elements of the ROS, and a complete PFSH. The examination was 8+ organ systems. The physician orders the immunizations to be given in the office today. Immunizations given subcutaneously: MMRV. What CPT codes are reported? Musculoskeletal Which system is given credit in the exam component when the provider documents "range of motion, strength, and stability" are adequate in both legs?" 99285 A 25 year-old male is brought in by the EMS to the ER for nausea and vomiting. The patient has elevated blood sugars per EMS. EMS and the physician are unable to get a history due to patient's altered mental status. The ED physician performed a comprehensive eight organ system exam and a high level MDM. Patient was transferred to ICU in stable condition. Total critical care time 25 minutes. What CPT code is reported? 00832 The correct anesthesia code for a ventral hernia repair on a 13 month old child is 01829 A patient is placed under anesthesia to have an exploratory surgery done on her wrist. The surgeon utilizes a small fiber optic scope and investigates the radius, ulna, and surrounding wrist bones. What should the anesthesiologist code for? When the anesthesiologist begins preparing the patient for the induction of anesthesia When does anesthesia time begin? [Show Less]
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CPC 2023 Exam Study Guide Questions and Answers 100% correct
Documentation (content) Proper code assignment is determined both by _____________ in the medical record and by the unique rules that govern each code set... [Show More] in that instance An auditor The role a coder may take on to verify that the documentation supports the codes the physician has selected Query the physician If the medical record is inaccurate or incomplete, it will not translate properly to the language of codes. What can a coder do in order for the medical record to be complete and accurate so they can bill properly? Quarterly (usually) How often are codes and insurance payment policies updated? NPP Non-Physician Provider (also known as mid-level providers or physician extenders) PA Physician assistant NP Nurse practitioner Commercial and Government The two types of primary insurances Commercial Carriers Private payers that may offer both group and individual plans Medicare The most significant government insurer; a federal health insurance program People over 65, blind or disabled individuals, and people with permanent kidney failure or end-stage renal disease Medicare provides coverage for what kind of people? ESRD end-stage renal disease Medicare Part A Helps cover inpatient hospital care, as well as care provided in skilled nursing facilities, hospice care, and home healthcare, Medicare Part B Covers medically necessary physicians' services, outpatient care, and other medical services (including some preventive services) not covered under Medicare Part A. It can be an optional benefit. Medicare Part C Also called Medicare Advantage, combines the benefits of Medicare Part A, Part B, and-sometimes- Part D. The plans are managed by private insurers approved by Medicare. Medicare Part D A prescription drug program available to all Medicare beneficiaries. Medicaid A health insurance assistance program for some low-income people (especially children and pregnant women) sponsored by federal and state governments. RBRVS Resource-Based Relative Value Scale Resource-Based Relative Value Scale (RBRVS) Medicare payments for physician services are standardized using _____ and are divided into three components. The physician work component, practice expense, and professional liability insurance (PLI) The three components used to determine resource cost for physician services. The Physician Work component Accounts for just over half (52 percent) of a procedure's/service's total relative value and is measured by time it takes to perform a service, technical skill, and physical effort. Practice Expense Accounts for 44 percent of the total relative value for each service and differ by site of service. For example, the expense of providing services in the hospital vs a physician's office. PLI Resource-Based Professional Liability Insurance Professional Liability Insurance (PLI) Accounts for 4 percent of the total relative value for each service CMS website Where can you find Physician Fee Schedule (PFS) information? PFS Physician Fee Schedule Medical Necessity Refers to whether a procedure or service is considered appropriate in a given circumstance NCD National Coverage Determinations National Coverage Determinations (NCD) Explains when Medicare will pay for items or services MAC Medicare Administrative Contractor Medicare Administrative Contractor (MAC) Responsible for interpreting national policies into reginal polices. Local Coverage Determinations (LCD) Regional policies converted from national polices by a Medicare Administrative Contractor (MAC). ABN Advance Beneficiary Notice Advanced Beneficiary Notice (ABN) A standardized form that explains to the patient why Medicare may deny the service or procedure HIPAA The Health Insurance Portability and Accountability Act Health Insurance Portability and Accountability Act (HIPAA) Provides federal protections for protected health information when held by covered entities HIPAA covered entities A healthcare provider, a health plan, and a healthcare clearinghouse PHI Protected Health Information Minimum Necessary requirement A key provision of HIPPA, under which only the _______ protected health information (PHI) should be shared to satisfy a particular purpose. HITECH Health Information Technology for Economic and Clinical Health Act Health Information Technology for Economic and Clinical Health Act (HITECH) Allows patients to request an audit trail showing all disclosures of their health information made through an electronic record. Health Information Technology for Economic and Clinical Health Act (HITECH) Requires that an individual be notified if there is an unauthorized disclosure or use of his or her health information. OIG Office of Inspector General Fraud To purposely bill for services that were never given or to bill for a service that has a high reimbursement than the services provided; The person does not have to possess knowledge of the violation for it to still be a considered offense. Abuse Consists of payment for items or services that are billed by providers in error that should not be paid for by Medicare. Compliance Plan A written set of instructions outlining the process for coding and submitting accurate claims, and what to do if mistakes are found. CPT Certified Procedural Terminology ICD-10-CM International Classification of Disease, 10th Revision Clinical Modification MP Malpractice OCR Office for Civil Right RVU Relative Value Unit Part D What part of Medicare should be billed for the pain medication by a pharmacy? Translating medical documentation into codes What is medical coding? Workers' Compensation Not a covered entity of HIPAA Blue Cross/Blue Shield A commercial payer When a service is not expected to be covered by Medicare When should an ABN be signed? $100 or 25% of cost The amount on an ABN should be within how much of the cost to the patient? Clearinghouse An entity that processes nonstandard health information they receive from another entity into a standard format Fraud Intentional billing of services not provided is considered _____ OIG Work Plan What OIG document should a provider review for potential problem areas that will receive special scrutiny in the upcoming year? The word root The base of a medical term and can stand alone as the main portion of a medical term. Combining vowels Attachments to a root word to link another root word or suffix and is always placed between two root words, even when the second root word begins with a vowel O and I The most common combining vowels A Prefix Typically attached to the beginning of a word to modify or alter its meaning; Indicates location, time, or number A Suffix Attached to the end of a word to modify or alter its meaning; Indicates procedure, condition, disorder, or disease Anterior (ventral) Toward the front of the body Posterior (dorsal) Toward the back of the body Medial Toward the midline of the body Lateral Toward the side of the body Proximal Nearer to the point of attachment or to a given reference point Distal Farther from the point of attachment of from a given reference point Superior (cranial) Above; toward the head Inferior (caudal) Below; toward the lower end of the spine Superficial (external) Closer to the surface of the body Deep (internal) Closer to the center of the body Sagittal Cuts through the midline of the body from front to back, dividing the body into the right and left sections Frontal (coronal) Cuts at a right angle to the midline, from side to side, dividing the body into front (anterior) and back (posterior) sections Transverse (horizontal)(axial) Cuts horizontally through the body, separating the body into upper (superior) and lower (inferior) sections The cell Basic unit of all living things Tissue A group of similar cells performing a specific task [Show Less]
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CPC Exam Questions and Answers 2023
Abstractor hospital employee who converts documented procedurs and diangoses into medical codes Abuse coding practices that lead to improper reimb... [Show More] ursement by error because they do not meet medical necessity, ex. changing diagnosis to be covered by insurance Accreditation an examination process the healthcare facility goes through to evaluate the facilities policies, procedures, and performance to meet higher standards. Accredited Having seal of approval after being evaluated and demonstrating quality standards Act/ Law/ Statute Legislation passed through Congress and signed by President or passed over his veto Actual Charge The amount the provider charges for medical services or supplies. Not always paid in full. Additional Benefits Health care services not covered by Medicare and are offered through the Medicare Advantage Organization for no additional premium. The benefits must equal the ACR (Adjusted Community Rating) Adjudication Health Insurance Claims process at the insurance company Adjusted Average Per Capita Cost (AAPCC) Estimate of how much Medicare will spend in a year for an average beneficiary Administrative Code Sets Non medical code sets that characterize a general business situation rather than a medical condition. Administrative Costs Medicare, Medicaid, CMS refer to this as their expenses to have the program, operating expenses, program management, etc. Administrative Data Health insurance information stored in automated information system about enrollment, eligibility, claims, etc. Administrative Law Judge (ALJ) hearing officer who presides over appeal conflicts between providers or beneficiaries, and Medicare contractors (MAC's) Administrative Simplification Part of HIPAA authorizing HHS (Health and Human Services) to 1. adopt standards for transactions & code sets; 2. adopt standard identifiers for health plans; 3. adopt standards to protect security & privacy of personally identifiable health information. Administrative Simplification Act Signed 12/17/01 allows HHS (Health & Human Services) to exclude providers from Medicare for HIPAA non-compliance of electronic claims and prohibit paper claims except in certain situations Admission Date The date the patient was admitted for inpatient care, outpatient, or start of care.For hospice, enter effective date of election of hospice benefits. Admitting Diagnosis Diagnosis code indicating patient's diagnosis at admission Admitting Physician The doctor responsible for admitting a patient to the hospital or other inpatient health facility Advance Beneficiary Notification (ABN) A notice from provider to patient that Medicare may deny payment. Patient must sign before services are provider, otherwise patient is not responsible if Medicare does not cover. Advanced Directive Statement written by patient on how they want medical decisions to be made. May include a Living Will or Durable Power of Attorney for healthcare. Allowed Charge Individual charge determination by carrier for a covered service or supply. Ambulatory Care All types of health services that do not require an overnight stay. Ambulatory Care Sensitive Conditions (ACSC) Medical condtions that if treated immediatly and managed properly should not require hospitalization. Ambulatory Payment Classification (APC) Medicare's outpatient prospective payment system in which services are grouped based on the resources needed and payment is fixed within each group Ambulatory Surgery Center (ASC) Outpatient surgery center not located in the hospital. Patient's may stay a few hours up to 1 night. American Hospital Association (AHA) Represents concerns of instituitional providers. They host the National Uniform Billing Committee (NUBC) which consults under HIPAA American Medical Association (AMA) Professional organization maintains CPT code sets, secretariat to National Uniform Claim Committee (NUCC) which consults under HIPAA. ASC payment group rate. ASHIM American Society of Health Informatics Managers, Inc. is a non-profit group of computer professionals that specialize in health information technology (HIT). They are certified through Certified Health Informatics System Professionals (CHISP) Ancillary Services Professional services by a hospital or inpatient facility. Xrays, drugs, labs, etc. Appeal Complaint by hospital or patient about a health care payment Approved Amount The fee Medicare sets as reasonable and pays to the provider. Assigned Claim Claim submittted by a provider who accepts Medicare Assignment Agreeing to acccept Medicare fees as payment in full Attending Physician Licensed physician who certifies the patient services via medical necessity and is primarily responsible for the patient's medical care and treatment. Automated Claim Review Claim review and etermination via system edits and don't require human intervention Basic Benefit Includes Medicare covered benefits (except hospice) and additional benefits Beneficiary The name of a person who has health care insurance through the insurance program Benefit Payment Amount paid by insurance after the deductible and coinsurance have been deducted Benefit Period Episode of care within hospitals & skilled nursing facilities (SNF). Begins on admission and ends 60 days after care has ended Benefits The money or services provided through an insurance policy Board Certified Doctor specializing in certain area of medicine and who passes an advanced exam. Primary care and specialists can both be board certified Business Associate Someone performs a function on behalf of a covered entity but is not part of the covered entity's workforce, outside business manager. Capitation Specified amount of money is paid to a health plan or doctor regardless of the services rendered in that period. One lump sum. Care Plan Written plan of services patient will receive to ensure the patient's best care physically, mentally & socially Caregiver Someone who cares for a patient who is ill, disabled, or aged. Can be relatives, friends or someone who is paid. Case Management Physician, nurse, or other person tracks use of facilities and resources of a patient to be sure they are receiving the care they need. Case Mix Distribution of patients into categories reflecting severity of illness or resource uses. Case Mix Index The average Diagnostic Related Groups (DRG) relative weight for all Medicare admissions Catastrophic Illness Serious and costly health problem that could be life-threatening or cause disability. Costs can cause patient financial hardship. Catastrophic Limit The highest amount a beneficiary is required to pay out of pocket during a certain period of time for certain covered charges. Center for Disease Control and Prevention (CDC) Organization that protects public health through monitoring disease trends, investigation outbreaks, implementing illness, and injury control. Center for Medicare & Medicaid Services (CMS) The Heath & Human Services (HHS) agency responsible for Medicare & parts of Medicaid. Maintains UB-04, oversight of HIPAA and maintains HCPCS code set & Medicare remittance advice (RA) remark codes. They promote higher quality care Certification the hospital passed a survey done by a state government agency. Medicare only covers hospital stays in hospitals that are certified or accredited. Civilian Health and Medical Program (CHAMPUS) Run by department of defense. Used to give medical care to active duty but now this is called TRICARE Charge Description Master (CDM) Electronic billing table where charge amounts are kept in a centralized place. Claim Request for payment for services or benefits received. Claims are called bills through Medicare Part A Claim Adjustment Reason Codes Identifies the reason for any difference in charge and payment. This code set is used in the X12 835 Claim Payment & Remittance Advice and the X12 837 Claim transactions and is maintained by Health Care Code Maintenance Committee Claim Status Code Identifies the status of a claim. This code set is used in the X12N 277 Claim Status Inquiry and Response transactions and is mainted by the Health Care Code Maintenance Committee CMS Agent State survey agency who participates in Medicare surveys and certification process. ex. private physician consulting with the State Agency (SA) or CMS regional office. UB-04 Claim form used by hospitals and facilities for billing procedures and services. CMS1500 Claim form used for billing physiicans and other services, ex physical therapy. Code of Federal Regulations Official compiliation of federal rules and requirements Code Set Set of codes used to encode data elements terms, codes, concepts, required under HIPAA Coinsurance Percentage of medical bill the beneficiary is responsible for paying. Community Mental Health Services Facility provides outpatient services for children, elderly, chronically ill, & residents discharged from inpatient treatment at a mental health facility. 24 hour day emergency care, partial hospitalization or psychosocial rehab, & screening for admission to inpatient facility. Comprehensive Inpatient Rehabilitation Facility Inpatient rehabilitation to patient's with physical disabilities. Comprehensive Outpatient Rehabilitation Facility (CORF) Outpatient rehabilitation Conditional Payment A payment made by Medicare in which another payer is responsible. Ex,, Auto is in litigation, if they pay, then Medicare will be reimbursed Consolidated Omnibus Budget Recondiliation Act (COBRA) A law that helps keep people covered by employer groups after coverage ended due to death of a spouse, losing a job, reduced hours, leaving voluntarily, or getting a divorce. The beneficiary may have to pay the premium however there is no administrative fee. Coordination of Benefits The process of determining which policy is first when a patient has 2 health care plans. [Show Less]
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CPC Exam 2022| 2023 Questions and Answers
medicare part A The part of the Medicare program that pays for hospitalization, care in a skilled nursing facility, home health care, and hospice care. ... [Show More] Medicare Part B the part of medicare that helps cover madically necessary physician services outpatient care and other medical services full services not covered under medicare part a part B is an optional benefit for which the patient must pay a premium in which generally requires a yearly deductible and co insurance Medicare Part C (Medicare Advantage) combines benefits of part A and B, sometimes D. Medicare—Part D Prescription drug coverage medical coding The process of translating this written or dictated medical record into a series of numeric and alpha numeric codes 2 primary types of insurers commercial insurance plans and government insurance plans Medicare provides coverage for people over the age of 65, bling or disabled individuals, and people with permanent kidney failure or end stage renal disease (ESRD) Medicaid a health insurance assistance program for low income people Advanced Beneficiary Notice (ABN) Document that informs covered patients that Medicare may not cover a certain service and the patient will be responsible for the bill required before billing the patient if coverage is denied HITECH Health Information Technology for Economic and Clinical Health Act - allows patients to request an audit trail of their disclosures of their health info made through the electronic health record - requires that an individual be notified if their is an unauthorized disclosure of their health info compliance plan A written set of instructions outlining the process for coding and submitting accurate claims, and what to do if mistakes are found. The AAPC was founded in what year? 1988 can a word have more than one root? yes blephar/o eyelid bucc/o cheek cholecyst/o gallbladder colp/o vagina cyst/o A fluid sac or pouch, urinary bladder derm/o skin encephal/o brain enter/o intestine hem/o, hemat/o blood my/o muscle myel/o spinal cord, bone marrow onych/o nail oste/o bone phleb/o vein pulm/o, pulmon/o lungs synov/i synovial fluid, joint, or membrane ab- away from ad- toward, near ante- before ec-, ecto- out, outside end/o in, within mon/o one poly- many, much post- after, behind -centesis puncture, tap -desis binding, fusion -ectomy excision, surgical removal -graphy act of recording data -pexy surgical fixation -plasty surgical repair, plastic surgery, reconstruction -tripsy crushing Anterior (ventral) toward the front of the body Posterior (dorsal) toward the back of the body Medial Toward the midline of the body Lateral toward the side of the body Proximal nearer to the point of attachment or to a given reference point Superior (cranial) above; toward the head Inferior (caudal) below; toward the lower end of the spine Superficial (external) closer to the surface of the body deep (internal) closer to the center of the body sagittal plane cuts body into left and right side frontal (coronal) plane vertical plane dividing the body or structure into front (anterior) and back (posterior) portions transverse plane (horizontal) (axial) cuts horizontally through the body and separates the body into upper (superior) and lower (inferior) sections Basic unit of all living things cell (4) connective tissue groups: adipose tissue, cartilage, bone, blood what does muscle tissue do? causes movement What are organs? two or more kinds of tissue together performing special body functions What are systems? a group of organs working together to perform a complex body function what is the cranial cavity? space in the skull or cranium that contains the brain what is the spinal (vertebral) cavity? space inside the spinal column containing the spinal cord what is the thoracic cavity? Space containing the heart, lungs, esophagus, trachea, bronchi, and thymus. what is the abdominal cavity? The space containing the lowest portion of the esophagus, the stomach, intestines (excluding the sigmoid colon and rectum), kidneys, liver, gallbladder, pancreas, spleen, and ureters. what is the pelvic cavity? The space containing the urinary bladder, certain productive organs, part of the large intestine, and the rectum. mucus membranes Line the interior walls of the organs and tubes that open to the outside of the body, such as those of the digestive, respiratory, urinary, and reproductive systems. serous membranes line cavities, including the thoracic cavity and internal organs. synovial membranes • line joint cavities • composed of connective tissue • secrete synovial fluid into joint cavities meninges Composed of 3 connective tissue membranes found within the dorsal cavity and serve as a protective covering of the brain and spinal cord. cutaneous membrane another name for skin largest organ system of the body? integumentary system the integumentary system is composed of? skin, hair, nails skin consists of ___ layers 2 epidermis and dermis hair has ___ structures 2 follicle and shaft Nails are composed of ___ parts 6 root, nail bed, nail plate, cuticle, perionychium, hyponychium musculoskeletal system is composed of? muscles, joints, tendons and joints Bone Classification long bones, short bones, flat bones, irregular bones, and sesamoid. closed fracture Does not involve a break in the skin compound fracture Projects through the skin with a possibility of infection comminuted fracture more than 2 pieces transverse fracture bone break with fract [Show Less]
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AAPC CPC Practice Questions with complete Answers
A 46-year-old female had a previous biopsy that indicated positive malignant margins anteriorly on the right side of her neck. A 0.5 cm margin was drawn ou... [Show More] t and a 15 blade scalpel was used for full excision of an 8 cm lesion. Layered closure was performed after the removal. The specimen was sent for permanent histopathologic examination. What are the CPT® code(s) for this procedure? A. 11626 B. 11626, 12004-51 C. 11626, 12044-51 D. 11626, 13132-51, 13133 C. 11626, 12044-51 A 30-year-old female is having 15 sq cm debridement performed on an infected ulcer with eschar on the right foot. Using sharp dissection, the ulcer was debrided all the way to down to the bone of the foot. The bone had to be minimally trimmed because of a sharp point at the end of the metatarsal. After debriding the area, there was minimal bleeding because of very poor circulation of the foot. It seems that the toes next to the ulcer may have some involvement and cultures were taken. The area was dressed with sterile saline and dressings and then wrapped. What CPT® code should be reported? A. 11043 B. 11012 C. 11044 D. 11042 C. 11044 A 64-year-old female who has multiple sclerosis fell from her walker and landed on a glass table. She lacerated her forehead, cheek and chin and the total length of these lacerations was 6 cm. Her right arm and left leg had deep cuts measuring 5 cm on each extremity. Her right hand and right foot had a total of 3 cm lacerations. The ED physician repaired the lacerations as follows: The forehead, cheek, and chin had debridement and cleaning of glass debris with the lacerations being closed with one layer closure, 6-0 Prolene sutures. The arm and leg were repaired by layered closure, 6-0 Vicryl subcutaneous sutures and Prolene sutures on the skin. The hand and foot were closed with adhesive strips. Select the appropriate procedure codes for this visit. A. 99283-25, 12014, 12034-59, 12002-59, 11042-51 B. 99283-25, 12053, 12034-59, 12002-59 C. 99283-25, 12014, 12034-59, 11042-51 D. 99283-25, 12053, 12034-59 D. 99283-25, 12053, 12034-59 A 52-year-old female has a mass growing on her right flank for several years. It has finally gotten significantly larger and is beginning to bother her. She is brought to the Operating Room for definitive excision. An incision was made directly overlying the mass. The mass was down into the subcutaneous tissue and the surgeon encountered a well encapsulated lipoma approximately 4 centimeters. This was excised primarily bluntly with a few attachments divided with electrocautery. What CPT® and ICD-10-CM codes are reported? A. 21932, D17.39 B. 21935, D17.1 C. 21931, D17.1 D. 21925, D17.9 C. 21931, D17.1 Question 5 PREOPERATIVE DIAGNOSIS: Right scaphoid fracture. TYPE OF PROCEDURE: Open reduction and internal fixation of right scaphoid fracture. DESCRIPTION OF PROCEDURE: The patient was brought to the operating room; anesthesia having been administered. The right upper extremity was prepped and draped in a sterile manner. The limb was elevated, exsanguinated, and a pneumatic arm tourniquet was elevated. An incision was made over the dorsal radial aspect of the right wrist. Skin flaps were elevated. Cutaneous nerve branches were identified and very gently retracted. The interval between the second and third dorsal compartment tendons was identified and entered. The respective tendons were retracted. A dorsal capsulotomy incision was made, and the fracture was visualized. There did not appear to be any type of significant defect at the fracture site. A 0.045 Kirschner wire was then used as a guidewire, extending from the proximal pole of the scaphoid distal ward. The guidewire was positioned appropriately and then measured. A 25-mm Acutrak® drill bit was drilled to 25 mm. A 22.5-mm screw was selected and inserted and rigid internal fixation was accomplished in this fashion. This was visualized under the OEC imaging device in multiple projections. The wound was irrigated and closed in layers. Sterile dressings were then applied. The patient tolerated the procedure well and left the operating room in stable condition. What CPT® code is reported for this procedure? A. 25628-RT B. 25624-RT C. 25645-RT D. 25651-RT A. 25628-RT An infant with genu valgum is brought to the operating room to have a bilateral medial distal femur hemiepiphysiodesis done. On each knee, the C-arm was used to localize the growth plate. With the growth plate localized, an incision was made medially on both sides. This was taken down to the fascia, which was opened. The periosteum was not opened. The Orthofix® figure-of-eight plate was placed and checked with X-ray. We then irrigated and closed the medial fascia with 0 Vicryl suture. The skin was closed with 2-0 Vicryl and 3-0 Monocryl®. What procedure code is reported? A. 27470-50 B. 27475-50 C. 27477-50 D. 27485-50 D. 27485-50 The patient is a 67-year-old gentleman with metastatic colon cancer recently operated on for a brain metastasis, now for placement of an Infuse-A-Port for continued chemotherapy. The left subclavian vein was located with a needle and a guide wire placed. This was confirmed to be in the proper position fluoroscopically. A transverse incision was made just inferior to this and a subcutaneous pocket created just inferior to this. After tunneling, the introducer was placed over the guide wire and the power port line was placed with the introducer and the introducer was peeled away. The tip was placed in the appropriate position under fluoroscopic guidance and the catheter trimmed to the appropriate length and secured to the power port device. The locking mechanism was fully engaged. The port was placed in the subcutaneous pocket and everything sat very nicely fluoroscopically. It was secured to the underlying soft tissue with 2-0 silk stitch. What CPT® code(s) is (are) reported for this procedure? A. 36556, 77001-26 B. 36558 C. 36561, 77001-26 D. 36571 C. 36561, 77001-26 Question 8 A CT scan identified moderate-sized right pleural effusion in a 50 year-old male. This was estimated to be 800 cc in size and had an appearance of fluid on the CT Scan. A needle is used to puncture through the chest tissues and enter the pleural cavity to insert a guidewire under ultrasound guidance. A pigtail catheter is then inserted at the length of the guidewire and secured by stitches. The catheter will remain in the chest and is connected to drainage system to drain the accumulated fluid. The CPT® code is: A. 32557 B. 32555 C. 32556 D. 32550 A. 32557 The patient is a 59-year-old white male who underwent carotid endarterectomy for symptomatic left carotid stenosis a year ago. A carotid CT angiogram showed a recurrent 90% left internal carotid artery stenosis extending into the common carotid artery. He is taken to the operating room for re-do left carotid endarterectomy. The left neck was prepped and the previous incision was carefully reopened. Using sharp dissection, the common carotid artery and its branches were dissected free. The patient was systematically heparinized and after a few minutes, clamps were applied to the common carotid artery and its branches. A longitudinal arteriotomy was carried out with findings of extensive layering of intimal hyperplasia with no evidence of recurrent atherosclerosis. A silastic balloon-tip shunt was inserted first proximally and then distally, with restoration of flow. Several layers of intima were removed and the endarterectomized surfaces irrigated with heparinized saline. An oval Dacron patch was then sewn into place with running 6-0 Prolene. Which CPT® code(s) is/are reported? A. 35301 B. 35301, 35390 C. 35302 D. 35311, 35390 B. 35301, 35390 A 52-year-old patient is admitted to the hospital for chronic cholecystitis for which a laparoscopic cholecystectomy will be performed. A transverse infraumbilical incision was made sharply dissecting to the subcutaneous tissue down to the fascia using access under direct vision with a Vesi-Port and a scope was placed into the abdomen. Three other ports were inserted under direct vision. The fundus of the gallbladder was grasped through the lateral port, where multiple adhesions to the gallbladder were taken down sharply and bluntly: The gallbladder appeared chronically inflamed. Dissection was carried out to the right of this identifying a small cystic duct and artery, was clipped twice proximally, once distally and transected. The gallbladder was then taken down from the bed using electrocautery, delivering it into an endo-bag and removing it from the abdominal cavity with the umbilical port. What CPT® and ICD-10-CM codes are reported? A. 47564, K81.2 B. 47562, K81.1 C. 47610, K81.2 D. 47600, K81.1 B. 47562, K81.1 A 70-year-old female who has a history of symptomatic ventral hernia was advised to undergo laparoscopic evaluation and repair. An incision was made in the epigastrium and dissection was carried down through the subcutaneous tissue. Two 5-mm trocars were placed, one in the left upper quadrant and one in the left lower quadrant and the laparoscope was inserted. Dissection was carried down to the area of the hernia where a small defect was clearly visualized. There was some omentum, which was adhered to the hernia and this was delivered back into the peritoneal cavity. The mesh was tacked on to cover the defect. What procedure code(s) is (are) reported? A. 49560, 49568 B. 49652 C. 49653 D. 49652, 49568 B. 49652 The patient is a 50-year-old gentleman who presented to the emergency room with signs and symptoms of acute appendicitis with possible rupture. He has been brought to the operating room. An infraumbilical incision was made which a 5-mm VersaStep™ trocar was inserted. A 5-mm 0- degree laparoscope was introduced. A second 5-mm trocar was placed suprapubically and a 12-mm trocar in the left lower quadrant. A window was made in the mesoappendix using blunt dissection with no rupture noted. The base of the appendix was then divided and placed into an Endo-catch bag and the 12-mm defect was brought out. Select the appropriate code for this procedure: A. 44970 B. 44950 C. 44960 D. 44979 A. 44970 A 45-year-old male is going to donate his kidney to his son. Operating ports where placed in standard position and the scope was inserted. Dissection of the renal artery and vein was performed isolating the kidney. The kidney was suspended only by the renal artery and vein as well as the ureter. A stapler was used to divide the vein just above the aorta and three clips across the ureter, extracting the kidney. This was placed on ice and sent to the recipient room. The correct CPT® code is: A. 50543 B. 50547 C. 50300 D. 50320 B. 50547 A 67-year-old female having urinary incontinence with intrinsic sphincter deficiency is having a cystoscopy performed with a placement of a sling. An incision was made over the mid urethra dissected laterally to urethropelvic ligament. Cystoscopy revealed no penetration of the bladder. The edges of the sling were weaved around the junction of the urethra and brought up to the suprapubic incision. A hemostat was then placed between the sling and the urethra, ensuring no tension. What CPT® code(s) is (are) reported? A. 57288 B. 57287 C. 57288, 52000-51 D. 51992, 52000-51 A. 57288 A 16-day-old male baby is in the OR for a repeat circumcision due to redundant foreskin that caused circumferential scarring from the original circumcision. Anesthetic was injected and an incision was made at base of the foreskin. Foreskin was pulled back and the excess foreskin was taken off and the two raw skin surfaces were sutured together to create a circumferential anastomosis. Select the appropriate code for this surgery: A. 54150 B. 54160 C. 54163 D. 54164 C. 54163 5 year-old female has a history of post void dribbling. She was found to have extensive labial adhesions, which have been unresponsive to topical medical management. She is brought to the operating suite in a supine position. Under general anesthesia the labia majora is retracted and the granulating chronic adhesions were incised midline both anteriorly and posteriorly. The adherent granulation tissue was excised on either side. What code should be used for this procedure? A. 58660 B. 58740 C. 57061 D. 56441 D. 56441 The patient is a 64 year-old female who is undergoing a removal of a previously implanted Medtronic pain pump and catheter due to a possible infection. The back was incised; dissection was carried down to the previously placed catheter. There was evidence of infection with some fat necrosis in which cultures were taken. The intrathecal portion of the catheter was removed. Next the pump pocket was incised and the pump was dissected from the anterior fascia. A 7-mm Blake drain was placed in the pump pocket through a stab incision and secured to the skin with interrupted Prolene. The pump pocket was copiously irrigated with saline and closed in two layers. What are the CPT® and ICD-10-CM codes for this procedure? A. 62365, 62350-51, T85.898A, Z46.2 B. 62360, 62355-51, T85.79XA C. 62365, 62355-51, T85.79XA D. 36590, I97.42, T85.898A C. 62365, 62355-51, T85.79XA The patient is a 73 year-old gentleman who was noted to have progressive gait instability over the past several months. Magnetic resonance imaging demonstrated a ventriculomegaly. It was recommended that the patient proceed forward with right frontal ventriculoperitoneal shunt placement with Codman® programmable valve. What is the correct code for this surgery? A. 62220 B. 62223 C. 62190 D. 62192 B. 62223 What is the CPT® code for the decompression of the median nerve found in the space in the wrist on the palmar side? A. 64704 B. 64713 C. 64721 D. 64719 C. 64721 A 2-year-old male has a chalazion on both upper and lower lid of the right eye. He was placed under general anesthesia. With a #11 blade the chalazion was incised and a small curette was then used to retrieve any granulomatous material on both lids. What CPT® code should be used for this procedure? A. 67801 B. 67805 C. 67800 D. 67808 D. 67808 An 80-year-old patient is returning to the gynecologist's office for pessary cleaning. Patient offers no complaints. The nurse removes and cleans the pessary, vagina is swabbed with betadine, and pessary replaced. For F/U in 4 months. What CPT® and ICD-10-CM codes are reported for this service? A. 99201, Z46.89 B. 99211, Z46.89 C. 99202, Z46.9 D. 99212, Z46.9 B. 99211, Z46.89 [Show Less]
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review for AAPC CPC exam 2023 Questions and Answers 100% correct
What anatomical or compartment contains all the thoracic viscera except the lungs? Mediastinum Who is responsible for enforcing the HIPAA security ... [Show More] rule Office of Civil Rights (OCR) ABN Advance Beneficiary Notice According to the OIG, internal monitoring and auditing should be performed by what means? Periodic audits What does the abbreviation MAC stand for? Medicare Administrative Contractor How many lobes make up the RIGHT lung? the right has 3 lobes the left has 2 lobes Condition in which the endometrial tissue is found outside of the uterus. Endometriosis A thin membrane lining the chambers of the heart and valves is called the: endocardium PHI Protected Health Information What is the TRUE statement in reporting pressure ulcers? Two codes are assigned when a patient is admitted with a pressure ulcer that evolves to another stage during the admission. The acronym MMRV stands for what? measles, mumps, rubella, and varicella Which of the following is not part of the small intestine? a. duodenum b. ileum c. jejunum d. cecum d. cecum Healthcare providers are responsible for developing ______________ policies and procedures regarding privacy in their practices. a. Patient hotline b. Work around procedures c. Fees d. Notices of Privacy Practices Notices of Privacy Practices A part of the male genital system sitting below the urinary bladder and surrounding the urethra is called the: a. testis b. scrotum c. prostate d. epididymis c. Prostate What is the Rinne test? a. Test using music as the focal point b. test for hearing loss using a vibrating tuning fork placed at the center of the head c. test using a 2-syllable word with equal stress on each syllable d. test measuring hearing using bone conduction and air conduction d. test measuring hearing using bone conduction and air conduction What is the difference between entropion and ectropion? A. Entropion is the inward turning of the eyelid and ectropion is the outward turning of the eyelid. B. Entropion is facial droop and ectropion is a facial spasm. C. Entropion is the outward turning of the hands and ectropion is the inward turning of the hands. D. Entropion inward turning of the feet and ectropion is the outward turning of the feet due to muscle disorder. a. entropion is the inward turning of the eyelid and ectropion is the outward turning of the eyelid. An arteriovenous anastomosis is used to increase blood flow in hemodialysis. Which one of the following describes a direct arteriovenous anastomosis? A. Insertion of a cannula B. A section of artery and a neighboring vein are joined C. A donor's vein is used to connect an artery and a vein D. Radical hysterectomy not otherwise specified E. A synthetic vein is used to connect an artery and a vein b. a section of the artery and a neighboring vein are joined Ventral, umbilical, spigelian and incisional are types of: A. Surgical approaches B. Hernias C. Organs found in the digestive system D. Cardiac catheterizations b. hernias When a patient is having a tenotomy performed on the abductor hallucis muscle, where is this muscle located? A. Foot B. Upper Arm C. Upper Leg D. Hand a. foot Which statement is TRUE when reporting pregnancy codes (O00-O9A): A. These codes can be used on the maternal and baby records. B. These codes have sequencing priority over codes from other chapters. C. Code Z33.1 should always be reported with these codes. D. The seventh character assigned to these codes only indicate a complication during the pregnancy. B: These codes have sequencing priority over codes from other chapters Which statement is TRUE about reporting codes for diabetes mellitus? A. If the type of diabetes mellitus is not documented in the medical record the default type is E11.- Type 2 diabetes mellitus. B. When a patient uses insulin, Type 1 is always reported. C. The age of the patient is a sole determining factor to report Type 1 . D. When assigning codes for diabetes and its associated condition(s), the code(s) from category E08-E13 are not reported as a primary code. a. if the type of diabetes mellitus is not documented in the medical record, the default type is E11: type 2 diabetes mellitus Which statement is TRUE for reporting external cause codes of morbidity (V00-Y99)? A. All external cause codes do not require a seventh character. B. Only report one external cause code to fully explain each cause. C. Report code Y92.9 if the place of occurrence is not stated. D. External cause codes should never be sequenced as a first-listed or primary code d. external cause codes should never be sequenced as a first-listed or primary code What is NOT included in CPT® surgical package? A. Typical postoperative follow-up care B. One related Evaluation and Management service on the same date of the procedure C. Returning to the operating room the next day for a complication resulting from the initial procedure D. Evaluating the patient in the post-anesthesia recovery area c. returning to the operating room the next day for a complication resulting from the initial procedure What is the term used for inflammation of the bone and bone marrow? A. Chondromatosis B. Osteochondritis C. Costochondritis D. Osteomyelitis d. osteomyelitis The root word trich/o means: A. Hair B. Sebum C. Eyelid D. Trachea a. hair Complete this series: Frontal lobe, Parietal lobe, Temporal lobe, ____________. A. Medulla lobe B. Occipital lobe C. Middle lobe D. Inferior lobe d. occipital lobe A patient is having pyeloplasty performed to treat an uretero-pelvic junction obstruction. What is being performed? A. Surgical repair of the bladder B. Removal of the kidney C. Cutting into the ureter D. Surgical reconstruction of the renal pelvis d. surgical reconstruction of the renal pelvis A patient that has cirrhosis of the liver just had an endoscopy performed showing hemorrhagic esophageal varices. The ICD-10-CM codes are reported: A. I85.01, K74.69 B. I85.11, K74.60 C. K74.60, I85.11 D. I85.00, K74.69 In the ICD-10-CM Alphabetic Index look for Varix/esophagus/in/cirrhosis of liver/bleeding referring you to code I85.11. This eliminates multiple choices A and D. In the Tabular List you will see an instructional note above codes I85.10 and I85.11 to Code first underlying disease. For the scenario, cirrhosis of liver (K74.60) is coded first then the esophageal varices with bleeding is coded as a secondary code. Eliminating multiple choice B. correct answer is C. K74.60, I85.11 Which statement is TRUE about Z codes: A. Z codes are never reported as a primary code. B. Z codes are only reported with injury codes. C. Z codes may be used either as a primary code or a secondary code. D. Z codes are always reported as a secondary code. c. Z codes may be used wither as a primary code or a secondary code Guidelines from which of the following code sets are included as part of the code set requirements under HIPAA? A. CPT® Category III codes B. ICD-10-CM C. HCPCS Level II D. ADA Dental Codes ICD-10-CM guidelines are the only guidelines specifically mentioned in HIPAA. While HIPAA requires the use of the other code sets listed, there is no specific mention of the other guidelines in the law. This information is found in the ICD-10-CM Official Guidelines for Coding and Reported in you ICD-10-CM codebook: These guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. These guidelines are based on the coding and sequencing instructions in Volumes I, II and III of ICD-10-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-10-CM diagnosis and procedure codes is required under the Health Insurance Portability and Accountability Act (HIPAA). Which statement is an example in which a diabetes-related problem exists and the code for diabetes is NEVER sequenced first? A. If the patient has an underdose of insulin due to an insulin pump malfunction. B. If the patient is being treated for secondary diabetes. C. If the patient is being treated for Type 2 diabetes and uses insulin. D. If the patient is diabetic with an associated condition. a. If the patient has an underdose of insulin due to an insulin pump malfunction. The ICD-10-CM guidelines (Section I.C.4.a.5): An underdose of insulin due to an insulin pump failure should be assigned T85.6-, as the principal or first listed code, followed by code T38.3X6-. Additional codes for the type of diabetes mellitus should also be assigned. Local Coverage Determinations (LCD) are published to give providers information on which of the following? A. Information on modifier use with procedure codes B. CPT® codes that are bundled C. Fee schedule information listed by CPT® code D. Reasonable and necessary conditions of coverage for an item or service d. Reasonable and necessary conditions of coverage for an item or service Which place of service code is reported on the physician's claim for a surgical procedure performed in an ASC? A. 21 B. 22 C. 24 D. 11 place of service codes are two digit numerical codes that define the location where the services are performed and reported on the CMS-1500 form. A complete chart of place -of-service codes are located in the front of the CPT book C. 24 If a ST elevation myocardial infarction (STEMI) converts to a non ST elevation myocardial infarction (NSTEMI) due to thrombolytic therapy, how is it reported, according to ICD-10-CM guidelines? A. As unspecified AMI B. As a subendocardial AMI C. As STEMI D. As a NSTEMI C. as STEMI ICD-10-CM guidelines (Section I.C.9.e.1) indicate: If STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI When a person has labyrinthitis what has the inflammation? A. Inner ear B. Brain C. Conjunctiva D. Spine a. inner ear An angiogram is a study to look inside: A. Female Reproductive System B. Urinary System C. Blood Vessels D. Breasts c. blood vessels What does oligospermia mean? A. Presence of blood in the semen B. Deficiency of sperm in semen C. Having sperm in urine D. Formation of spermatozoa b. deficiency of sperm in semen The breakdown of this term: combining form olig/o means too few or too little and spermia refers to the condition of the sperm. The definition is too low or too few sperm. In the Alphabetic Index look for Oligospermia N46.11. In the Tabular List oligospermia is indicated as a type of male infertility. [Show Less]
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AAPC CPC exam prep Compliance and Regulatory Questions and Answers 2023
What document is referenced to when looking for potentialproblem areas identified by the government indicatingscrutiny of the services within the coming ye... [Show More] ar?: A) OIG Compliance Plan Guidance B) OIG Security Summary C) OIG Work Plan D) OIG Investigation Plan C (Rationale: Twice a year, the OIG releases a Work Plan outlining its priorities for the fiscal year ahead. Within the Work Plan, potential problem areas with claims submissions are listed and will be targeted with special scrutiny.) What form is provided to a patient to indicate a servicemay not be covered by Medicare and the patient may be responsible for the charges?: A) LCD B) CMS-1500 C) UB-04 D) ABN D (Rationale: An Advanced Beneficiary Notice (ABN) is used when a Medicare beneficiary requests or agrees to receive a procedure or service that Medicare may not cover. This form notifies the patient of potential out of pocket costs for the patient.) Under HIPAA, what would be a policy requirement for "minimum necessary"? " A) Only individuals whose job requires it may have access to protected health information. B) Only the patient has access to his or her own protected health information. C) Only the treating provider has access to protected health information. D) Anyone within the provider's office can have access to protected health information. A (Rationale: It is the responsibility of a covered entity to develop and implement policies, best suited to its particular circumstances to meet HIPAA requirements. As a policy requirement, only those individuals whose job requires it may have access to protected health information.) Which statement describes a medically necessary service? : A) Performing a procedure/service based on cost to eliminate wasteful services. B) Using the least radical service/procedure that allows for effective treatment of the patient's complaint or condition. C) Using the closest facility to perform a service or procedure. D) Using the appropriate course of treatment to fit within the patient's lifestyle. B (Rationale: Medical necessity is using the least radical services/procedure that allows for effective treatment of the patient's complaint or condition.) According to the example LCD from Novitas Solutions, which of the following conditions is considered a systemic condition that may result in the need for routine foot care? : A) arthritis B) chronic venous insufficiency C) hypertension D) muscle weakness B (Rationale: According to the LCD, Chronic venous insufficiency is a systemic condition that may result in the need for routine foot care.) When presenting a cost estimate on an ABN for a potentially noncovered service, the cost estimate should be within what range of the actual cost? A) $25 or 10 percent B) $100 or 10 percent C) $100 or 25 percent D) An exact amount C (Rationale: CMS instructions stipulate, "Notifiers must make a good faith effort to insert a reasonable estimate...the estimate should be within $100 or 25 percent of the actual costs, whichever is greater.") Which act was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) and affected privacy and security? : A) HIPAA B) HITECH C) SSA D) PPACA B What document assists provider offices with the development of Compliance Manuals? A) OIG Compliance Plan Guidance B) OIG Work Plan C) OIG Suggested Rules and Regulations D) OIG Internal Compliance Plan A (Rationale: The OIG has offered compliance program guidance to form the basis of a voluntary compliance program for physician offices. Although this was released in October 2000, it is still considered as active compliance guidance today.) Select the TRUE statement regarding ABNs. A) ABNs may not be recognized by non-Medicare payers. B) ABNs must be signed for emergency or urgent care. C) ABNs are not required to include an estimate cost for the service. D) ABNs should be routinely signed by Medicare Beneficiaries in case Medicare doesn't cover a service. A (Rationale: ABNs may not be recognized by non-Medicare payers. Providers should review their contracts to determine which payers will accept an ABN for services not covered.) Who would NOT be considered a covered entity under HIPAA? A) Doctors C) HMOs D) Clearinghouses E) Patients E (Rationale: Covered entities in relation to HIPAA include Health Care Providers, Health Plans, and Health Care Clearinghouses. The patient is not considered a covered entity although it is the patient's data that is protected.) What type of profession, other than coding, might skilled coders enter?: A) Physicians, insurance carriers, nurses B) Front desk personnel, HR dept C) Consultants, educators, medical auditors D) None of the above C What is the difference between outpatient and inpatient coding?: A) Outpatient coders use ICD-10-CM and ICD-10-PCS. B) Outpatient coders only focuse on hospital services and Inpatient coders focuse on physician services. C) Inpatient coders have more interaction than Outpatient coders. D) Inpatient coders use ICD-10-CM and ICD-10-PCS. D What is a mid-level provider? A) Non-licensed PAs B) Physician withholder C) Mid-level providers include physician assistants (PA) and nurse practitioners (NP). D) NPs with Bachelor's Degree C What are the different parts of Medicare? A) Part A, B, D B) Part A, B, C, D C) Part E, F, G, H D) Part A and B B Evaluation and management (E/M) services are often provided and documented in a standard format. One such format is SOAP notes. What does SOAP represent? A) Subjective, Objective, Assessment, Plan B) Statement, Observation, Action, Prepare C) Symptoms, Objective, Auscultation, Percussion D) Subjective, Observation, Action, Plan A What are five tips for coding operative (op) reports? A) Look for key words, Ignore unfamiliar words, Skip the body, Ignore pathology reports, Only code procedures from the header B) Diagnosis code reporting, Start with the procedures listed, Look for key words, Highlight unfamiliar words, Read the body C) Highlight familiar words, Look for key words, Read the body, Only code what you have highlighted, Code procedure only D) Read the headers only, Look for key words, Highlight familiar words, Ignore pathology report, Code diagnosis only B What is medical necessity?: A) Services to a Medicare beneficiary that are billed for unreasonable and unnecessary treatment. B) The most radical service/procedure that allows for effective treatment of the patient's complaint or condition. C) Something insurance plans do not care about. D) Relates to whether a procedure or service is considered appropriate in a given circumstance. D What is not a common reason Medicare may deny a procedure or service?: A) Patient's condition B) Frequently proposed C) Covered service D) Experimental C Under the Privacy Rule, the minimum necessary standard does NOT apply to what type of disclosures?: A) Uses or disclosures to drug companies. B) Disclosures to or requests by family members. C) Disclosures to the individual who is the subject of the information. D) Uses or disclosures to insurance companies. C Which is not one of the seven key components of an internal compliance plan?: A) Develop open lines of communication. B) Conduct training but not perform education on practice standards and procedures. C) Enforce disciplinary standards through well-publicized guidelines. D) Conduct internal monitoring and auditing through the performance of periodic audits. B The ____describes whether specific medical items, services, treatment procedures or technologies are considered medically necessary under Medicare: A) National Coverage Determinations Manual B) Internet Only Manual C) Medicare Severity-Diagnosis Related Groups (MS-DRG) D) Medicare Physician Fee Schedule A According to the AAPC Code of Ethics, which term is NOT listed as an ethical principle of professional conduct?: A) Integrity B) Efficiency C) Responsibility D) Commitment B According to AAPC's Code of Ethics, an AAPC member shall use only ____ and ____ means in all professional dealings: A) private and professional B) legal and ethical C) legal and profitable D) efficient and inexpensive B What is the definition of medical coding?: A) Translating documentation into numerical/alphanumerical codes used to obtain reimbursement. B) Deciphering explanation of benefits provided by an insurance carrier. C) Translating documentation into software compatible notes. D) Translating the services a provider performs into documentation. A If an NCD does not exist for a particular service/procedure performed on a Medicare patient, who determines coverage?: A) Medicare Administrative Contractor (MAC) B) The physician providing the service C) Current Procedural Terminology (CPT®) guidelines D) Centers for Medicare & Medicaid Services (CMS) A Many coding professionals go on to find work as: A) Accountants B) Medical Assistants C) Financial Planners D) Consultants D LCDs only have jurisdiction in their ____: A) Locality B) Region C) District D) State B A covered entity does NOT include: A) Health plans B) Patients C) Healthcare providers D) Clearinghouses B In what year was HITECH enacted as part of the American Recovery and Reinvestment Act?: A) 2010 B) 2000 C) 2007 D) 2009 D HIPAA stands for: A) Health Insurance Portability and Accountant Advice B) Health Information Privacy Access Act C) Health Insurance Provider Assistance Action D) Health Insurance Portability and Accountability Act D Which option below is NOT a covered entity under HIPAA?: A) Workers' Compensation B) Medicaid C) Medicare D) BCBS A AAPC credentialed coders have proven mastery of what information?: A) Code sets B) Evaluation and management principles C) Documentation guidelines D) All of the above D What is PHI?: A) Provider healthcare interchange B) Private health insurance C) Provider healthcare incident-to D) Protected health information D Which of the following choices is NOT a benefit of an active compliance plan?: A) Eliminates risk of an audit. B) Fewer billing mistakes. C) Increases accuracy of provider documentation. D) Faster, more accurate payment of claims. A The Medicare program is made up of several parts. Which part covers provider fees without the use of a private insurer?: A) Part B B) Part A C) Part C D) Part D A When coding an operative report, what action would NOT be recommended?: A) Highlighting unfamiliar words. B) Starting with the procedure listed. C) Coding from the header without reading the body of the report. D) Reading the body of the report. C [Show Less]
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CPC exam Vocabulary Questions and Answers
Adren/o ; Adrenal/o Adrenal gland; epinephrine Adrenocortic Adrenal cortex Endocrin/o Endocrine glands or system Hypophys/o Pituit... [Show More] ary gland ; Hypophysis Insul/o Pancreatic Islets Parathyr/o ; Parathyroid/o Parathyriod gland Pituitar/o Pituitary gland; Hypophysis Thyr/o ; Thyroid/o Thyroid gland Cerebr/o Cerebrum Cortic Cerebral Cortex; outer portion Encephal/o Brain Gangli/o ; Ganglion Ganglion Gil Neuroglia cells Medull/o Medulla Oblongata medulla(inner section) ; Middle , Soft, Marrow Mening/o ; Menige/o Meninges Myel/o Spinal Cord; Bone Marrow Narc/o Stupor, Numbness, Sleep Neur/o ; Neur/i Nervous system, Nervous tissue ; Nerve Psych/o Mind Radicul/o Spinal nerve root Somn/o ; Somn/i Sleep Colp/o Vagina Episi Vulva Gyn/o ; Gynec/o Woman Hyster/o Uterus Mast/o Breast ; Mammary gland Men/o ; Mens Menstruation Metr/o : Metr/i Uterus O/o Ovum ; egg cell Oophor/o Ovary Ov/o ; Ovul/o Ovum: egg cells Salping/o Oviduct ; Tube [Show Less]
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