Medical Billing and Reimbursement
Textbook Exam Questions
Course Introduction
Medical Billing and Reimbursement introduces students to the foundational principles and procedures involved in processing healthcare claims and securing payment for medical services. The course covers the healthcare revenue cycle, insurance terminology, patient registration, coding of diagnoses and procedures (ICD-10, CPT, and HCPCS), electronic and paper claim submission, and follow-up processes for claim resolution. Students learn to navigate multiple payer systems, interpret Explanation of Benefits (EOB) statements, and comply with legal and ethical standards, including HIPAA regulations. Practical exercises focus on applying billing techniques and managing reimbursement cycles to ensure accuracy and efficiency in medical practice administration.
Recommended Textbook
ICD 10 CM PCS Coding Theory and Practice 2017 Edition 1st Edition by Karla R. Lovaasen
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26 Chapters
1611 Verified Questions
1611 Flashcards
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Chapter 1: The Rationale for and History of Coding
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Sample Questions
Q1) All of the following are members of the cooperating parties EXCEPT ____.
A)NCHS
B)AHA
C)AAPC
D)AHIMA
Answer: C
Q2) AAPC
A)American Academy of Professional Coders
B)Certified Coding Specialist
C)American Hospital Association
D)National Center for Health Statistics
E)Registered Health Information Technician
Answer: A
Q3) Which of the following statements follows the AHIMA Standards of Ethical Coding?
A)Coders should change codes as requested by the business office for payment.
B)Coders should share personal health information with anyone who asks for it.
C)Coders should assign only codes supported by documentation in the record.
D)It is acceptable for coders to participate in practices that do not follow the official coding guidelines.
Answer: C
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Chapter 2:
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Sample Questions
Q1) In some cases a patient is ready to be discharged from the hospital,but at the last minute the patient develops a condition that requires him or her to stay an additional night.An example of when a patient might have to stay an additional night is when the patient ____.
A)is feeling better
B)has no pain
C)has no additional cough
D)develops a fever
Answer: D
Q2) A query should contain all of the following items EXCEPT ____.
A)date of service
B)amount of increased reimbursement due to query
C)patient name
D)area for provider signature
Answer: B
Q3) The patient history and physical need to be performed and documented within ___________ hours of admission for an inpatient encounter.
Answer: 24
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Chapter 3: ICD-10-Cm Format and Conventions
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Sample Questions
Q1) The letter "X" in ICD-10-CM can be found in the fifth or sixth character position for some codes as a placeholder.
A)True
B)False
Answer: True
Q2) Which statement is NOT true of inclusion terms?
A)An "inclusion note" under a code indicates that the terms excluded from the code are to be coded elsewhere.
B)The terms may be included under some codes.
C)These terms are the conditions for which that code number is to be used.
D)The inclusion terms are not necessarily exhaustive.
Answer: A
Q3) An "Excludes1 note" under a code indicates that the terms excluded from the code are to be coded elsewhere.
A)True
B)False
Answer: True
Q4) What are the two tables found in the Alphabetic Index in ICD-10-CM?
Answer: Neoplasm Table and the Table of Drugs and Chemicals
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Chapter 4: Basic Steps of Coding
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Sample Questions
Q1) What is the subterm in "aspiration pneumonia"?
Q2) The main term in "aplastic anemia" is ____.
A)anemia
B)aplasia
C)aplastic
D)none of the above
Q3) Which of the following is a basic step in coding?
A)Review the medical record.
B)Identify main term(s)in the Alphabetic Index.
C)Assign codes to the highest level of specificity by verifying in the Tabular List.
D)All of the options are correct.
Q4) The coder should rely solely on the discharge summary to capture all of the diagnoses and procedures that were treated and performed.
A)True
B)False
Q5) What is the main term in "rheumatoid arthritis"?
Q6) What is the main term in "infantile eczema"?
Q7) The __________,if available,is the first step in the process of record review for code selection.
Page 6
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Chapter 5: General Coding Guidelines for Diagnosis
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Sample Questions
Q1) Etiology/manifestation convention requires ____ code(s)to fully describe a single condition that affects multiple body systems.
A)one
B)two
C)three
D)zero
Q2) A(n)____ is a residual effect (condition produced)after the acute phase of an illness or injury has terminated.
A)combination effect
B)acute effect
C)sequela
D)chronic effect
Q3) When you assign separate codes that are used to identify acute and chronic conditions,the acute code is sequenced first.
A)True
B)False
Q4) What is the diagnosis code(s)for thoracolumbar scoliosis (neuromuscular)due to past history of poliomyelitis?
Q5) What are the diagnosis code(s)for acute and chronic pancreatitis?
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Chapter 6: Introduction to ICD-10-PCS
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Sample Questions
Q1) Alphabetic Index entry for gastric banding (stomach)
Q2) Alphabetic Index entry for brachytherapy prostate
Q3) The maxillary sinus is in what body system?
Q4) Open excisional biopsies of liver and pancreas
Q5) Putting in or on biological or synthetic material that physically reinforces and/or augments the function of a portion of a body part is called ____.
A)restriction
B)insertion
C)supplement
D)revision
Q6) The omentum is in what body system?
Q7) How many characters are in an ICD-10-PCS code?
Q8) Ligatures,sutures,and clips are not considered to be devices.
A)True
B)False
Q9) ICD-10-PCS is divided into how many sections?
Page 8
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Chapter 7: General Coding Guidelines for Other Medical-
and Surgical-Related Procedures and Ancillary Procedures
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109 Verified Questions
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Sample Questions
Q1) The first character value for a physical rehabilitation or diagnostic audiology procedure is I.
A)True
B)False
Q2) The approach for chiropractic manipulation is always external.
A)True
B)False
Q3) In the substance abuse section,characters five,six,and seven are for qualifiers.
A)True
B)False
Q4) Hearing treatment with cerumen management
Q5) Radionuclide is the second character in the nuclear medicine section.
A)True
B)False
Q6) Extracorporeal therapy uses equipment outside the body for a therapeutic purpose that does not involve the assistance or performance of a physiological function.
A)True
B)False
Q7) In utero repair of cardiovascular system,laparoscopic approach
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Chapter 8: Coding Medical and Surgical Procedures
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Sample Questions
Q1) When a diagnostic procedure is performed for the principal diagnosis and a procedure for definitive treatment is performed for a secondary diagnosis,the procedure for definitive treatment is the principal procedure.
A)True
B)False
Q2) Open CABG bypass of two coronary arteries using the saphenous vein (aorta to coronary artery)and one artery with the left internal mammary artery,which was used as a pedicle graft to coronary artery.The left greater saphenous vein was harvested via percutaneous endoscopic approach.Cardiopulmonary bypass machine was utilized during the procedure.
Q3) If a patient's procedure is canceled before he or she shows up at the hospital,what is the correct Z code to assign?
A)Z53.09 Surgical or other procedure not carried out because of contraindication
B)Z53.20 Surgical or other procedure not carried out because of patient's decision
C)Z53.9 Procedure not carried out for other reasons
D)None of the above
Q4) Cutting off all or a portion of the upper or lower extremities is ____.
Q5) Taking or letting out fluids and/or gases from a body part is called ____.
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Chapter 9: Symptoms,
signs, and
Abnormal
Clinical and Laboratory Findings Not Elsewhere Classified, and Z Codes
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Sample Questions
Q1) The infant was seen in the ER for fever.Physician documented fever due to vaccination.
A)R50.81
B)R50.82
C)R50.83
D)R50.2
Q2) The patient was admitted for prophylactic breast removal.The patient has a strong family history of breast cancer and the patient has severe fibrocystic disease in both breasts,making breast examination difficult.The patient was taken to the OR,and a bilateral simple mastectomy was performed.The patient recovered with no problems.The pathology report showed no evidence of malignancy.
Final Diagnosis: Family history of breast cancer;severe fibrocystic disease.
Procedure: Bilateral simple mastectomy.
A)Z40.8,N60.11,N60.12,0HTV0ZZ
B)Z40.01,Z80.3,N60.11,N60.12,0HTV0ZZ
C)Z40.01,Z80.3,N60.19,0HTT0ZZ,0HTU0ZZ
D)N60.11,N60.12,Z40.01,0HTT0ZZ,0HTU0ZZ
Q3) Urinary hesitancy due to enlarged prostate: __________
Q4) Impending stroke with dizziness and facial weakness: __________
Q5) Encounter for admission examination for prisoner: __________
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Chapter 10: Certain Infectious and Parasitic Diseases
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Sample Questions
Q1) TB stands for ____________________.
Q2) Trench mouth is coded to ____.
A)A69.0
B)A69.1
C)A27.9
D)A36.3
Q3) Hepatitis ____ is spread through contact with infected blood,through sex with an infected person,or during childbirth.There is a vaccine for this kind of hepatitis.
A)A
B)B
C)C
D)D
Q4) Name an AIDS-defining illness that usually attacks an immunocompromised individual.
Q5) Assign the code for German measles.
Q6) Assign the code for scarlet fever.
Q7) Assign the code for suspected carrier of group B strep.
Q8) Assign the code for chickenpox.
Q9) Assign the code for asymptomatic HIV.
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Chapter 11: Neoplasms
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Sample Questions
Q1) Malignancy that originates in the bone marrow
A)Well differentiated
B)Sarcomas
C)Fibromas
D)Metastasis
E)Leukemias
F)Melanomas
G)Carcinomas
H)Undifferentiated
I)Myeloma
J)Grading
K)Primary site
L)Staging
M)Adenocarcinoma
Q2) Ovarian (left)malignancy with malignant ascites.Diagnostic paracentesis was performed and confirmed the malignant ascites.
A)R18.0,Z85.43,0W9G30Z
B)R18.0,C56.2,0W9G3ZX
C)C56.1,R18.8,0W9G3ZZ
D)C56.2,R18.0,0W9G3ZX
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Page 14
Chapter 12: Diseases of the Blood and Blood-Forming
Organs and Certain Disorders Involving the Immune
Mechanism
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Sample Questions
Q1) Anemia due to neoplastic disease can be used as the principal diagnosis code in ICD-10-CM if the reason for the encounter is to treat the anemia.
A)True
B)False
Q2) A procedure,such as leukapheresis,plateletpheresis,and plasmapheresis,that separates the different components of the blood and removes a certain part of the blood
A)Apheresis
B)Blood
C)Autologous transfusion
D)5000 to 10,000/mm³
E)Hemoglobin (HGB)
F)Purpura
G)Idiopathic
H)Hematocrit (Hct)
I)Bone marrow biopsy
J)WBC
K)Secondary thrombocytopenia
Q4) Familial erythrocytosis: __________ Page 15
Q3) Thrombocytopenia due to chronic alcoholism: __________
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Chapter 13: Endocrine, nutritional, and Metabolic Diseases
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Sample Questions
Q1) Dietary surveillance and counseling
A)Z79.890
B)Z90.411
C)Z83.49
D)Z86.39
E)Z71.3
Q2) A patient is admitted to the ER with DKA in type 1 diabetes and dehydration.The patient has a history of diabetic polyneuropathy.The patient is receiving insulin.The patient is treated and stable for discharge in 2 days.
A)E10.10,E86.0,E10.42
B)E10.11,E86.0,E10.42
C)E10.42,E10.10,E86.9
D)E10.10,E86.1,E10.42
Q3) If a gland becomes larger,this is called ____________________,and if it becomes smaller,this is called ____________________.
Q4) DKA in patient with uncontrolled type 1 diabetes: __________
Q5) Marasmus: __________
Q6) When there is hypersecretion of hGH after puberty,a condition called acromegaly,where does the overgrowth occur?
Page 17
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Chapter 14: Mental, behavioral, and Neuro developmental Disorders
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Sample Questions
Q1) What drug could be given to treat ADD or ADHD?
A)Dilantin
B)Librium
C)Paxil
D)Ritalin
Q2) Munchausen's syndrome: __________
Q3) Seizures are a common form of alcohol withdrawal.
A)True
B)False
Q4) Adjustment disorder with depressed mood due to unemployment.
A)Z56.0,F43.21
B)F43.21,Z56.0
C)F43.20
D)F43.23,Z56.0
Q5) ADHD,combined type: __________
Q6) Cirrhosis of liver due to alcohol dependence in remission: __________
Q7) Name some symptoms/signs that characterize ADD or ADHD.
Q8) ____________________ is a progressive deterioration of mental faculties characterized by impairment of memory and one or more cognitive impairments. Page 18
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Chapter 15: Diseases of the Nervous System, diseases of
the Eye and Adnexa, and Diseases of the Ear and Mastoid Process
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Sample Questions
Q1) Patient is admitted for a senile cataract in the right eye to be removed by phacoemulsification with IOL replacement via percutaneous approach.
A)H25.21,08RK3JZ
B)H25.89,08DK3ZZ
C)H25.9,08RJ3JZ
D)H25.11,08DJ3ZZ
Q2) How is hydrocephalus treated most commonly?
Q3) The two parts of the peripheral nervous system are the ____________________ nervous system and the ___________________ nervous system.
Q4) What drug could be given to treat Alzheimer's?
A)Sinemet
B)Depakote
C)Aricept
D)Dilantin
Q5) The spinal cord is located in the ____________________ foramen.
Page 20
Q6) Legal blindness in the United States is defined as severe or profound impairment in both eyes.
A)True
B)False
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Chapter 16: Diseases of the Circulatory System
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Sample Questions
Q1) Patient with alcoholic cirrhosis of the liver with bleeding esophageal varicewas admitted to the hospital.There was no evidence of withdrawal symptoms due to patient's alcohol dependence.
A)I85.11,K70.31,F10.19
B)K70.30,I85.11,F10.20
C)I85.11,K70.30,F10.20
D)K70.30,I85.00,F10.19
Q2) Patient comes to the hospital with chest pain.A diagnostic left heart cath is performed,and no coronary artery disease is observed.The cardiologist documents the diagnosis as noncardiac chest pain.
A)R07.9,4A0239Z
B)R07.89,4A023N7
C)R07.9,4A023N7
D)R07.89,A023N8
Q3) History of heart transplant
A)Z82.3
B)Z94.1
C)Z95.811
D)Z95.9
E)Z76.82
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Chapter 17: Diseases of the Respiratory System
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Sample Questions
Q1) Inhalers,nebulizers,and steroids
A)Chronic bronchitis
B)Respiratory failure
C)Influenza
D)Sinusitis
E)Emphysema
F)Asthma
Q2) Chronic obstructive pulmonary disease is a term used to describe the accumulation of fluid in the pleural space.
A)True
B)False
Q3) Family history of other chronic respiratory conditions
A)Z82.5
B)Z83.6
C)Z87.891
D)Z85.22
E)Z48.24
F)Z77.090
G)Z93.0
Q4) Idiopathic pulmonary fibrosis: __________
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Chapter 18: Diseases of the Digestive System
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Sample Questions
Q1) Appendicitis with abscess: __________
Q2) All of the following are part of the digestive system EXCEPT the ____.
A)aortic valve
B)liver
C)gallbladder
D)salivary glands
Q3) A patient is admitted with recurrent right inguinal hernia.The hernia cannot be reduced,and the patient is taken to the OR for an open repair of indirect hernia with mesh.The patient spikes a fever on day 2,and workup reveals a UTI.What codes are applicable?
Q4) Used as feeding tubes for patients who are having difficulty eating,are malnourished,or are aspirating food
A)Nissen fundoplication
B)Herniorrhaphy
C)Appendectomy
D)Colostomy
E)Lysis of adhesions
F)PEG (percutaneous endoscopic gastrostomy)
G)TIPS (transjugular intrahepatic portosystemic shunt)procedure
H)Whipple procedure
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Chapter 19: Diseases of the Skin and Subcutaneous Tissue
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Sample Questions
Q1) Nail horn,left thumb: __________
Q2) What is excisional debridement?
Q3) Granuloma pyogenicum: __________
Q4) The sebaceous glands secrete an oily substance called ____________________.
Q5) A patient is admitted from the nursing home with suspected aspiration pneumonia.The attending physician documents that the patient has pressure ulcers on both buttocks.The left side has a stage 2 ulcer,and the right side has a stage 1 ulcer.
A)J69.0,L89.322,L89.311
B)J18.9,L89.301,L89.319
C)J18.9,L98.419
D)J69.0,L98.411,L98.412
Q6) Patient was admitted because of the development of blistering and erosion of skin and mucous membranes.About 10 days ago the patient had fever,sore throat,and headache and was thought to have influenza.The patient was diagnosed with Stevens-Johnson syndrome due to history of pneumonia.
A)L51.3,J18.9
B)L51.3,Z87.01
C)L51.1,Z87.01
D)L51.1,J18.9
Page 25
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Chapter 20: Diseases of the Musculoskeletal System and Connective Tissue
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Sample Questions
Q1) Osteomyelitis is an infection of the bone that often starts in another part of the body and is spread by the blood.
A)True
B)False
Q2) What does the abbreviation AKA stand for?
Q3) Staphylococcal pyogenic arthritis of left knee: __________
Q4) Lower limb amputation status-below left knee
A)Z87.39
B)Z82.61
C)Z82.69
D)Z96.641
E)Z89.512
F)Z13.828
G)Z13.820
Q5) ICD-10-CM uses the sixth character when coding to identify pathologic fractures.
A)True
B)False
Q7) Kaschin-Beck disease,right ankle: __________ Page 26
Q6) ____________________ is a metabolic bone disorder that results in decreased bone mass and density.
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Chapter 21: Diseases of the Genitourinary System
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Sample Questions
Q1) GN stands for ____________________.
Q2) ____________________ is the presence of blood in the urine.
Q3) Tight hymenal ring: __________
Q4) Patient was seen in the ER with left flank pain.Discharge diagnosis is stone,left kidney.
A)N20.0,N23
B)N20.0
C)R10.9
D)N23
Q5) Small kidneys,bilaterally: __________
Q6) Male patient with intrinsic sphincter deficiency with urinary stress incontinence with insertion of artificial bladder neck sphincter via open approach: __________
Q7) Vesicoperineal fistula: __________
Q8) Overflow incontinence is the constant dribbling of urine.Treatments for overflow incontinence include all of the following EXCEPT ____.
A)Kegel exercises
B)diet
C)immediate surgery
D)bladder training
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Chapter 22: Pregnancy, childbirth, and the Puerperium
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Q1) Younger than 16 at date of delivery
A)Young obstetric patient
B)Antepartum
C)Primigravida
D)Puerperium
E)Gravid
F)Elderly OB patient
Q2) What happens in a molar pregnancy?
Q3) The period of time from delivery through the first 6 weeks postpartum
A)Young obstetric patient
B)Antepartum
C)Primigravida
D)Puerperium
E)Gravid
F)Elderly OB patient
Q4) What drug could be given to induce labor?
A)Stadol
B)Epidural
C)Pitocin
D)Terbutaline
29
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Chapter 23: Certain Conditions Originating in the Perinatal
Period and Congenital Malformations, deformations, and
Chromosomal Abnormalities
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Sample Questions
Q1) A disorder that involves incomplete development of the brain,spinal cord,and/or their protective coverings
A)Klinefelter's syndrome
B)Spina bifida
C)Meckel's diverticulum
D)Marfan syndrome
E)Tetralogy of Fallot
F)Down syndrome
Q2) What does AGA stand for?
Q3) Which of the following makes a condition clinically significant?
A)The condition requires a clinical evaluation.
B)The condition requires therapeutic treatment.
C)The condition requires an extended hospital stay.
D)All of the above are correct.
Q4) A code from category A41,septicemia,should not be used on a(n)____ record.
A)newborn
B)child
C)teenager
D)adult
Q5) Congenital pigeon chest: __________
30
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Chapter 24: Injuries and Certain Other Consequences of
External Cases and External Causes of Morbidity
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Q1) The patient was admitted for observation for internal injury after an accident at work.The patient,who does construction work,fell into a pit but was quickly rescued by coworkers.CT scan and X-rays were taken to evaluate for internal injury.No respiratory issues were noted.On the following morning,the patient had no complaints and was discharged to home.
Discharge Diagnosis: Contusion on forehead.
A)Z04.1,S00.83xA,W17.4xxA,Y92.69,Y99.1
B)Z04.2,S00.83xA,W17.2xxA,Y92.69,Y99.0
C)Z04.3,S00.83xS,W17.0xxA,Y92.69,Y99.0
D)S00.83xA,W17.2xxA,Y92.69,Y99.8
Q2) A break in a bone is called a(n)____________________.
Q3) Where are foreign bodies most likely to enter?
Q4) The patient (civilian)has chronic posttraumatic stress syndrome following a terrorist attack.
A)F43.12,Y38.9x2S
B)F43.11,Y38.9x2A
C)F43.10,Y38.9x2S
D)Z86.59,Y38.9x2A
Q5) Fractured coccyx,initial encounter: __________
Q6) Fifteen mosquito bites on right lower leg,initial encounter: __________ Page 32
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Chapter 25: Burns, Adverse Effects, and Poisonings
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Sample Questions
Q1) First- and second-degree burn of face due to gas flame from stove in kitchen at patient's house while cooking: __________
Q2) A patient combined prescription Percodan with beer and became stuporous and drowsy.
A)T40.2x1A,T51.0x1A,R40.1,R40.0
B)T40.2x1D,T51.0x1D,R40.1,R40.0
C)T40.2x1S,T51.0x1S,R40.1,R40.0
D)T40.2x1A,T51.0x1A
Q3) All of the following are to be considered when one is questioning whether a poisoning has occurred EXCEPT whether the ____.
A)wrong medication was taken
B)wrong dose was taken
C)medication belongs to another person
D)medication was taken 30 minutes after the scheduled time
Q4) Are healthcare providers required to report suspicion of abuse to the authorities?
Q5) Spontaneous hematoma in right thigh muscle due to anticoagulant;patient is taking Coumadin as prescribed for mechanical mitral valve replacement: __________
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Chapter 26: Complications of Surgical and Medical Care
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48 Verified Questions
48 Flashcards
Source URL: https://quizplus.com/quiz/43725
Sample Questions
Q1) Patient admitted with an abscess due to Streptococcus of abdominal surgical wound,initial encounter.Cultures were positive for Streptococcus.The abscess of the skin was incised and drained.
A)T81.4,A49.1,Y84.9,0H97X0Z
B)T81.4,L02.211,B95.5,Y84.9,0H97Z0Z
C)T81.4xxA,L02.211,B95.5,Y83.9,0H97XZZ
D)T81.4xxA,A49.1,Y83.9,0H97XZZ
Q2) Patient presents with pseudoaneurysm right femoral artery due to recent cardiac cath at another facility.
A)I72.4,Y84.0
B)I72.8,Y84.2
C)I97.89,Y84.8
D)I97.89,I72.4,Y84.0
Q3) Code only complications that occur within 2 weeks of a transplant surgery.
A)True
B)False
Q4) Leaking silicone breast implant,initial visit: __________
Q5) When no entry is found under the main term for the condition,the coder should refer to the main term ____________________.
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