Medical Insurance and Coding Exam Review
Course Introduction
This course provides an in-depth exploration of medical insurance processes and the fundamental concepts of medical coding. Students will learn about the major types of health insurance plans, the reimbursement cycle, and the legal and ethical considerations in medical billing. The course covers essential coding systems, such as ICD, CPT, and HCPCS, and their application in documenting and reporting medical diagnoses and procedures. Emphasis is placed on accurate claim submission, resolving billing discrepancies, and understanding compliance with regulatory requirements, equipping students with the knowledge and practical skills needed for entry-level positions in medical billing and coding.
Recommended Textbook
Step by Step Medical Coding 2016 1st Edition by Carol J. Buck
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27 Chapters
1233 Verified Questions
1233 Flashcards
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Chapter 1: Reimbursement, Hipaa, and Compliance
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50 Verified Questions
50 Flashcards
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Sample Questions
Q1) Under the RBRVS, the unit value is termed ____________________ Value Unit.
Answer: Relative relative
Q2) The Medicare program was established in:
A)1955
B)1960
C)1965
D)1970
Answer: C
Q3) For endoscopic procedures, Medicare allows the full value of the highest valued endoscopy, plus the difference between the next highest endoscopy and the ____________________ endoscopy.
Answer: highest
Q4) The coder's responsibility is to ensure that the data are as accurate as possible not only for classification and study purposes but also to obtain appropriate reimbursement. A)True
B)False
Answer: True
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Chapter 2: An Overview of ICD-10-CM
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15 Flashcards
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Sample Questions
Q1) ICD-10-CM codes are alphanumeric, with all codes beginning with a number.
A)True
B)False
Answer: False
Q2) The following are characteristics of the ICD-10-CM index:
A)Main terms are in bold type.
B)Subterms are indented under the main term.
C)Only the first four characters of some codes are given.
D)All of the above.
Answer: D
Q3) Which organization has been responsible for the development of ICD-10-CM?
A)NCHS
B)AHIMA
C)AMA
D)AHA
Answer: A
Q4) ICD-10-CM codes have a maximum of five characters.
A)True
B)False
Answer: False
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Chapter 3: ICD-10-CM Outpatient Coding and Reporting
Guidelines
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28 Verified Questions
28 Flashcards
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Sample Questions
Q1) Established patient presents with chest pain. He has a history of previous myocardial infarction and coronary artery bypass surgery.
Answer: Chest pain
Q2) The term "primary diagnosis" is the same as the first-listed diagnosis. A)True
B)False
Answer: True
Q3) An established patient is seen for migraines and seizures, to rule out the possibility of a brain tumor. ____________________
Answer: Migraines
Seizures
Q4) A patient is admitted to an observation unit for a medical condition that has worsened and is then admitted as an inpatient to the same hospital for the same medical condition. The primary diagnosis would be the medical condition that led to the admission.
A)True
B)False
Answer: True
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Chapter 4: Using ICD-10-CM
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35 Flashcards
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Sample Questions
Q1) Each unique I-10 diagnosis code may be reported more than once for an encounter.
A)True
B)False
Q2) Multiple codes are often required for late effects, complication codes, and obstetric codes.
A)True
B)False
Q3) Pseudocyst of the pancreas.
ICD-10-CM Code:____________________
Q4) Acute and chronic respiratory failure.
ICD-10-CM Code:____________________
Q5) Primary hypertension.
ICD-10-CM Code:____________________
Q6) Systemic lupus erythematosus with associated endocarditis (M32.11) is an example of dual coding.
A)True
B)False
Q7) Subsequent encounter for a joint injection for a patient with acute pain due to a sprained right acromioclavicular joint.
ICD-10-CM Codes:____________________, _____________________
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Chapter 5: Introduction to CPT
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Sample Questions
Q1) According to the CPT Surgery Guidelines, what is the code for the following unlisted procedures: Unlisted procedure, neck or thorax?
Code: ____________________
Q2) According to the CPT manual, modifier -91 is not to be used when tests are ____ to confirm initial results.
A)ordered
B)rerun
C)directed
D)selected
Q3) UFR
A)See Uroflowmetry
B)See Audiologic Function Test; Ear, Nose, and Throat
C)See Lipoprotein, Blood
Q4) The two-digit modifier used by an Ambulatory Surgery Center (ASC) or hospital outpatient unit for a discontinued procedure prior to the administration of anesthesia is
Q5) The ____________________ section Guidelines contain the definition of the chief complaint.
Q6) Appendix C of the CPT manual contains examples of ____________________ codes.
Page 7
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Chapter 6: Introduction to Level II National Codes HCPSC
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Sample Questions
Q1) intrathecal
A)IT
B)IV
C)IM
D)SC
E)IHN
Q2) Level II National Modifiers are located in the introduction section of the HCPCS and also in Appendix A of CPT.
A)True
B)False
Q3) intramuscular
A)IT
B)IV
C)IM
D)SC
E)IHN
Q4) Do not report HCPCS modifiers with ________ CPT Category II codes.
Q5) What is the HCPCS Level II code for Injection, gadoterate meglumine, 0.1 ml?
Q6) J codes do not include drug _____________.
Q7) Medicare and other federal payers do not recognize ___ codes.
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Chapter 7: Modifiers
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Sample Questions
Q1) Multiple modifiers are indicated with which modifier?
A)-47
B)-50
C)-22
D)-99
Q2) The modifier that indicates multiple procedures is:
A)-32
B)-51
C)-22
D)-26
Q3) Modifier -80, Assistant Surgeon, is used when:
A)two surgeons perform a distinct part of the surgery
B)the surgery is complex and requires several physicians
C)a second surgeon provides assistance to the primary surgeon
D)all of the above
Q4) Modifiers are used to indicate what type of information?
A)bilateral procedure
B)multiple procedures
C)service greater than usually required
D)all of the above
Page 9
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Chapter 8: Evaluation and Management EM Services
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67 Flashcards
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Sample Questions
Q1) Critical care codes are reported based on:
A)the three key components-history, exam, MDM
B)time
C)amount of documentation
D)procedures performed
Q2) The examination is the ____ portion of the E/M service.
A)subjective
B)objective
C)assessment
D)plan
Q3) The four types of patient status are: ________________, ___________________, ________________, and ____________________
Q4) History and exam of the normal newborn infant born in a hospital setting.
CPT Code: ___________________
Q5) Donald Mayors is a homebound patient who is experiencing some new problems with managing his diabetes. Dr. Martin, who has never seen this patient before, drives to Donald's residence and spends 20 minutes examining the patient and explaining the adjustments that are to be made in the insulin dosage. The medical decision making is straightforward.
CPT Code: ____________________
Page 10
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Chapter 9: Anesthesia
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Sample Questions
Q1) Anesthesia for bilateral vasectomy.
CPT Code: ____________________
Q2) Qualifying anesthesia circumstances are adjunct codes and are used when the administration of the anesthesia is more difficult.
A)True
B)False
Q3) When time is calculated for anesthesia services, the time begins when:
A)the patient arrives in the operating room
B)the anesthesiologist begins preparing the patient for anesthesia
C)the anesthesiologist begins to administer the anesthesia
D)the surgeon makes the first incision
Q4) In the Anesthesia section of the CPT manual, the codes are usually divided first by which of the following?
A)specific procedure
B)anatomic site
C)degree of difficulty
D)amount of time
Q5) Anesthesia for radical hysterectomy.
CPT Code: ____________________
Q6) ____________________ of the CPT manual lists some HCPCS modifiers.
Page 11
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Chapter 10: Surgery Guidelines and General Surgery
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Sample Questions
Q1) 34800-34834
A)Spine: Arthrodesis
B)Excision-Benign Lesions
C)Endovascular Repair of Abdominal Aortic Aneurysm
D)Transcatheter Procedures
Q2) Information given in the notes preceding a subsection is also contained in the section Guidelines.
A)True
B)False
Q3) When the words "separate procedure" appear after the descriptor of a code, you know which of the following about that code?
A)The procedure was the only service provided earlier on that day.
B)The procedure provided was on a day other than the major procedure.
C)The procedure was a minor procedure that would only be reported if it was the only service provided.
D)The procedure is always bundled into any other service provided.
Q4) Third-party payers determine the contents of a surgical package.
A)True
B)False
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Chapter 11: Extension 1: Chapter-Specific Guidelines:
ICD-10-CM Chapters 1-10
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Sample Questions
Q1) Sickle-cell crisis with acute chest syndrome.
ICD-10-CM Code: _____________________
Q2) The secondary cancer should be listed before the primary cancer if the secondary cancer is the reason for the visit.
A)True B)False
Q3) Acute bilateral lacrimal canaliculitis due to Staphylococcus aureus.
ICD-10-CM Codes: ____________________, ____________________
Q4) Encounter for screening for HIV due to high-risk heterosexual behavior.
ICD-10-CM Codes: _____________________, _____________________
Q5) Chronic asthmatic bronchitis with COPD.
ICD-10-CM Code: _____________________
Q6) Congestive heart failure.
ICD-10-CM Code: ____________________
Q7) Central pain and chronic pain have the same meaning. A)True B)False
Q8) Arthritis due to Lyme disease.
ICD-10-CM Code: ____________________ Page 13
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Page 14
Chapter 13: Musculoskeletal System
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Sample Questions
Q1) Jane was playing volleyball in her high school gymnasium, and during a dive for the ball she fell, landing hard on her right shoulder area. She presented to the orthopedic office in severe pain in the area of her collarbone. Radiologic exams were taken of the area, and it was found that the sternoclavicular joint had been dislocated. The physician applied pressure and moved the bone back into its proper location. Strapping was then applied. Report only the repair, not the x-ray.
CPT Code: ____________________
Q2) Bone grafts for spinal surgery are often coded in conjunction with a surgical procedure. What is the appropriate modifier to apply to the bone graft code?
A)No modifier
B)-51
C)-59
D)-22
Q3) An orthopedic surgeon cannot report the service of ultrasonic guidance because this is a radiologic procedure, and only a radiologist can report services represented in the Radiology section.
A)True
B)False
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Chapter 14: Integumentary System
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Sample Questions
Q1) Fine-needle aspiration of the breast without imaging:
A)19000
B)19100
C)10021
D)19030
Q2) Excision defined as full thickness would be through the:
A)epidermis
B)dermis
C)subcutaneous tissue
D)muscle
Q3) What two items are needed to correctly code for local treatment of burns?
A)length and width of burn
B)width and depth of burn
C)percentage of body surface and depth of burn
D)percentage of body surface and width of burn
Q4) Mastectomy that is done for gynecomastia:
A)19300
B)19301
C)19303
D)19305
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Chapter 14: Respiratory System
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Sample Questions
Q1) A chest tube may be used as an indwelling method of draining the accumulated fluid in the pleural space.
A)True
B)False
Q2) Bronchoscopy with placement of catheter for intracavitary radioelement application.
CPT Code: ____________________
Q3) Excision of tracheal tumor using cervical approach. CPT Code: ____________________
Q4) Drainage of an abscess in the nose via internal approach. CPT Code: ____________________
Q5) What is the method that a physician uses to control a nosebleed?
A)packing
B)ligation
C)cauterization
D)all of the above
Q6) Endoscopic biopsy of lung mass. CPT Code: ____________________
Q7) Endoscopic lobectomy of a single lobe. CPT Code: ____________________
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Chapter 15: Extension 2: Chapter-Specific Guidelines:
ICD-10-CM Chapters 11-14
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Sample Questions
Q1) Boil on the face, due to Staphylococcus epidermidis.
ICD-10-CM Codes:_____________________, _____________________
Q2) Mucocele of the gallbladder.
ICD-10-CM Code:_____________________
Q3) Mucinosis of the skin.
ICD-10-CM Code: _____________________
Q4) Dyskinesia of esophagus.
ICD-10-CM Code:_____________________
Q5) Acquired hallux valgus, right foot.
ICD-10-CM Code:____________________
Q6) A stress fracture is the same as a pathologic fracture.
A)True
B)False
Q7) Postgastrectomy dumping syndrome.
ICD-10-CM Code:_____________________
Q8) Staphylococcus aureus arthritis of the left ankle is an example of when the organism is reported first, followed by a code to report the pyogenic arthritis.
A)True
B)False
Page 18
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Chapter 16: Cardiovascular System
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Sample Questions
Q1) Selective catheterization of both renal arteries. The right femoral artery was entered by Seldinger technique, and a 6-French sheath was placed. No heparin was used. The patient had a BP of over 200 systolic. After placement of the 6-French sheath, a pigtail catheter was introduced and an aortogram was done in the AP projection using 20 cc of dye. Next a 5-French Cobra catheter was introduced, and both the left renal artery and the right renal artery were selectively opacified. The patient was sent to her room in good condition without complications after renal angiograms had been done, the sheath had been removed, and hemostasis had been secured.
Results: Right renal artery-there is a single right renal artery with a minimal irregularity along the wall, but no evidence of significant fibromuscular dysplasia or stenosis is noted. The distal nephrogram appears unremarkable.
Left renal artery-there are two renal arteries, the upper pole renal artery rising in the normal location and the lower pole renal artery considerably lower. Both these vessels appear relatively unremarkable with no stenosis or fibromuscular dysplasia seen either. CPT Code: (Surgery Code) ____________________
Q2) Venous bypass graft for occlusive disease, femoral-popliteal.
CPT Code: ____________________
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Chapter 17: Hemic, Lymphatic, Mediastinum, and Diaphragm
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Sample Questions
Q1) The mediastinum is located between the lungs.
A)True
B)False
Q2) The ____ manufactures most blood cells.
A)bone marrow
B)spleen
C)lymph nodes
D)liver
Q3) Resection of a mediastinal tumor.
CPT Code: ____________________
Q4) The stem cell harvesting in 38205 is the collection of stem cells from the bone marrow.
A)True
B)False
Q5) What word describes a lymphadenectomy in which only the lymph nodes are removed?
A)radical
B)partial
C)segmental
D)limited
Q6) The mediastinum category code range is ____________________. Page 21
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Chapter 18: Digestive System
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Sample Questions
Q1) If totally unrelated to the condition requiring critical care, code 43752 can be coded with the critical care codes.
A)True
B)False
Q2) Transection of the esophagus with repair for esophageal varices.
CPT Code: ____________________
Q3) The correct code for an intraoperative colonic lavage is 44701.
A)True
B)False
Q4) For a fine-needle aspiration of the salivary gland, the correct code would be 42400.
A)True
B)False
Q5) With the exception of incisional and ventral hernias, the use of mesh or other prosthesis is not separately reported when performing hernia repairs.
A)True
B)False
Q6) I&D of a peritonsillar abscess.
CPT Code: ____________________
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Chapter 19: Urinary and Male Genital Systems
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Sample Questions
Q1) A complete transurethral electrosurgical resection of the prostate.
CPT Code: ___________________
Q2) Endoscopic procedures within the Urinary subsection, Kidney subheading, are often divided based on this unique factor:
A)patient condition
B)urgency of procedure
C)existence of a stoma
D)recurrence of condition
Q3) When coding 51797 it is necessary to add a modifier -51.
A)True
B)False
Q4) Bilateral vasectomy.
CPT Code: ____________________
Q5) Kidney stone
A) Prostatectomy
B) Retroperitoneal
C) Nephrectomy
D) Manometric study
E) Bladder aspiration
F) Calculus
24
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Chapter 20: Reproductive, Intersex Surgery,
Female
Genital
System, and Maternity Care and Delivery
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Sample Questions
Q1) This term describes an incision of the vagina to gain access to the peritoneal cul-de-sac to explore or to drain an abscess.
A)perineoplasty
B)colpocentesis
C)colpocleisis
D)oophorectomy
Q2) Patient presents for a laparoscopic salpingostomy.
CPT Code: ____________________
Q3) Vaginal delivery with episiotomy and use of forceps.
CPT Code: ____________________
Q4) Antepartum care only after vaginal delivery by another physician, eight visits. CPT Code: ____________________
Q5) A radical vulvectomy is the removal of greater than 80% of the vulvar area.
A)True
B)False
Q6) What Surgery subheading has only two codes?
A)Urinary System
B)Intersex Surgery
C)Laparoscopy
D)Delivery
Page 25
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Chapter 21: Extension 3: Chapter-Specific Guidelines :
ICD-10-CM Chapters 15-21
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Sample Questions
Q1) Salpingitis following complete spontaneous abortion.
ICD-10-CM Code: ____________________
Q2) Transitory neonatal hypoglycemia.
ICD-10-CM Code: ____________________
Q3) The perinatal period extends from before birth through 28 days after birth.
A)True
B)False
Q4) Congenital cystic kidney disease.
ICD-10-CM Code: ____________________
Q5) A surgical complication is one that takes place as a result of a procedure.
A)True
B)False
Q6) Heart murmur.
ICD-10-CM Code: ____________________
Q7) The postpartum period begins immediately after delivery and continues for twelve weeks.
A)True
B)False
Q8) Fever, unknown origin.
ICD-10-CM Code: ____________________ Page 27
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Chapter 22: Endocrine and Nervous Systems
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Sample Questions
Q1) In the Surgery of Skull Base, the ____ procedure is the method used to obtain exposure of the lesion.
A)radical
B)definitive
C)approach
D)intubation
Q2) Posterior hemilaminectomy with herniated discectomy L2 thru L4. (Separate the codes with a comma in your response as follows: XXXXX, XXXXX.)
CPT Codes: ____________________, ____________________
Q3) Burr hole
A) method of identifying a specific area or point in the brain
B) removal of a portion of the skull
C) a small opening in the skull
D) an incision of the skull
Q4) What procedure is often performed with a laminectomy?
A)discectomy
B)corpectomy
C)arthrodesis
D)creation of a shunt
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Chapter 23: Eye, Ocular Adnexa, Auditory, and Operating Microscope
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Sample Questions
Q1) Otoplasty of the right ear, with size reduction. CPT Code: ____________________
Q2) Cataract and lens replacement uses ____ different approaches.
A)3
B)2
C)4
D)1
Q3) The destruction codes in the Posterior Segment subsection include one or more sessions.
A)True
B)False
Q4) The codes in the Eye and Ocular Adnexa subsection are bilateral codes.
A)True
B)False
Q5) Bilateral repair of blepharoptosis with frontalis muscle technique. CPT Code: ____________________
Q6) Removal of impacted cerumen from both ears using wax curettes and suction. CPT Code: ____________________
Q7) Sclera lesion excision, left eye.
CPT Code: ____________________ Page 30
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Chapter 24: Radiology Section
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Sample Questions
Q1) Epididymography, supervision and interpretation only. CPT Code: ____________________
Q2) Also known as a CAT scan, this technique allows safe, painless, and rapid diagnosis in previously inaccessible areas of the body
A)venography
B)lymphangiography
C)magnetic resonance
D)myelogram
E)cholangiography
F)computed tomography
G)angiography
H)pelvimetry
I)ultrasound
J)tomography
Q3) There are four subheadings in the Radiology section.
A)True
B)False
Q4) Renal venography, unilateral, selective, supervision, and interpretation. CPT Code: ____________________
Q5) ____________________ means lying down.
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Chapter 25: Pathology/Laboratory Section
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Sample Questions
Q1) A Pap smear utilizing the Bethesda system done by manual screening and computer-assisted re-screening under physician supervision.
CPT Code: ____________________
Q2) CLINICAL DIAGNOSIS AND HISTORY: Recurrent bladder tumor
TISSUE(S) SUBMITTED: Biopsy, bladder
GROSS DESCRIPTION: Specimen is received in fixative and consists of three pieces of tissue. The largest piece measures 0.3 x 0.3 cm and the smallest piece measures 0.2 x 0.1 cm in greatest dimensions.
MICROSCOPIC DESCRIPTION: 1 microscopic slide examined.
DIAGNOSIS: Urinary bladder, needle biopsy-chronic cystitis (cystica) with squamous metaplasia
CPT Code: ____________________
Q3) A definitive drug screening for amphetamine.
CPT Code: ____________________
Q4) Peripheral blood smear interpretation by physician with a written report. CPT Code: ____________________
Q5) Qualitative analysis is defined as:
A)determining the amounts and proportions of chemical constituents
B)analysis of a substance in order to ascertain the nature of chemical constituents
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Chapter 26: The Medicine Section
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Sample Questions
Q1) A 12-year-old presented for a diagnostic analysis of his cochlear implant including programming.
CPT Code: ____________________
Q2) Fluorescein angiography with interpretation and report.
CPT Code: ____________________
Q3) Electroconvulsive therapy.
CPT Code: ____________________
Q4) Ventricular angiography cardiac catheterization imaging services, interpretation, and report.
CPT Code: ____________________
Q5) Total body plethysmography, with interpretation and report.
CPT Code: ____________________
Q6) An interactive psychiatric diagnostic interview examination is typically furnished to children.
A)True
B)False
Q7) Electronic analysis of dual-chamber pacemaker system with reprogramming including the evaluation of parameters at rest and during activity.
CPT Code: ____________________
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Chapter 27: Inpatient Coding
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Sample Questions
Q1) The root operation that is defined as restoring, to the extent possible, a body part to its natural anatomic structure is:
A)map
B)replacement
C)restriction
D)repair
Q2) The American Hospital Association is responsible for the development of ICD-10-PCS.
A)True
B)False
Q3) Patient was discharged with a diagnosis of probable myocardial infarction.
Q4) Patient is admitted following an outpatient procedure because of an exacerbation of the patient's asthma. What is the principal diagnosis?
A)the reason for the patient's outpatient procedure
B)a code for cancellation of the procedure
C)an aftercare V code
D)exacerbation of asthma
Q5) Patient was admitted with shortness of breath and edema due to decompensation of congestive heart failure.
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