Question 1

Which type of fee is approved by the insurance carrier for a difficult or complicated service?

Accepted Answer

The term "reasonable" in the context of insurance refers to fees that are approved by the insurance carrier for services that may be more difficult or complicated, ensuring that the payment is fair and justified for the level of service provided.

Question 2

The payment system used by Medicare is the __________.

Accepted Answer

The Resource-Based Relative Value Scale (RBRVS) is the payment system used by Medicare. It determines payments for physicians' services based on the resource costs needed to provide them, taking into account factors like the physician's work, practice expenses, and malpractice insurance costs.

Question 3

How many coding systems are used to keep track of the many thousands of possible diagnoses and of procedures and services by the physicians, and to simplify the process of verifying the medical necessity of each procedure?

Accepted Answer

The correct answer is D: Two. The two coding systems used to keep track of diagnoses and procedures are the International Classification of Diseases (ICD) and the Current Procedural Terminology (CPT).

Question 4

Which type of code is used to report what is wrong with the patient or what brought the patient to see the physician?

Accepted Answer

Diagnostic codes are used to describe a patient's condition or reason for seeking medical care, indicating what is wrong with the patient.

Question 5

Which type of code is used for reporting each procedure and service that the physician has documented in treating the patient?

Accepted Answer

Procedural codes are used to report the specific procedures and services performed by healthcare providers, such as those documented by physicians in treating patients.

Question 6

Codes used for the diagnosis of external causes in ICD-10-CM begin with which letter or letter range?

Accepted Answer

Codes for the diagnosis of external causes in ICD-10-CM start with letters V, W, X, and Y, covering a range of circumstances from transport accidents to exposure to forces of nature.

Question 7

Michael last visited his physician, which is a single-physician office practice, in September 2006. He is at the office today for a sore throat and chest congestion. Since he was already a patient, the medical insurance coder submitted an established patient E/M code to Michael's insurance carrier for payment. The insurance carrier requested additional documentation regarding the visit. Which of the following may have been the reason?

Accepted Answer

Michael's visit should have been coded as a new patient E/M (Evaluation and Management) category because he had not been seen in the practice for over three years. According to most insurance carriers, a patient is considered new if they have not received any professional services from the physician or another physician of the same specialty and in the same practice within the past three years.

Question 8

During Michael's sick visit a CBC was performed. Which type of code(s) should be used for the service?

Accepted Answer

Bundled codes are used in medical billing to include multiple procedures that are commonly performed together under a single comprehensive code, which would include both the visit and the CBC if they are standardly performed together during a sick visit.

Question 9

The Evaluation and Management section of procedure codes falls within which range of CPT codes?

Accepted Answer

The Evaluation and Management (E&M) section of Current Procedural Terminology (CPT) codes ranges from 99201 to 99480. These codes are used for billing various types of patient encounters, including office visits, hospital visits, and consultations.

Question 10

The Anesthesiology section of procedure codes falls within which range of CPT codes?

Accepted Answer

The Anesthesiology section of Current Procedural Terminology (CPT) codes falls within the range of 00100-01999 for anesthesia procedures and 99100-99140 for additional anesthesia services.

Question 11

The Surgery section of procedure codes falls within which range of CPT codes?

Accepted Answer

The Surgery section of Current Procedural Terminology (CPT) codes falls within the range of 10021-69990.

Question 12

The Radiology section of procedure codes falls within which range of CPT codes?

Accepted Answer

The Radiology section of Current Procedural Terminology (CPT) codes falls within the range of 70010-79999. This range includes diagnostic imaging, diagnostic ultrasound, radiation oncology, and nuclear medicine procedures.

Question 13

The Pathology and Laboratory section of procedure codes falls within which range of CPT codes?

Accepted Answer

The Pathology and Laboratory section of procedure codes in the Current Procedural Terminology (CPT) falls within the range of 80047-89398.

Question 14

CPT codes are ______ digit numbers.

Accepted Answer

CPT codes are five-digit numbers used to describe medical, surgical, and diagnostic services.

Question 15

ICD-10-CM codes are the _______ revision of ICD.

Accepted Answer

ICD-10-CM codes represent the Tenth Revision of the International Classification of Diseases.

Question 16

Updates to the diagnostic coding system are published ___________________.

Accepted Answer

Updates to the diagnostic coding system are published annually to ensure that the coding system remains current with changes in medical practice and new understandings of diseases and conditions.

Question 17

The ICD-10-CM uses ________-digit codes for broad categories of diseases, injuries, and symptoms.

Accepted Answer

The ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) uses codes that range from three to seven digits in length. The first three characters specify the category of the diagnosis, and additional characters (up to seven) provide more detail about the condition.

Question 18

Updated CPT manuals are published ______________________.

Accepted Answer

Updated CPT (Current Procedural Terminology) manuals are published every year to ensure that the coding system remains up-to-date with the medical, surgical, and diagnostic services changes.

Question 19

The implementation date for the ICD-10-CM code is set for:

Accepted Answer

The ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) code system was implemented on October 1, 2014, in the United States for all HIPAA-covered entities.

Question 20

Which of the following is not an advantage of ICD-10-CM?

Accepted Answer

ICD-10-CM offers a higher level of specificity, expands categories, and includes more bilateral codes, making it more detailed and comprehensive than its predecessor. However, it does not have fewer categories; instead, it has more detailed and expanded categories to accommodate the increased specificity and new diagnoses.

Quiz 7: Insurance and Coding