Deck 18: Medical Insurance Coding

Question 1

Which of the following volumes is the alphabetic index of ICD-9-CM?

A) Volume I
B) Volume II
C) Volume III
D) Volume IV

Answer 1

Volume II

Question 2

What is necessary in order to authorize release of medical information to an insurance carrier?

A) A verbal agreement between the patient and the doctor is necessary.
B) A medical release from the patient is needed.
C) A handshake between the patient and the doctor is all that is necessary.
D) Authorization is never required to release medical information.
E) Physicians never have to share medical information.

Answer 2

A medical release from the patient is needed.

Question 3

Which of the following best describes the purpose of a physician's fee profile?

A) To analyze office fees
B) To reflect charges for services and reimbursement rates
C) To prevent downcoding
D) To subrogate monies

Answer 3

To reflect charges for services and reimbursement rates

Question 4

Which section of the CPT book includes coding of lacerations?

A) Medicine
B) Surgery
C) Pathology
D) Laboratory

Question 5

Which of the following is NOT included in the recommended procedure for researching CPT code numbers using the index?

A) Search for the service or procedure in the alphabetic index.
B) Find a suggested number or range of numbers.
C) Search for the suggested number range in the tabular list.
D) Choose the correct code number for description.
E) Choose a modifier for all diagnoses and procedures.

Question 6

Which of the following should be used to check for patient eligibility?

A) Point-of-service device
B) Claims register
C) Universal claim form
D) Explanation of benefits

Question 7

Which of the following applies to the coding book used for specifying services and procedures performed in the medical office?

A) ICD-9-CM
B) RBRVS
C) CPT
D) EOB

Question 8

Which of the following information is NOT included in coding?

A) Visit complexity
B) Diagnosis for visit
C) Specific procedures
D) Counseling

Question 9

Which section of the CPT book includes coding of immunizations and chemotherapy?

A) Medicine
B) Surgery
C) Pathology
D) Laboratory

Question 10

Which of the following organizations developed ICD-9-CM?

A) American Medical Association
B) Centers for Medicare and Medicaid Services
C) World Health Organization
D) Health Care Financing Administration

Question 11

Which of the following is completed using data from the patient's electronic health record in most offices today?

A) CMS 1490
B) UB92
C) CMS 1500
D) HCFA form

Question 12

Which of the following is a convention used when there is not enough information to find a more specific code?

A) NEC
B) NOS
C) V codes
D) E codes

Question 13

Which of the following is a record of claims sent to the insurance carrier?

A) Point-of-service device
B) Claims register
C) Universal claim form
D) Explanation of benefits

Question 14

Which of the following are codes applied to an injury or poisoning?

A) Modifiers
B) V codes
C) E codes
D) Injury codes

Question 15

Why is it important for the medical assistant to understand medical insurance coding?

A) Needed to transfer all information
B) Assists explanations to patients
C) Helps the patient file claims
D) Serves as basis for the information on the claim form

Question 16

Which of the following is NOT included in the insurance carrier's role?

A) Check to see that there are no pre-existing condition restrictions.
B) Ensure that the provider has a contract with the carrier.
C) Ensure that coverage was in force at the time of treatment.
D) Collect a co-payment from the physician.
E) Ensure that amounts meet usual and customary standards.

Question 17

How many major sections are in the Current Procedural Terminology reference book?

A) Four
B) Five
C) Six
D) Seven

Question 18

Which of the following ICD-9-CM volumes is recommended as the first reference when coding diagnoses?

A) Volume I
B) Volume II
C) Volume III
D) Volume IV

Question 19

Which of the following is NOT affected by coding accuracy?

A) Ruling out a diagnosis
B) Physician reimbursement
C) Resubmissions
D) Medical records

Question 20

On completion of the processing of the claim,the insurance company sends what to the insured person?

A) POS
B) Claim remittance
C) EOB
D) 1490 form

Question 21

The new CMS-1500 form is distinguishable from the old form in that the 1500 symbol and date are located where?

A) Top right margin
B) Bottom right margin
C) Bottom left margin
D) Top left margin

Question 22

Which of the following is the claim form used for filing inpatient admissions claims?

A) CMS 1500
B) UB-04
C) CMS 1490
D) HCFA 1500

Question 23

Separating the components of a procedure and reporting them as billable codes with charges in order to increase reimbursement rates is known as what?

A) Upcoding
B) Unbundling
C) Bundling
D) Downcoding

Question 24

Use the following scenario to answer the questions below:
Patrick fell from a tree, hurt his arm, and his face was cut. His mother took him to the physician's office where a greenstick fracture of the wrist was put in a splint. A laceration was repaired on his cheek. He was given a tetanus injection.
How many procedure codes would apply to the preceding scenario?

A) One
B) Two
C) Three
D) Four
E) Five

Question 25

Which of the following are diagnosis codes used primarily with cancer registries?

A) V codes
B) E codes
C) DRG codes
D) M codes

Question 26

Which of the following occurs when the insurance carrier is deliberately billed a higher rate service than what was performed to order for the provider to obtain greater reimbursements?

A) Upcoding
B) Bundling
C) Downcoding
D) Unbundling

Question 27

Which of the following applies to codes used as supplements to the basic CPT system and are required when reporting services and procedures to Medicare and Medicaid patients?

A) HCPCS
B) M codes
C) E&M codes
D) DRGs

Question 28

Which of the following is recommended to do first when a claim is not paid within 4-6 weeks?

A) Allow the carrier 30 days more to pay the claim.
B) Check the carrier's regulations for payment.
C) Call the insurance carrier and ask about the delay.
D) Resubmit the claim.

Question 29

Which of the following is the volume of the ICD-9-CM known as the tabular list?

A) Volume I
B) Volume II
C) Volume III
D) Volume I-III

Question 30

Use the following scenario to answer the questions below:
Patrick fell from a tree, hurt his arm, and his face was cut. His mother took him to the physician's office where a greenstick fracture of the wrist was put in a splint. A laceration was repaired on his cheek. He was given a tetanus injection.
How many diagnosis codes will the preceding scenario require?

A) One
B) Two
C) Three
D) Four
E) Five

Question 31

The ICD-CM 10th revision will utilize alphanumeric codes that will consist of up to how many characters?

A) Five
B) Six
C) Seven
D) Eight