Deck 29: Procedural and Diagnostic Coding

Question 1

When coding,you isolate the main term from the provider's statement and then look it up in the:

A) table of contents
B) index
C) subterm directory
D) explanation of abbreviations

Answer 1

index

Question 2

Services performed in the office are generally marked on a patient's encounter form by the:

A) provider
B) clinical medical assistant
C) administrative medical assistant
D) patient

Answer 2

provider

Question 3

The Evaluation and Management (E/M)section codes are divided into ____ categories of provider services.

A) 8
B) 11
C) 19
D) 24

Answer 3

19

Question 4

Most physician offices utilize the version of the ICD-9-CM manual that has only which two volumes?

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

Question 5

The National codes are approved and maintained jointly by all but which of the following organizations?

A) Centers for Medicare and Medicaid Services (CMS)
B) Health Insurance Association of America
C) Blue Cross Blue Shield Association
D) National Hospital Association

Question 6

Tools known as crosswalks or ____ will be used to help convert an ICD-9-CM/PCS code to an ICD-10-CM/PCS code.

A) general equivalence mappings
B) electronic codes
C) sidebars
D) conduits

Question 7

All of these statements are true about ICD-10-CM,except:

A) ICD-10-CM will help reduce coding errors.
B) ICD-10-CM provides greater coding accuracy and specificity.
C) When implemented,the United States will be the only nation using the ICD-10-CM coding system.
D) ICD-10-CM will result in improved efficiency of care and lower costs.

Question 8

The International Classification of Diseases,9th Revision,Clinical Modification (ICD-9-CM)will remain in use in the United States until October 1 of what year?

A) 2015
B) 2016
C) 2017
D) 2018

Question 9

As a result of the Medicare Modernization Act of 2004,new,revised,and deleted codes must be implemented every year on which date?

A) June 21
B) April 15
C) July 4
D) January 1

Question 10

When coding,the primary reason for the office visit is listed first,and other reasons are listed in what order?

A) chronological order
B) numerical order
C) alphabetical order
D) order of importance

Question 11

Which level of the Healthcare Common Procedural Coding System (HCPCS)includes National codes?

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

Question 12

Who publishes Current Procedural Terminology (CPT)?

A) World Health Organization
B) American Public Health Association
C) American Medical Association
D) Department of Health and Human Services

Question 13

In which volume of the ICD-9-CM will you find the Classification of Drugs by the American Hospital Formulary?

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

Question 14

Which HCPCS Level II codes are temporary codes for procedures,services,and supplies?

A) J codes
B) G codes
C) L codes
D) M codes

Question 15

When records are reviewed by third-party payers,if a procedure is not documented,it:

A) will be reimbursed at only 50 percent of the standard rate
B) will be reimbursed at only 10 percent of the standard rate
C) is considered to never have been performed
D) must be resubmitted with a statement of explanation from the provider

Question 16

A _____ is used to inform third-party payers that circumstances for a particular code have been altered.

A) modifier
B) translator
C) qualifier
D) provision

Question 17

ICD codes are descriptive of the:

A) presenting disease or condition
B) presenting symptoms
C) form of treatment used
D) medications used in treatment

Question 18

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Pathology and Laboratory

A)99201–99499
B)00100–01999,99100–99140
C)10021–69990
D)70010–79999
E)80047–89398
F)90281–99199,99500–99607

Question 19

Assigning a diagnosis code that does not match patient documentation for the purpose or increasing reimbursement through the DRG system is known as:

A) downcoding
B) upcoding
C) unbundling
D) bundling

Question 20

Which section of Volume II of the ICD-9-CM manual includes the Index to External Causes of Injuries and Poisonings?

A) section 1
B) section 2
C) section 3
D) section 4

Question 21

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Radiology

A)99201–99499
B)00100–01999,99100–99140
C)10021–69990
D)70010–79999
E)80047–89398
F)90281–99199,99500–99607

Question 22

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Use of decimal after 3 characters

A)ICD-9-CM
B)ICD-10-CM
C)both ICD-9-CM and ICD-10-CM

Question 23

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Medicine

A)99201–99499
B)00100–01999,99100–99140
C)10021–69990
D)70010–79999
E)80047–89398
F)90281–99199,99500–99607

Question 24

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Counseling

A)key component
B)contributory factor

Question 25

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Characters 2-7 are alpha or numeric

A)ICD-9-CM
B)ICD-10-CM
C)both ICD-9-CM and ICD-10-CM

Question 26

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Level of history obtained

A)key component
B)contributory factor

Question 27

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Coordination of care

A)key component
B)contributory factor

Question 28

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Characters 2-5 are numeric

A)ICD-9-CM
B)ICD-10-CM
C)both ICD-9-CM and ICD-10-CM

Question 29

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Degree of medical decision making involved

A)key component
B)contributory factor

Question 30

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Level of examination performed

A)key component
B)contributory factor

Question 31

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Amount of time the provider spent

A)key component
B)contributory factor

Question 32

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Anesthesiology

A)99201–99499
B)00100–01999,99100–99140
C)10021–69990
D)70010–79999
E)80047–89398
F)90281–99199,99500–99607

Question 33

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Evaluation and Management (E/M)

A)99201–99499
B)00100–01999,99100–99140
C)10021–69990
D)70010–79999
E)80047–89398
F)90281–99199,99500–99607

Question 34

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
First character is alpha

A)ICD-9-CM
B)ICD-10-CM
C)both ICD-9-CM and ICD-10-CM

Question 35

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Total of 3-5 characters

A)ICD-9-CM
B)ICD-10-CM
C)both ICD-9-CM and ICD-10-CM

Question 36

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Total of 3-7 characters

A)ICD-9-CM
B)ICD-10-CM
C)both ICD-9-CM and ICD-10-CM

Question 37

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Always at least 3 characters

A)ICD-9-CM
B)ICD-10-CM
C)both ICD-9-CM and ICD-10-CM

Question 38

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
First character is numeric or alpha

A)ICD-9-CM
B)ICD-10-CM
C)both ICD-9-CM and ICD-10-CM

Question 39

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Surgery

A)99201–99499
B)00100–01999,99100–99140
C)10021–69990
D)70010–79999
E)80047–89398
F)90281–99199,99500–99607

Question 40

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Nature of the presenting problem

A)key component
B)contributory factor

Question 41

​Which of the following would not be a required step in utilizing medical necessity guidelines?

A) ​review of the family history section of the progress note
B) ​review of the narrative diagnostic finding(s)indicated
C) ​review the order from provider
D) ​looking over the entire encounter form and progress note to make sure that all procedures and services and diagnoses are identified

Question 42

​HCPCS Level I codes are known as:

A) ​National codes
B) ​ICD-10-CM
C) ​Current Procedural Terminology
D) ​all of the above

Question 43

​Match the "general rules" for assigning CPT or ICD codes.Note: Answers may be used more than once.
​Code the minimum number of diagnoses that fully describe the patient's care received on that visit

A)​CPT
B)​ICD

Question 44

​Where in the CPT manual would you find information about modifiers?

A) ​Alphabetic index
B) ​Tabular list
C) ​Appendix A
D) ​Appendix C

Question 45

​The AMA defines medical necessity as services or procedures that a prudent physician would provide to a patient in order to prevent,diagnose,or treat an illness,injury,or disease or the associated symptoms in a manner that is:

A) ​in accordance with the generally accepted standard of medical practice
B) ​clinically appropriate in terms of frequency,type,extent,site,and duration
C) ​not for the intended economic benefit of the health plan or purchaser or the convenience of the patient,physician,or other health care provider
D) ​all of the above

Question 46

​Match the "general rules" for assigning CPT or ICD codes.Note: Answers may be used more than once.
​Sequence codes correctly so that it is possible to understand the chronology of events (e.g. ,the reason for the visit and care).

A)​CPT
B)​ICD

Question 47

​The 2014 CPT manual uses symbols to indicate specific information about code numbers.For example,the + symbol stands for:

A) ​add-on code
B) ​new code
C) ​revised text
D) ​modifier-51 exempt

Question 48

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Each character can be alphanumeric

A)ICD-9-PCS
B)ICD-10-PCS

Question 49

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Alpha characters are not case-sensitive

A)ICD-9-PCS
B)ICD-10-PCS

Question 50

​Which of the following statements is not true when using HCPCS Level II codes?

A) ​The search for the correct HCPCS code begins in the Index.
B) ​The search for the correct HCPCS code begins in the Tabular List.
C) ​When appropriate,the correct HCPCS modifier should be appended to provide additional information.
D) ​Both CPT and HCPCS Level II codes can be reported on the same claim.

Question 51

​Match the "general rules" for assigning CPT or ICD codes.Note: Answers may be used more than once.
​Identify the main term in the index

A)​CPT
B)​ICD

Question 52

​Match the "general rules" for assigning CPT or ICD codes.Note: Answers may be used more than once.
​Never code directly from the index

A)​CPT
B)​ICD

Question 53

​Upcoding can result in:

A) ​increased revenue to the practice
B) ​capturing all related procedures and diagnoses for the patient visit
C) ​serious fines and penalties
D) ​none of the above

Question 54

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
Always at least 3 characters

A)ICD-9-PCS
B)ICD-10-PCS

Question 55

​Which of the following statements is true regarding HCPCS Level II codes?

A) ​Level II codes were developed to identify products and supplies for which there are no CPT codes.
B) ​Level II codes are composed of one alpha and four numeric characters.
C) Level II G codes are temporary codes for procedures,services,and supplies.
D) ​All of the above

Question 56

​The main rule to remember of the ICD coding rules,which says that the reason for the patient visit (encounter)is coded first is known as the:

A) ​indexing rule
B) ​reason rule
C) ​supporting rule
D) ​classification rule

Question 57

​A payer practice in which a reported evaluation and management service is reduced to a lower level based strictly on the diagnosis code reported is known as:

A) ​upcoding
B) ​bundling
C) ​downcoding
D) ​unbundling

Question 58

Identify whether each of the following is a format characteristic of the ICD-9-PCS or the ICD-10-PCS.(Answers may be used more than once. )
No decimal is used

A)ICD-9-PCS
B)ICD-10-PCS

Question 59

​Match the "general rules" for assigning CPT or ICD codes.Note: Answers may be used more than once.
​Analyze the provider's statement or description for the service provided and isolate the main term

A)​CPT
B)​ICD

Question 60

​Match the "general rules" for assigning CPT or ICD codes.Note: Answers may be used more than once.
​Code each problem to the highest level of specificity (third,fourth,or fifth digit)available in the classification

A)​CPT
B)​ICD

Question 61

​The ICD-9-CM manual is organized into three volumes.Match the Volume with the description provided.Note: Answers may be used more than once.
​includes supplementary classifications such as V-codes (factors influencing health status and contact with health service)and E-codes (external causes of injury and poisoning)

A)​Volume I
B)​Volume II
C)​Volume III

Question 62

​The ICD-9-CM manual is organized into three volumes.Match the Volume with the description provided.Note: Answers may be used more than once.
​Contains appendices of M-codes-Morphology of Neoplasms

A)​Volume I
B)​Volume II
C)​Volume III

Question 63

​The ICD-9-CM manual is organized into three volumes.Match the Volume with the description provided.Note: Answers may be used more than once.
​Contains appendices of List of Three-Digit Categories

A)​Volume I
B)​Volume II
C)​Volume III

Question 64

​The ICD-9-CM manual is organized into three volumes.Match the Volume with the description provided.Note: Answers may be used more than once.
​Section 2-Table of Drugs and Chemicals

A)​Volume I
B)​Volume II
C)​Volume III

Question 65

​The ICD-9-CM manual is organized into three volumes.Match the Volume with the description provided.Note: Answers may be used more than once.
​Contains appendices of Classification of Industrial Accidents According to Agency

A)​Volume I
B)​Volume II
C)​Volume III

Question 66

​The ICD-9-CM manual is organized into three volumes.Match the Volume with the description provided.Note: Answers may be used more than once.
​Hospital codes use this volume to code procedures

A)​Volume I
B)​Volume II
C)​Volume III

Question 67

​Match the "general rules" for assigning CPT or ICD codes.Note: Answers may be used more than once.
​The reason for the patient visit (encounter)is coded first

A)​CPT
B)​ICD

Question 68

​The ICD-9-CM manual is organized into three volumes.Match the Volume with the description provided.Note: Answers may be used more than once.
​Section 3-Index to External Causes of Injuries and Poisonings (for assigning E-codes)

A)​Volume I
B)​Volume II
C)​Volume III

Question 69

​Four major objectives guided the development of ICD-10-PCS.Match the objective to its definition.
​Each character within a code should have the same meaning within the same procedure section and across other procedure sections

A)​completeness
B)​expandability
C)​multiaxial
D)​standardized terminology

Question 70

​The ICD-9-CM manual is organized into three volumes.Match the Volume with the description provided.Note: Answers may be used more than once.
​Section 1-Alphabetic Index to Diseases and Injuries

A)​Volume I
B)​Volume II
C)​Volume III

Question 71

​Match the "general rules" for assigning CPT or ICD codes.Note: Answers may be used more than once.
​The codes have to be sequenced in relation to the intensity and level of service provided

A)​CPT
B)​ICD

Question 72

​Match the "general rules" for assigning CPT or ICD codes.Note: Answers may be used more than once.
​Review all descriptions of codes listed for main terms and subterms to be sure the correct code is selected

A)​CPT
B)​ICD

Question 73

​The ICD-9-CM manual is organized into three volumes.Match the Volume with the description provided.Note: Answers may be used more than once.
​Is an alphabetic index organized into three main sections

A)​Volume I
B)​Volume II
C)​Volume III

Question 74

​Match the "general rules" for assigning CPT or ICD codes.Note: Answers may be used more than once.
​Code correctly and completely any diagnosis or procedure that affects the care,influences the health status,or is a reason for treatment on that visit

A)​CPT
B)​ICD

Question 75

​Match the "general rules" for assigning CPT or ICD codes.Note: Answers may be used more than once.
​Check for any relevant subterms under the main term

A)​CPT
B)​ICD

Question 76

​The ICD-9-CM manual is organized into three volumes.Match the Volume with the description provided.Note: Answers may be used more than once.
​Contains appendices of Classification of Drugs by the American Hospital Formulary

A)​Volume I
B)​Volume II
C)​Volume III

Question 77

​The ICD-9-CM manual is organized into three volumes.Match the Volume with the description provided.Note: Answers may be used more than once.
​A tabular list,organized into 17 chapters,with conditions listed by body systems in one chapter and by conditions according to their causes in another chapter

A)​Volume I
B)​Volume II
C)​Volume III

Question 78

​Four major objectives guided the development of ICD-10-PCS.Match the objective to its definition.
​Meanings of terms within ICD-10-PCS should be the same regardless of whether they have multiple meanings in everyday usage

A)​completeness
B)​expandability
C)​multiaxial
D)​standardized terminology

Question 79

​ICD-10-CM will enhance coding.Benefits include:

A) ​greater coding accuracy and specificity
B) ​improvement in tracking and responding to international public health threats
C) ​higher-quality information for assessing quality,safety,and efficiency
D) ​all of the above

Question 80

​Four major objectives guided the development of ICD-10-PCS.Match the objective to its definition.
​There is a unique code for all substantially different procedures

A)​completeness
B)​expandability
C)​multiaxial
D)​standardized terminology