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Medical Billing and Coding (MBC1) ICD
Questions and Answers.
The standard office visit fee for a procedure is $1400. Your physician is contracting with ABC insurance and the fee schedule is $1275, what would the contractual adjustment be? a) $ b) $ c) $1. d) $1.120 - Correct answer a) $ If both parents have health insurance, the parent whose insurance is primary is the a) Mother b) Father c) One who has had insurance the longest d) One whose birthday is first in the year - Correct answer d) One whose birthday is first in the year In ICD-10-CM, a placeholder character is used for codes requiring the seventh character extender. This placeholder is represented as a) A default code b) An A c) An X d) An 1 - Correct answer c) An X What does the prefix "hypo-" mean? a) Large b) Abnormal c) Above Normal d) Below Normal - Correct answer d) Below Normal If the doctor is a Participating Provider, what does this mean?
a) The payment goes to the patient and the doctor must bill the patient for any services rendered b) The physician is a certified HIPAA doctor c) The physician will accept the amount paid by the insurance company and will be responsible to write off the non-allowed amount d) The physician can charge what they feel is reasonable and customary for their geographical location and will be paid 100% of their fee - Correct answer c) The physician will accept the amount paid by the insurance company and will be responsible to write off the non-allowed amount When a claim is "denied' by the insurance carrier. What is your next step? a) Write off the charge because it cannot be billed to the patient b) Investigate to see why it was denied and rebill with information to support payment c) Appeal claim with State Insurance Commissioner d) Give all appeals to your office administrator or physician for them to review before you write off any charges - Correct answer b) Investigate to see why it was denied and rebill with information to support payment The radius is located in the: a) Lower leg b) Upper leg c) Lower arm d) Upper arm - Correct answer c) Lower arm Which answer below is not covered under Medicare Part A? a) Skilled Nursing Hospital services b) Skilled Nursing Home services c) Physician Office services d) Hospice services - Correct answer c) Physician Office services
The fluid part of the blood is called: a) Red blood cells b) White blood cells c) Platelets d) Plasma - Correct answer d) Plasma NEC means not elsewhere coded. a) True b) False - Correct answer a) True If an ICD-10 code ends with the letter A, it means that this is the first encounter. a) True b) False - Correct answer a) True Treatment for a compound fracture to the left tibia due to a fall from a ladder while completing a task at work should be billed to: a) The patient's healthcare insurance b) No-fault insurance c) Medicare accident coverage d) None of the above - Correct answer d) None of the above The largest section of the CPT codebook is: a) Surgery b) Table of Neoplasms c) Anesthesia d) Table of Drugs and Chemicals - Correct answer a) Surgery In which ICD-10 code range would you find the code for «painful respiration"? a) C00 - 149 b) JOO - 199 c) 100 - 199 d) VOO - Y99 - Correct answer b) JOO - 199
Deductible must be met before payment can be expected for insurance providers. a) True b) False - Correct answer a) true A "+" in front of a code identifies it as a(n): a) Non-payable code b) Add-on code c) Bilateral procedure d) Surgical package - Correct answer b) Add-on code Obtaining insurance carrier's consent to proceed with patient care and treatment is: a) Beneficiary b) Modifier c) Medicare Part D d) Preauthorization - Correct answer d) Preauthorization Separating a code so that you can make more money is known as: a) Unbundling codes b) Bundled codes c) Neoplasm codes d) External cause codes - Correct answer b) Bundled codes A person under another person's policy that is eligible to receive benefits is known as: a) Bundled codes b) Modifier c) Ecodes d) Beneficiary - Correct answer d) Beneficiary This 58 year-old male patient is having an outpatient procedure in an Ambulatory Surgery Center. Prior to the administration of
The payment a patient receives from an insurance company is known as a: a) Claim b) Reimbursement c) Payment option d) Payment entry - Correct answer b) Reimbursement If a patient does not have any health coverage, what portion of the bill are they responsible for? a) All b) Half c) None d) It depends on the healthcare facility visited - Correct answer a) All Which answer below is covered under Medicare Part B? a) Skilled Nursing Home services b) Skilled Hospice Care services C) Physician Office services d) Hospital services - Correct answer C) Physician Office services If a patient has Medicare and Medicaid, which is primary? a) Medicare b) Medicaid c) Depends on the age of the patient d) Depends on program they have had the longest - Correct answer c) Depends on the age of the patient What organ stores bile until needed for digestion? a) Liver b) Pancreas c) Kidney d) Gallbladder - Correct answer d) Gallbladder
What is the name of the standard claim form used to submit hospital services to Medicare and other insurance payers? a) UB b) CMS c) CMS d) HAS - Correct answer a) UB In which ICD-10 code range would you find the code for "endometriosis of ovary"? a) E00 - E b) 000 - 0094 c) 100 - 199 d) JOO - 199 - Correct answer b) 000 - 0094 On a CMS 1500 claim form, what block is used for the diagnosis codes? a) Box 24E b) Box 24D c) Box 21 d) Box 24 - Correct answer c) Box 21 What does CPT stand for? a) Current Procedural Terminology b) Current Practicing Terminology c Clinical Procedural Terminology d) Clinical Practicing Terminology - Correct answer a) Current Procedural Terminology A patient comes into the office with ear pain. After further examination it is revealed the patient has severe cerumen impaction. The doctor removes the ear wax from both ears. What modifier is used with removal of impacted cerumen for both ears? a) 25 b) 50
b) Per government regulations, you have only 30 days from the date of service to file insurance claims c) You must file the claim within a set amount of time vour insurance contract indicates for it to be paid d) You must file the claim within 60 days of dictation by the provider that an insurance company will cover. - Correct answer c) You must file the claim within a set amount of time vour insurance contract indicates for it to be paid A formulary is a list of a) Surgical procedure costs b) Prescription drug costs c) Outpatient procedures d) Emergency room conditions - Correct answer b) Prescription drug costs If the physician had to stop in the middle of a procedure because the patient's blood pressure was dropping and they could not stabilize it, which modifier would you use? a) 23 b) 52 c) 53 d) None would be used - Correct answer c) 53 The term "aging" refers to unpaid insurance claims or patient balances that are due past Days. a) 10 b) 30 c) 90 d) 120 - Correct answer c) 90 Veins carry: a) oxygenated blood b) blood away from the heart
c) blood toward the heart d) lumen - Correct answer c) blood toward the heart The physician bills for a procedure in the amount of $100.00. Medicare allows $80.00 and the patient is responsible for 20% of the allowable. How much is paid to the physician by Medicare? a) 84 b) 16 c) 64 d) 20 - Correct answer c) 64 Mental disorders are classified using ICD-10 codes in the range of a) FOO - F b) MOO - M c) JOO - J d) 100 - 199 - Correct answer a) FOO - F Industry updates should be set in the medical billing software: a) True b) False - Correct answer a) True An "S at the end of an ICD-10 code indicates an initial encounter. a) True b) False - Correct answer b) False A patient is seen in the office because of complications with his diabetes and thyroid. The doctor ordered lab work, took a detailed history and performed an examination. The patient also had a skin tag that he asked the doctor to remove from his neck that was bothersome. What modifier would be used for this office visit? a) 25 b) 59 c) 51
d) Box 11 - Correct answer c) Box 9 A crossover claim is when claim information is ______ sent from Medicare to a secondary insurance company. a) Never b) Accidentally c) Incompletely d) Automatically - Correct answer d) Automatically Which of the following diagnoses would be coded using the Table of Neoplasms? a) Cyclophoria b) Aphakia of right eye (due to trauma) c) Benign carcinoid tumor of the small intestine, unspecified portion d) Newborn esophageal reflux - Correct answer c) Benign carcinoid tumor of the small intestine, unspecified portion ______ insurance is an extra insurance policy that covers claims for deductibles and coinsurance. a) Additional b) Tertiary c) Security d) Supplemental - Correct answer d) Supplemental What is the definition of "deductible"? a) The amount the insurance company will pay before patient co- insurance benefits are calculated b) A specific dollar amount set by the insurance company for medical service that is rendered c) The amount the patient is financially responsible for before an insurance policy provides payment d) The amount the insurance company is financially responsible for before other benefits are paid - Correct answer c) The amount
the patient is financially responsible for before an insurance policy provides payment Which word part pertains to the kidneys? a) lith/o b) -lysis c) nephr/o d) -uria - Correct answer c) nephr/o ICD-10-CM codes 000-099 are used to describe a) Pregnancy, childbirth, and the puerperium b) Certain infectious and parasitic diseases c) Diseases of the circulatory system d) Diseases of the skin and subcutaneous tissue - Correct answer a) Pregnancy, childbirth, and the puerperium All CPT codes begin with a letter. a) True b) False - Correct answer b) False What is an HMO? a) A utilization management program that performs external utilization review services b) Prior authorizations that are required for outpatient services c) Amounts commonly charged for a service within a particular geographic region d) A type of health coverage - Correct answer b) Prior authorizations that are required for outpatient services What is the name of the tube that connects the larynx to the right and left bronchi? a) Trachea b) Thyroid cartilage c) Vocal Cords d) Epiglottis - Correct answer a) Trachea
A -degree burn involves blisters and damage to the dermis and epidermis. a) first b) second c) third d) dermabrasion - Correct answer b) second Which diagnosis would require the use of the Table of Drugs and Chemicals? a) Adverse effect of carbonic-anhydrase inhibitors, benzodiazepines and other diuretics, initial encounter b) Dependence on renal dialysis c) Fecal impaction d) Phonological disorder - Correct answer a) Adverse effect of carbonic-anhydrase inhibitors, benzodiazepines and other diuretics, initial encounter Which of the following is one of the benefits of the ICD-10-CM and ICD-10-PCS? a) Identifying fraud and abuse b) Designing payment systems and processing claims c) Enhanced ability to conduct public health surveillance d) All of the above - Correct answer d) All of the above A patient has a biopsy of deep cervical lymph nodes on May 8 and the pathology a report comes back showing malignancy. She elects to have a lymphadectomy on May 11 by her physician. What modifier would be used on the lymphadenectomy? a) 57 b) 58 c) 76 d) 78 - Correct answer a) 57 Where are modifiers entered on the CMS 1500 form? a) Box 22
b) Box 9 c) Box 24 d) Box 12 - Correct answer c) Box 24 If the provider does not have a contract with a commercial insurance carrier, you can bill the patient for usual and customary fees. a) True b) False - Correct answer b) False Which of the following is the correct range for codes for anesthesia? a) 00100- b) 10021- c) 70010- d) 90281-99199 - Correct answer a) 00100- CPT coding allows the provider to be paid for telephone conversations with patients: a) Under certain circumstances b) Never c) Always d) Only if provider is a pediatrician - Correct answer c) Always To qualify for Medicare coverage, the recipient must: a) Be 65 or older b) Have permanent kidney failure c) Be disabled d) Any of the above - Correct answer d) Any of the above Dx is an abbreviation for code. a) Symptom b) Prescription c) Diagnosis
The process of checking an insurance claim for errors is known as a) Scrubbing b) Fact-checking c) Washing d) Double-checking - Correct answer a) Scrubbing The second digit in all ICD-10 codes must be numerical. a) True b) False - Correct answer a) True A child can be covered on their parent's insurance at age 24 if they are: a) Underemployed b) Diagnosed with cancer c) A full-time student d) Never; coverage stops at 23 - Correct answer c) A full-time student The Affordable Care Act is often referred to as: a) Obamacare b) COBRA c) Medicare d) Medicaid - Correct answer a) Obamacare The following code range would be the place to find the code for "Corrosion of third degree of right thigh, initial encounter: a) JOO - J b) T00 - T c) 100 - 199 d) K00 -K95 - Correct answer b) T00 - T An insurance claim that results from a work-related injury or illness is known as a) Disability insurance
b) Workers' compensation c) Long-term care insurance d) Medicaid - Correct answer b) Workers' compensation A nurse is preparing the patient for his colonoscopy. Patient informs the nurse he has taken all steps necessary for his prep. The doctor performs a colonoscopy but after advancing the scope past the splenic flexure the physician must fop the procedure because the patient did not ily cleanse the large intestine and he is unable to ontinue the procedure. What modifier would be attached to the procedure? a) 52 b) 53 c) 58 d) 76 - Correct answer b) 53 Another name for the eardrum is? a) Tympanic membrane b) Malleus c) Cochlea d) Incus - Correct answer a) Tympanic membrane All Evaluation and Management codes begin with the # 9. a) True b) False - Correct answer b) False The place of service code for procedures performed in an independent laboratory is: a) 11 b) 81 c) 23 d) 90 - Correct answer d) 90 With the passage of the Affordable Care Act, insurance carriers can deny claims for preexisting conditions:
