Test Bank Chapter 19 Procedural Coding

1.

To ensure reimbursement at the highest allowed level, CPT codes must ____.  
 

2.

The most frequently used CPT codes are the ____.  
 

3.

For reporting an evaluation and management code, CPT considers a patient to be “new” if the patient has not received professional services from any provider in the medical practice within the past ____ year(s).  
 

4.

When unbundling is done intentionally to receive more payment than is allowed, the claim is likely to be considered ____.  
 

5.

The Healthcare Common Procedure Coding System (HCPCS) was originally developed for use in coding services, such as durable medical equipment, for ____.  
 

6.

Analysis of the connection between the diagnostic and procedural information on a claim is called ____.  
 

7.

An act of deception used to take advantage of another person or entity is called ____.  
 

8.

A healthcare provider who practices under false qualifications or credentials is guilty of ____.  
 

9.

Medical offices usually have a(n) ____ to help minimize the risk of fraud by discovering and correcting coding and billing problems.  
 

10.

Having a medical practice compliance plan in place ____.  
 

11.

A medical provider bills separately for a comprehensive metabolic panel and a quantitative glucose test, which is normally included in the metabolic panel. This is an example of which of the following fraudulent coding and billing practices?  
 

12.

When a patient has no symptoms of a disease and the provider performs the tests for that disease at the patient's request, the provider has committed which of these fraudulent coding and billing practices?  
 

13.

Billing for a moderate level evaluation and management service when only a simple BP check and injection were carried out is an example of ____.  
 

14.

There is a question concerning a claim for a procedure submitted last year. Where will you look to double-check the codes in question?  
 

15.

A plus sign (+) is used to indicate ____.  
 

16.

Modifiers to CPT codes indicate ____.  
 

17.

National codes issued by CMS that cover many supplies and durable medical equipment are ____.  
 

18.

Inaccuracy in linking diagnostic codes and procedural codes will result in all of the following except ____.  
 

19.

The CPT is updated and new codes are provided for use beginning ____.  
 

20.

Which of the following is not one of the six main sections in the CPT manual?  
 

21.

In order to find information regarding prefixes and suffixes used in the CPT coding manual, you would look in the ____.  
 

22.

Which of the following best describes the CPT code format?  
 

23.

To complete the description for a CPT code that has an indented description, you should ____.  
 

24.

When coding CPT procedures, an add-on code will describe ____.  
 

25.

If a code description has changed since the last revision of the CPT manual, what symbol is placed next to the CPT code?  
 

26.

What symbol next to a CPT code tells you that moderate sedation is included in the procedure?  
 

27.

What symbol appears next to codes that are new since the last CPT revision?  
 

28.

What symbol appears next to a code that appears out of numerical sequence?  
 

29.

A modifier indicates that ____.  
 

30.

Where in the CPT manual will information about the proper use of modifiers be found?  
 

31.

Where in the CPT manual can you find a complete listing of all add-on codes?  
 

32.

Dr. Moore is scheduled to perform a routine removal of a mole from Ralph's left shoulder under local anesthesia. Dr. Moore has injected the local anesthetic and is about to begin the procedure when Ralph suddenly has a panic attack and states, "I just can't handle this!" Dr. Moore halts the procedure. When you code for this procedure, which of the following modifiers will you use?  
 

33.

Dr. Breckell is scheduled to perform a cyst removal on Haley's right hand. After he begins the procedure, he notices that the cyst is much larger than anticipated and is involved with nerves and ligaments in the right thumb. Complete cyst removal takes 30 minutes longer than expected. Which modifier would you use to describe this special circumstance?  
 

34.

An example of a Category II code is a code used for ____.  
 

35.

Which of the following items is not required for a service to be considered a consultation?  
 

36.

Counseling codes are used only if ____.  
 

37.

Which of the following is not a potential reason for downcoding?  
 

38.

For coding purposes, which of the following is not a level of patient history?  
 

39.

For coding purposes, which of the following is not a complexity level for medical decision making?  
 

40.

Nathan is in the medical office today complaining of a sore throat and fever. After ruling out strep throat, the practitioner diagnoses a common cold and tells Nathan to take over-the-counter medications for symptom relief. In which category does Nathan’s chief complaint fall?  
 

41.

Which of the following statements about surgical coding for the musculoskeletal system is not true?  
 

42.

Which subsection of the surgery section include procedures on the spleen and bone marrow?  
 

43.

How many codes are required for giving a patient an injection of a vaccine?  
 

44.

When coding a surgical code, where should you look to be sure you find the correct code?  
 

45.

You have consulted the index in the CPT and discovered that a dressing for a burn is found in procedure codes 16010-16030. To correctly code the dressing for the burn, you should ____.  
 

46.

After you decide on the appropriate CPT code(s) for a procedure, you should ____.  
 

47.

Which of the following best describes HCPS Level II codes?  
 

48.

A plus sign (+) is used for ________ codes, indicating procedures that are carried out in addition to a main procedure.  
 
________________________________________

49.

A(n) ________ plan is a strategy for finding, correcting, and preventing fraudulent medical office practices.  
 
________________________________________

50.

The CPT contains codes that represent medical ________, such as surgery and diagnostic tests, and medical services, such as an examination to evaluate a patient's condition.  
 
________________________________________

51.

_______ codes are the most frequently used of all CPT codes because they are used by all physicians in any medical specialty.  
 
________________________________________

52.

A(n) ________ patient is one that has been seen by any providers in the same specialty of the medical practice within the past three years.  
 
________________________________________

53.

The period of time that is covered for follow-up care after surgery is called the ________ period.  
 
________________________________________

54.

The use of a(n) ________ with a CPT code shows that some special circumstance applies to the service or procedure the physician performed.  
 
________________________________________

55.

The CPT considers a patient ________ if that person has not received professional services from the physician within the last three years.  
 
________________________________________

56.

You will locate procedure codes in the __________ manual.  
 
________________________________________

57.

The extent of the __________ conducted is one of the key factors that determine the level of service based on guidelines in the E/M section of the CPT.  
 
________________________________________

58.

The ________ of the medical decision making is a key factor in determining the level of E/M codes selected.  
 
________________________________________

59.

The extent of the patient ________ taken is a key factor in determining the level of E/M codes selected.  
 
________________________________________

60.

The HCPCS ________ codes are more commonly known as CPT codes.  
 
________________________________________

61.

An example of an HCPCS Level ________ code is E0781, for an ambulatory infusion pump.  
 
________________________________________

62.

HCPCS Level II codes are called ________ codes and cover supplies and DME.  
 
________________________________________

63.

The ________ coding system has two levels and is used for coding services for Medicare patients.  
 
________________________________________

64.

Each procedure or service performed on or for a patient during a patient encounter is reported on healthcare claims using a(n) ________ code.  
 
________________________________________

65.

Similar care that is being provided to the same patient by more than one physician is known as ________ care.  
 
________________________________________

66.

The fraudulent practice of coding a procedure or service at a higher level than that provided to receive a higher level of reimbursement is known as code creep, overcoding, overbilling, or ________.  
 
________________________________________

67.

Care provided to unstable, critically ill patients that require constant bedside attention is known as ________ care.  
 
________________________________________

68.

Any code that includes more than one procedure in its description is considered a(n) ________ code.  
 
________________________________________

69.

When an insurance carrier bases reimbursement on a code level lower than the one submitted by the provider, this is called ________.  
 
________________________________________

70.

One of the elements of a physical exam is the ________ exam, which can include any of the following: BP sitting or lying, pulse, respirations, temperature, height, weight, and general appearance.  
 
________________________________________

71.

A patient comes to the office for an annual physical and at the end of the examination the patient complains of low back pain that has been bothering him for a few weeks.  Which modifier should be used with the E/M code for the low back pain to explain the need for two E/M codes at the same visit?  
 

72.

In order for a service to be considered a consultation, the service must meet the 3Rs. Which of the following are the correct 3Rs?  
 

73.

When coding E/M from the CPT manual, you must first know whether the patient is new or ______ and where the services took place.  
 
________________________________________

74.

G0008 is an example of a ______ level II code.  
 
________________________________________

75.

A maximum of up to ___ modifiers can be assigned per CPT procedure code?