Certified Professional Coding Test questions and answers GRADED A

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Certified Professional Coding Test questions and answers GRADED A Coding is Correct Answer: the process of translating this written or dictated medical record into a series of numeric or alpha-num ... eric codes Proper code assignment is determined by Correct Answer: content of the medical record and by the unique rules that governs each code set What are 3 things that Coder must master Correct Answer: 1. anatomy 2. medical terminology 3. must be detail-oriented Medical coders assign a code to what Correct Answer: 1. Each diagnosis 2. Service/procedure 3. Supply, using the classification system when applicable The classification system determines ______ Correct Answer: the amount health care providers will be reimbursed if the patient is covered by Medicare, Medicaid, or other insurance programs using the system A coder must evaluate the medical record for Correct Answer: 1. completeness and accuracy 2. communicate regularly with physicians and the health care professional to clarify DX or obtain additional PT info. Techicians who speciallize in coding inpatient hospital services are referred as Correct Answer: 1. Health information coders 2. medical record coders 3. Coder/abstractors 4. Coding Specialist What is MS-DRGs and what does it do? Correct Answer: 1. Medicare Severity-Diagnosis Related Groups 2. Determines the amt the hospital will be reimbursed if the PT is covered by Medicare or other insurance programs What is EHR Correct Answer: Electronic health record Skilled coders may become Correct Answer: consulatants, educators or medical auditors What is the difference between Hospital and Physican Services Correct Answer: 1. Outpatient coding (physician services)- learning CPT, HCPCS, LEVEL II, ICD-9 CM codes Volume 1 and 2 2. Inpatient coding (Hospital services)- Learning CPT, ICD-9 CM codes Volumes 1,2,3 and MS-DRGS What is APC and who uses it Correct Answer: Ambulatory Payment Classification- outpatient facility coders (physician services What is the coder's role in a physician's office Correct Answer: Extremely important for the proper reimbursement of services and the livelihood of the physician What is a physican degree of education Correct Answer: 4 years of college, 4 years of medical school plus 3 to 5 years of residency. What are mid-level providers and who can be classified as one? Correct Answer: 1. Mid-level providers are know as physician extenders 2. Physician assistants (PA) and Nurse Practitioners (NP) What are the requirement for a PA and what Correct Answer: 1. 26 1/2 month program to complete 2. Licensed to practice medicine under physician supervision NP must have Correct Answer: A Master's Degree in Nursing In simplest terms, how many payers are there? Correct Answer: 2 Private insurance plans and government insurance plans Commercial carriers are considered what Correct Answer: Private payers that offer both group and individual plans. Private Payers contracts may vary but may include _____ Correct Answer: hospitalization, basic, and major medical coverage. What is the most significant government insurer Correct Answer: Medicare What is Medicare Correct Answer: Federal health insurance program- Administered by the Center for Medicare & Medicaid Services (CMS) What is CMS and what does it provide Correct Answer: Center for Medicare & Medicaid Services (CMS) provides coverage for people over the age of 65, blind, or disabled individuals, people with end -stage renal disease CMS regulations often serves as the____ word in coding requirement for Medicare and Non-Medicare payers alike Correct Answer: Last What are the parts of Medicare Correct Answer: Medicare A Medicare B Medicare C Medicare D What is Medicare Part A? Correct Answer: Covers inpatient hospital care, as well as care provided in skilled nursing facilites, hospice care, and home health care What is Medicare Part B? Correct Answer: Covers medically necessary doctors' services, outpatient care, other medical services (including some preventive service not covered under Medicare Part A) Medicare Part B is considered what? Correct Answer: A optional benefit for which the patient must pay a premium and which generally requires a yearly copay Where is Medicare Part B usually used Correct Answer: Physician offices (Outpatient Facility) What is Medicare Part C Correct Answer: Combines the benefits of Medicare Part A, Part B, and sometimes Part D. What is Medicare Part C also called Correct Answer: Medicare Advantage What is PPO Correct Answer: Preferred Provider Organizations What is HMO Correct Answer: Health Maintenace Organizations Which plan covers PPO and HMO Correct Answer: Medicare Part C What is the CMS-HCC Correct Answer: Center for Medicare & Medicaid Services-Hierarchical condition category What does the CMS-HCC provide Correct Answer: Risk adjument model provides adjusted payment based on a patient's disease and demographic factors. If a coder does not include all pertinent diagnoses and co-morbidities, the provider may lose out on what Correct Answer: additional reimbursement for which he/she is entitled. What is Medicare Part D Correct Answer: Prescription drug coverage program available to all Medicare beneficiaries. Private companies approved by Medicare provide the coverage. What is Medicaid Correct Answer: A health insurance assistance program for some low income people (especially children and pregnant women) sponsored by federal and state governments Medicaid is administered on___________ Correct Answer: a state-by-state basis and coverage varies- although each of the state programs adheres to certain federal guidelines When is a physican considered a "participating physician" Correct Answer: When contracted with a insurance carrier whether that be a private insurance company or a governmental. Participating Providers (Par Providers) are required to accept__________________ Correct Answer: the allowed payment amount determined by the insurance carrier as the fee for payment and follow all other guidelines stipulated by the contract The difference between the physican's fee and the insurance carriers allowed amount is Correct Answer: adjusted by the participating provider Non-participating Providers (non par) are? Correct Answer: 1. providers not contracted with the insurance carriers 2. not required to make the adjustment What is limiting charge Correct Answer: Limits set on what can be charged for each CPT code, no matter if the physican is Par or Non-Par What is a medical record Correct Answer: Documentation or the recording of pertinent facts and observation about an individual's health history, including past and present illness, tests, treatments and outcomes Medical record chronologically Correct Answer: documents patient care to assist in continuity of care between providers, facilitate claims review and payment Can a Medical record serve as legal document Correct Answer: YES All services provided to a patient are_______ Correct Answer: supported and documented in the medical record What are coders required to do with the medical records? Correct Answer: Read and understand the documentation in the medical record in order to accurately code the services rendered. What are some different types of services documented in a medical record? Correct Answer: Evaluation and management Operative reports X-Rays Evaluation and Management services are provided in what standard format Correct Answer: SOAP What is SOAP documentation? Correct Answer: S- Subjective O-Objective A- Asssessment P-Plan What is the definition of O in SOAP? Correct Answer: objective-The provider assesses and documents the patient's illness using observation, palpation, auscultation and percussion. Test and other services performed may be documented here as well What is the definition of A in SOAP? Correct Answer: Assessment-Evaluation and conclusion made by the provider. This is usually where the diagnosis(es) for the services are found What is the definition of P in SOAP? Correct Answer: Plan-Course of Action. Here, the provider will list eh next steps for the patient, whether it is ordering additional test, or taking over the counter medication What is a operative report Correct Answer: a document the detail of a procedure performed on a patient What will most operative notes have Correct Answer: Header and Body what are some of things that operative header note might include? Correct Answer: 1. Date and time of procedure 2. Name of surgeon, co-surgeon, assistant surgeon 3. Typer of anethesia and anestheiology provider name 4. Pre-operative and post-operative diagnoses 5. Procedures performed 6. Complications What are some of things that operative body note might include? Correct Answer: 1. indication for surgery 2. details of the procedure (s) 3. Findings What is the approximate percentage of an operative report that contains words less important to a coder? Correct Answer: 20 % What is the task for a coder with an operative report? Correct Answer: to break down the information and applying the correct code. What are the 5 most important Coding Tips for operative reports for a coders Correct Answer: 1. Diagnosis code reporting 2. Start with the procedures listed 3. Look for key words 4. Highlight unfamiliar words 5. Read the body What does the first coding tip mean for the operative report for a coder ? Correct Answer: Diagnosis code reporting- Use the post-operative diagnosis for coding unless there are further defined diagnoses or additional diagnoses found in the body or finding of the operative report. What does the second coding tip mean for the operative report for a coder? Correct Answer: Start with the procedures listed- For the coder who is new to coding a procedure , one way of quickly starting the research process is by focusing on the procedures listed in the header. Read the note in its entirety to verify the procedures performed. Procedures listed in the header may not be listed correctly and procedures documented with the body of the report may not be listed in the header at all. It will help a coder with a place to start What does the third coding tip mean for the operative report for a coder? Correct Answer: Look for key words- Key words may include locations ana anatomical structures involved, surgicial approach, procedure method, procedure type, siiz and number and the surgical instruments used during the procedure What does the fourth coding tip mean for the operative report for a coder? Correct Answ [Show More]

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