Medical Coding 300plus questions with
answers to study ICD-10 coding
(Answered)
Coding is
the process of translating this written or dictated medical record into a series of numeric
or alpha-numeric codes
Proper code assignment is determined by
content of the medical record and by the unique rules that governs each code set
What are 3 things that Coder must master
1. anatomy
2. medical terminology
3. must be detail-oriented
Medical coders assign a code to what
1. Each diagnosis
2. Service/procedure
3. Supply, using the classification system when applicable
The classification system determines ______
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
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
1. Health information coders
2. medical record coders
3. Coder/abstractors
4. Coding Specialist
What is MS-DRGs and what does it do?
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
Electronic health record
Skilled coders may become
consulatants, educators or medical auditors
What is the difference between Hospital and Physican Services
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
,Ambulatory Payment Classification- outpatient facility coders (physician services
What is the coder's role in a physician's office
Extremely important for the proper reimbursement of services and the livelihood of the
physician
What is a physican degree of education
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?
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
1. 26 1/2 month program to complete
2. Licensed to practice medicine under physician supervision
NP must have
A Master's Degree in Nursing
In simplest terms, how many payers are there?
2
Private insurance plans and government insurance plans
Commercial carriers are considered what
Private payers that offer both group and individual plans.
Private Payers contracts may vary but may include _____
hospitalization, basic, and major medical coverage.
What is the most significant government insurer
Medicare
What is Medicare
Federal health insurance program- Administered by the Center for Medicare & Medicaid
Services (CMS)
What is CMS and what does it provide
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
Last
What are the parts of Medicare
Medicare A
Medicare B
Medicare C
Medicare D
What is Medicare Part A?
Covers inpatient hospital care, as well as care provided in skilled nursing facilites,
hospice care, and home health care
What is Medicare Part B?
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?
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
Physician offices (Outpatient Facility)
What is Medicare Part C
Combines the benefits of Medicare Part A, Part B, and sometimes Part D.
What is Medicare Part C also called
Medicare Advantage
What is PPO
Preferred Provider Organizations
What is HMO
Health Maintenace Organizations
Which plan covers PPO and HMO
Medicare Part C
What is the CMS-HCC
Center for Medicare & Medicaid Services-Hierarchical condition category
What does the CMS-HCC provide
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
additional reimbursement for which he/she is entitled.
What is Medicare Part D
Prescription drug coverage program available to all Medicare beneficiaries. Private
companies approved by Medicare provide the coverage.
What is Medicaid
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___________
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"
When contracted with a insurance carrier whether that be a private insurance company
or a governmental.
Participating Providers (Par Providers) are required to
accept__________________
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
adjusted by the participating provider
Non-participating Providers (non par) are?
1. providers not contracted with the insurance carriers
2. not required to make the adjustment
What is limiting charge
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
answers to study ICD-10 coding
(Answered)
Coding is
the process of translating this written or dictated medical record into a series of numeric
or alpha-numeric codes
Proper code assignment is determined by
content of the medical record and by the unique rules that governs each code set
What are 3 things that Coder must master
1. anatomy
2. medical terminology
3. must be detail-oriented
Medical coders assign a code to what
1. Each diagnosis
2. Service/procedure
3. Supply, using the classification system when applicable
The classification system determines ______
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
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
1. Health information coders
2. medical record coders
3. Coder/abstractors
4. Coding Specialist
What is MS-DRGs and what does it do?
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
Electronic health record
Skilled coders may become
consulatants, educators or medical auditors
What is the difference between Hospital and Physican Services
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
,Ambulatory Payment Classification- outpatient facility coders (physician services
What is the coder's role in a physician's office
Extremely important for the proper reimbursement of services and the livelihood of the
physician
What is a physican degree of education
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?
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
1. 26 1/2 month program to complete
2. Licensed to practice medicine under physician supervision
NP must have
A Master's Degree in Nursing
In simplest terms, how many payers are there?
2
Private insurance plans and government insurance plans
Commercial carriers are considered what
Private payers that offer both group and individual plans.
Private Payers contracts may vary but may include _____
hospitalization, basic, and major medical coverage.
What is the most significant government insurer
Medicare
What is Medicare
Federal health insurance program- Administered by the Center for Medicare & Medicaid
Services (CMS)
What is CMS and what does it provide
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
Last
What are the parts of Medicare
Medicare A
Medicare B
Medicare C
Medicare D
What is Medicare Part A?
Covers inpatient hospital care, as well as care provided in skilled nursing facilites,
hospice care, and home health care
What is Medicare Part B?
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?
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
Physician offices (Outpatient Facility)
What is Medicare Part C
Combines the benefits of Medicare Part A, Part B, and sometimes Part D.
What is Medicare Part C also called
Medicare Advantage
What is PPO
Preferred Provider Organizations
What is HMO
Health Maintenace Organizations
Which plan covers PPO and HMO
Medicare Part C
What is the CMS-HCC
Center for Medicare & Medicaid Services-Hierarchical condition category
What does the CMS-HCC provide
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
additional reimbursement for which he/she is entitled.
What is Medicare Part D
Prescription drug coverage program available to all Medicare beneficiaries. Private
companies approved by Medicare provide the coverage.
What is Medicaid
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___________
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"
When contracted with a insurance carrier whether that be a private insurance company
or a governmental.
Participating Providers (Par Providers) are required to
accept__________________
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
adjusted by the participating provider
Non-participating Providers (non par) are?
1. providers not contracted with the insurance carriers
2. not required to make the adjustment
What is limiting charge
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
