MEDICAL CODING PRACTICE EXAM 1
QUESTIONS WITH VERIFIED
ANSWERS
National Codes - Answer-Example:
Q0113 Pinworm examinations (kit given= supply billed)
A0100 Non-emergency transportation; taxi
D0270 Bitewing-single film
H0030 Behavioral health hotline service
J0120 Injection, tetracycline, up to 250 mg
P9019 Platelets, each unit
K0005 Ultralightweight wheelchair
Coding of underlying diseases - Answer-both the manifestation of the condition and
its underlying cause need to be listed. ITALICIZED codes are never to be reported
w/o an additional code and they are never to be reported as the patients primary
diagnosis.
Brackets [ ] - Answer-used to enclose synonyms, alternative wordings or explanatory
phrases
Parentheses ( ) - Answer-Used to enclose supplementary words which may or may
not be present in the disease statement and which do not affect code selection per
se.
Colon : - Answer-are placed after an incomplete term which requires one or more of
the modifying terms that follow it in order to make the code assignable to a given
category.
Braces { } - Answer-Used to enclose a series of terms, each of which is modified by
the statement appearing to the right of the brace.
ICD-9 volumes - Answer-Vol 1= "Diseases- Tabular List"
Vol 2= "Diseases- Alphabetical Index"
Vol 3= Listing of procedure codes and an index to the procedures.
"E" Codes - Answer-EXTERNAL causes of injuries and poisonings. Shouldn't be
listed as a primary diagnosis; they are considered supplementary codes.
Modifyer -59 - Answer-"DISTINCT PROCEDURE"
Indicates that codes that usually are bundled together as a part of a global code are
in this particular circumstance describing DISTINCT or SEPARATE precedures
Phantom Employees - Answer-Expensing employees or hours worked that do not
exist
Phantom Billing - Answer-Billing for tests not performed
, Code Jamming - Answer-Inserting or "jamming" incorrect ICD-9 code to get
coverage for a lab or test
Reflex Testing - Answer-Automatically running a test based on a previous test result
w/o the MD/PA requesting the second test
Services not Rendered - Answer-The simplest scheme of HC fraud is the billing for
services that were never rendered to patients
Up Coding - Answer-Inflating the seriousness of the patient's condition or the level of
E/M needed to help the patient to obtain a higher reimbursement the one is entitled
Unbounding - Answer-using tow codes when a combined code exists
Kickbacks - Answer-a bribe or financial incentive
Stark Law - Answer-a physician is prohibited from making any referral to a provider
of designated health services if the physician has a "financial relationship" with the
provider. a healthcare provider is prohibited from submitting for services rendered to
patients referred in violation of the statute
False information - Answer-Billing for services not provided or not at the level billed
for
False Claims Act- allows individuals to file claims against companies that they think
have defrauded the government. More than $17 billion dollars have been recovered
by the government since 1987
Lack of medical Neccessity - Answer-it is improper to bill medicare for services or
treatment that is not medically necessary. To knowingly do so is a violation of the
false claims act.
CPT, Category I - Answer-Evaluation and Management (E/M) Services
Describe services provided to evaluate patients and manage their care
These codes are widely used and cover a large portion of the medical care provided
to patients
Codes are specific to setting (office, hospital, ER, home) and whether it is a new or
established pt.
Codes are based on what was done (and documented) in three areas:
History
Physical examination
Medical decision making
bundling - Answer-Many procedure codes also include procedures and supplies that
are routinely necessary to perform the procedure
Only services not typically performed, or materials not typically used, should be billed
separately
QUESTIONS WITH VERIFIED
ANSWERS
National Codes - Answer-Example:
Q0113 Pinworm examinations (kit given= supply billed)
A0100 Non-emergency transportation; taxi
D0270 Bitewing-single film
H0030 Behavioral health hotline service
J0120 Injection, tetracycline, up to 250 mg
P9019 Platelets, each unit
K0005 Ultralightweight wheelchair
Coding of underlying diseases - Answer-both the manifestation of the condition and
its underlying cause need to be listed. ITALICIZED codes are never to be reported
w/o an additional code and they are never to be reported as the patients primary
diagnosis.
Brackets [ ] - Answer-used to enclose synonyms, alternative wordings or explanatory
phrases
Parentheses ( ) - Answer-Used to enclose supplementary words which may or may
not be present in the disease statement and which do not affect code selection per
se.
Colon : - Answer-are placed after an incomplete term which requires one or more of
the modifying terms that follow it in order to make the code assignable to a given
category.
Braces { } - Answer-Used to enclose a series of terms, each of which is modified by
the statement appearing to the right of the brace.
ICD-9 volumes - Answer-Vol 1= "Diseases- Tabular List"
Vol 2= "Diseases- Alphabetical Index"
Vol 3= Listing of procedure codes and an index to the procedures.
"E" Codes - Answer-EXTERNAL causes of injuries and poisonings. Shouldn't be
listed as a primary diagnosis; they are considered supplementary codes.
Modifyer -59 - Answer-"DISTINCT PROCEDURE"
Indicates that codes that usually are bundled together as a part of a global code are
in this particular circumstance describing DISTINCT or SEPARATE precedures
Phantom Employees - Answer-Expensing employees or hours worked that do not
exist
Phantom Billing - Answer-Billing for tests not performed
, Code Jamming - Answer-Inserting or "jamming" incorrect ICD-9 code to get
coverage for a lab or test
Reflex Testing - Answer-Automatically running a test based on a previous test result
w/o the MD/PA requesting the second test
Services not Rendered - Answer-The simplest scheme of HC fraud is the billing for
services that were never rendered to patients
Up Coding - Answer-Inflating the seriousness of the patient's condition or the level of
E/M needed to help the patient to obtain a higher reimbursement the one is entitled
Unbounding - Answer-using tow codes when a combined code exists
Kickbacks - Answer-a bribe or financial incentive
Stark Law - Answer-a physician is prohibited from making any referral to a provider
of designated health services if the physician has a "financial relationship" with the
provider. a healthcare provider is prohibited from submitting for services rendered to
patients referred in violation of the statute
False information - Answer-Billing for services not provided or not at the level billed
for
False Claims Act- allows individuals to file claims against companies that they think
have defrauded the government. More than $17 billion dollars have been recovered
by the government since 1987
Lack of medical Neccessity - Answer-it is improper to bill medicare for services or
treatment that is not medically necessary. To knowingly do so is a violation of the
false claims act.
CPT, Category I - Answer-Evaluation and Management (E/M) Services
Describe services provided to evaluate patients and manage their care
These codes are widely used and cover a large portion of the medical care provided
to patients
Codes are specific to setting (office, hospital, ER, home) and whether it is a new or
established pt.
Codes are based on what was done (and documented) in three areas:
History
Physical examination
Medical decision making
bundling - Answer-Many procedure codes also include procedures and supplies that
are routinely necessary to perform the procedure
Only services not typically performed, or materials not typically used, should be billed
separately
