CDEO Study Guide exam questions with
correct answers
Congestive |Heart |Failure |- |VERIFIED |ANSWER✔✔-A |chronic |condition |in |which |the |heart |doesn't |
pump |blood |as |well |as |it |should.
Hypertension |- |VERIFIED |ANSWER✔✔-A |condition |in |which |the |force |of |the |blood |against |the |artery |
walls |is |too |high.
HEDIS |- |VERIFIED |ANSWER✔✔-Healthcare |Effectiveness |Data |and |Information |Set
HIPAA |- |VERIFIED |ANSWER✔✔-Health |Insurance |Portability |and |Accountability |Act
MPFS |- |VERIFIED |ANSWER✔✔-Medicare |National |Physician |Fee |Schedule
Multiple |procedure |rule |- |VERIFIED |ANSWER✔✔-The |highest |value |code |is |paid |at |100%. |The |second |
highest |value |code |is |paid |at |50%. |Each |additional |code |is |paid |at |25%. |Add |on |codes |are |exempt |
from |the |multiple |procedure |rule. |They |are |paid |at |100%.
Bullet |symbol |- |VERIFIED |ANSWER✔✔-Indicates |new |procedures |and |services |added |to |the |CPT |book.
Triangle |symbol |- |VERIFIED |ANSWER✔✔-Indicates |that |the |description |of |the |code |has |been |revised
Opposing |horizontal |triangles |- |VERIFIED |ANSWER✔✔-Indicates |new |and |revised |text, |other |than |in |
procedure |descriptors
Forbidden |symbol |- |VERIFIED |ANSWER✔✔-Identifies |codes |that |are |modifier |51 |exempt |and |exempt |
from |the |multiple |procedure |rule
Bull's-eye |symbol |- |VERIFIED |ANSWER✔✔-Identifies |codes |that |include |moderate |sedation. |When |this
|is |located |next |to |a |code, |moderate |sedation |can |not |be |reported |separately.
Unlisted |procedure |code |- |VERIFIED |ANSWER✔✔-These |are |reported |when |an |existing |CPT |code |does
|not |describe |the |procedure. |To |facilitate |these |claims, |provide |the |operative |report |and |suggest |an |
appropriate |fee.
Chief |complaint |- |VERIFIED |ANSWER✔✔-The |reason |for |the |encounter. |A |CC |is |required |for |every |
encounter |except |a |preventive |service. |If |the |CC |is |missing, |you |are |to |report |CPT |code |99499: |
Unlisted |E&M |service. |"Follow |up" |can |not |be |the |reason |for |the |visit.
HPI |- |VERIFIED |ANSWER✔✔-Description |of |the |development |of |the |patient's |illness |from |the |list |of |
signs |or |symptoms, |or |from |the |previous |encounter, |to |the |present. |The |provider |must |document |the
|HPI. |There |are |8 |elements |of |the |HPI.
Location |- |VERIFIED |ANSWER✔✔-Anatomical |place, |position, |or |site |of |the |chief |complaint.
Quality |- |VERIFIED |ANSWER✔✔-Characteristics |about |the |problem, |such |as |how |it |looks |or |feels.
, Severity |- |VERIFIED |ANSWER✔✔-A |degree |or |measurement |of |how |bad |it |is.
Duration |- |VERIFIED |ANSWER✔✔-How |long |the |chief |complaint |has |been |occurring, |or |the |time |when
|the |complaint |occurred,
Timing |- |VERIFIED |ANSWER✔✔-Measurement |of |when |or |at |what |frequency |they |noticed |the |
complaint.
Context |- |VERIFIED |ANSWER✔✔-What |the |patient |was |doing, |their |environmental |factors, |the |
circumstances |surrounding |the |complaint.
Modifying |factors |- |VERIFIED |ANSWER✔✔-Anything |that |makes |the |problem |better |or |worse
Associated |signs |and |symptoms |- |VERIFIED |ANSWER✔✔-Associated |secondary |complaints.
Three |chronic |conditions |- |VERIFIED |ANSWER✔✔-The |HPI |can |also |be |calculated |based |on |
documentation |of |the |status |of |three |chronic |or |inactive |conditions
ROS- |Review |of |Symptoms |- |VERIFIED |ANSWER✔✔-An |account |of |the |body |systems |obtained |through
|a |series |of |questions |seeking |to |spot |signs |or |symptoms |the |patient |may |be |experiencing. |This |can |be
|documented |by |the |provider |or |staff.
Fraud |- |VERIFIED |ANSWER✔✔-CMS |defines |as |making |false |statements |or |misrepresenting |facts |to |
obtain |an |underserved |benefit |or |payment |from |a |federal |healthcare |program. |Examples |on |page |3 |of
|study |guide
Abuse |- |VERIFIED |ANSWER✔✔-CMS |defines |as |an |action |act |results |in |unnecessary |costs |to |a |federal |
healthcare |program, |either |directly |or |indirectly. |Examples |on |page |3 |of |study |guide
Federal |False |Claims |Act |(FCA) |- |VERIFIED |ANSWER✔✔-SEE |PAGE |3 |STUDY |GUIDE |FOR |A-G |
QUALIFICATIONS |**(page |4, |first |full |paragraph |states: |the |FCA |is |violated |by |submitting |a |false |claim |
with |knowledge |that |it |is |false; |however, |the |act |states |that |a |violation |may |occur |even |if |here |is |not |
intent |to |defraud). |DOES |NOT |apply |to |claims, |records, |or |statements |made |under |the |IRS |code |of |
1986.
Reverse |Federal |False |Claims |Act |- |VERIFIED |ANSWER✔✔-The |final |section |(a.1.G) |of |the |Federal |False
|Claims |Act, |it |provides |liability |where |a |person |acts |improperly |to |avoid |paying |money |owed |to |the |
government. |Examples |are |given |on |page |3 |of |study |guide.
Physician |Self-Referral |law |AKA-Stark |Law |- |VERIFIED |ANSWER✔✔-Also |known |as |he |Stark |Law; |bans |
physicians |from |referring |patients |for |certain |services |to |entities |in |which |the |physician |or |an |
immediate |family |member |has |a |direct |or |indirect |financial |relationships. |These |are |designated |as |
self-referrals. |The |Stark |Law |also |bans |the |entity |from |billing |Medicare |or |Medicaid |for |the |services |
provided |as |a |result |of |self-referral. |(Banned |services |list |is |located |on |page |4 |of |study |guide) |** |
applies |to |Physicians |only. |** |no |language |for |proof |or |intent--has |strict |liability |for |overpayments.
Financial |relationship |- |VERIFIED |ANSWER✔✔-Defined |as |a |direct |or |indirect |ownership |interest, |or |
compensation |arrangement |with |any |entity |that |furnishes |a |DHS |(Designated |Health |Service, |page |4 |
study |guide)
correct answers
Congestive |Heart |Failure |- |VERIFIED |ANSWER✔✔-A |chronic |condition |in |which |the |heart |doesn't |
pump |blood |as |well |as |it |should.
Hypertension |- |VERIFIED |ANSWER✔✔-A |condition |in |which |the |force |of |the |blood |against |the |artery |
walls |is |too |high.
HEDIS |- |VERIFIED |ANSWER✔✔-Healthcare |Effectiveness |Data |and |Information |Set
HIPAA |- |VERIFIED |ANSWER✔✔-Health |Insurance |Portability |and |Accountability |Act
MPFS |- |VERIFIED |ANSWER✔✔-Medicare |National |Physician |Fee |Schedule
Multiple |procedure |rule |- |VERIFIED |ANSWER✔✔-The |highest |value |code |is |paid |at |100%. |The |second |
highest |value |code |is |paid |at |50%. |Each |additional |code |is |paid |at |25%. |Add |on |codes |are |exempt |
from |the |multiple |procedure |rule. |They |are |paid |at |100%.
Bullet |symbol |- |VERIFIED |ANSWER✔✔-Indicates |new |procedures |and |services |added |to |the |CPT |book.
Triangle |symbol |- |VERIFIED |ANSWER✔✔-Indicates |that |the |description |of |the |code |has |been |revised
Opposing |horizontal |triangles |- |VERIFIED |ANSWER✔✔-Indicates |new |and |revised |text, |other |than |in |
procedure |descriptors
Forbidden |symbol |- |VERIFIED |ANSWER✔✔-Identifies |codes |that |are |modifier |51 |exempt |and |exempt |
from |the |multiple |procedure |rule
Bull's-eye |symbol |- |VERIFIED |ANSWER✔✔-Identifies |codes |that |include |moderate |sedation. |When |this
|is |located |next |to |a |code, |moderate |sedation |can |not |be |reported |separately.
Unlisted |procedure |code |- |VERIFIED |ANSWER✔✔-These |are |reported |when |an |existing |CPT |code |does
|not |describe |the |procedure. |To |facilitate |these |claims, |provide |the |operative |report |and |suggest |an |
appropriate |fee.
Chief |complaint |- |VERIFIED |ANSWER✔✔-The |reason |for |the |encounter. |A |CC |is |required |for |every |
encounter |except |a |preventive |service. |If |the |CC |is |missing, |you |are |to |report |CPT |code |99499: |
Unlisted |E&M |service. |"Follow |up" |can |not |be |the |reason |for |the |visit.
HPI |- |VERIFIED |ANSWER✔✔-Description |of |the |development |of |the |patient's |illness |from |the |list |of |
signs |or |symptoms, |or |from |the |previous |encounter, |to |the |present. |The |provider |must |document |the
|HPI. |There |are |8 |elements |of |the |HPI.
Location |- |VERIFIED |ANSWER✔✔-Anatomical |place, |position, |or |site |of |the |chief |complaint.
Quality |- |VERIFIED |ANSWER✔✔-Characteristics |about |the |problem, |such |as |how |it |looks |or |feels.
, Severity |- |VERIFIED |ANSWER✔✔-A |degree |or |measurement |of |how |bad |it |is.
Duration |- |VERIFIED |ANSWER✔✔-How |long |the |chief |complaint |has |been |occurring, |or |the |time |when
|the |complaint |occurred,
Timing |- |VERIFIED |ANSWER✔✔-Measurement |of |when |or |at |what |frequency |they |noticed |the |
complaint.
Context |- |VERIFIED |ANSWER✔✔-What |the |patient |was |doing, |their |environmental |factors, |the |
circumstances |surrounding |the |complaint.
Modifying |factors |- |VERIFIED |ANSWER✔✔-Anything |that |makes |the |problem |better |or |worse
Associated |signs |and |symptoms |- |VERIFIED |ANSWER✔✔-Associated |secondary |complaints.
Three |chronic |conditions |- |VERIFIED |ANSWER✔✔-The |HPI |can |also |be |calculated |based |on |
documentation |of |the |status |of |three |chronic |or |inactive |conditions
ROS- |Review |of |Symptoms |- |VERIFIED |ANSWER✔✔-An |account |of |the |body |systems |obtained |through
|a |series |of |questions |seeking |to |spot |signs |or |symptoms |the |patient |may |be |experiencing. |This |can |be
|documented |by |the |provider |or |staff.
Fraud |- |VERIFIED |ANSWER✔✔-CMS |defines |as |making |false |statements |or |misrepresenting |facts |to |
obtain |an |underserved |benefit |or |payment |from |a |federal |healthcare |program. |Examples |on |page |3 |of
|study |guide
Abuse |- |VERIFIED |ANSWER✔✔-CMS |defines |as |an |action |act |results |in |unnecessary |costs |to |a |federal |
healthcare |program, |either |directly |or |indirectly. |Examples |on |page |3 |of |study |guide
Federal |False |Claims |Act |(FCA) |- |VERIFIED |ANSWER✔✔-SEE |PAGE |3 |STUDY |GUIDE |FOR |A-G |
QUALIFICATIONS |**(page |4, |first |full |paragraph |states: |the |FCA |is |violated |by |submitting |a |false |claim |
with |knowledge |that |it |is |false; |however, |the |act |states |that |a |violation |may |occur |even |if |here |is |not |
intent |to |defraud). |DOES |NOT |apply |to |claims, |records, |or |statements |made |under |the |IRS |code |of |
1986.
Reverse |Federal |False |Claims |Act |- |VERIFIED |ANSWER✔✔-The |final |section |(a.1.G) |of |the |Federal |False
|Claims |Act, |it |provides |liability |where |a |person |acts |improperly |to |avoid |paying |money |owed |to |the |
government. |Examples |are |given |on |page |3 |of |study |guide.
Physician |Self-Referral |law |AKA-Stark |Law |- |VERIFIED |ANSWER✔✔-Also |known |as |he |Stark |Law; |bans |
physicians |from |referring |patients |for |certain |services |to |entities |in |which |the |physician |or |an |
immediate |family |member |has |a |direct |or |indirect |financial |relationships. |These |are |designated |as |
self-referrals. |The |Stark |Law |also |bans |the |entity |from |billing |Medicare |or |Medicaid |for |the |services |
provided |as |a |result |of |self-referral. |(Banned |services |list |is |located |on |page |4 |of |study |guide) |** |
applies |to |Physicians |only. |** |no |language |for |proof |or |intent--has |strict |liability |for |overpayments.
Financial |relationship |- |VERIFIED |ANSWER✔✔-Defined |as |a |direct |or |indirect |ownership |interest, |or |
compensation |arrangement |with |any |entity |that |furnishes |a |DHS |(Designated |Health |Service, |page |4 |
study |guide)
