Healthcare Reimbursement-Chapter 2
Test Questions and Correct Answers
HIPAA (Health Insurance Portability and Accountability Act) ✅Designated the code
sets for healthcare services reporting to public and private insurers.
HITSP (Health Information Technology Standards Panel) ✅identified standards for the
electronic exchange of health information
NCHS (National Center for Health Statistics) ✅A division of the CDC responsible for
developing and publishing ICD-10 CM in the USA
The clinical modification of ICD has several uses: ✅-Classifying morbidity and mortality
information for statistical purposes
-Classifying diagnosis and procedure information for epidemiological and clinical
research
-Indexing Hospital records by disease and surgical procedure
-Reporting information to various health care reimbursement systems
-Analyzing resource consumption patterns
-Analyzing adequacy of reimbursement for health services
Providers use the clinical modification of ICD coding to determine payment categories
for various PPSs including the following: ✅-Hospital inpatient: Medicare severity
diagnosis related groups (MS-DRGs)
-Hospital rehabilitation: case mix groups (CMGs)
-Long term care: long-term care Medicare severity diagnosis related groups (LTC-MS-
DRGs)
-Home health: home health resource groups (HHRGs)
ICD-10-CM Diagnosis Codes ✅-The first three characters are a category code
-The fourth and fifth characters or subcategory codes that provide the specificity
necessary to accurately describe a patient's clinical condition
-some codes have a seventh character to further describe the circumstances of the
condition
ICD-10-CM contains two volumes: ✅-The tabular list of diseases and injuries
-The alphabetic index to diseases
ICD-10-PCS contains four sections: ✅Index, tables, code listings, and appendices
HCPCS ✅Healthcare Common Procedure Coding System-A two-tiered system of
procedural codes used primarily for ambulatory care and physician services. HCPCS
codes are frequently attached to inpatient and outpatient charge description masters for
, convenience and to facilitate communication between providers and payers about
services and supplies included in the CPT or HCPCS level II system
CPT ✅Current Procedural Terminology-used throughout the United States to report
diagnostic and surgical services and procedures
CPT has several uses: ✅-Communication vehicle for public and private reimbursement
systems
-development of guidelines for medical care review
-basis for local, regional, national use comparisons
-medical education and research
The terminology of CPT consist of the following six sections: ✅-evaluation and
management
-anesthesia
-surgery
-radiology
-pathology and laboratory
-medicine
The surgery section of CPT is further divided as follows: ✅-integumentary system
(10021-19499)
-musculoskeletal system (20005-29999)
-respiratory system (30000-32999)
-cardiovascular system (33010-39599)
-digestive system (40490-49999)
-urinary system (50010-53899)
-male genital system (54000-55980)
-female genital system (56405-58999)
-maternity care and delivery (59000-59899)
-endocrine system (60000-60699)
-nervous system (61000-64999)
-Eye and ocular adnexa (65091-68899)
-auditory system (69000-69979)
-operating microscope (69990)
CPT Category 1 codes: ✅-Describe a procedure or service that is consistent with
contemporary medical practice and that is performed by many physicians in clinical
practice in multiple locations
-represented by five character in numeric code
-unlisted codes are used to report services and procedures that are not represented by
an existing code
CPT category II codes: ✅-Were created to facilitate data collection for certain services
and to test results that contribute positive health outcomes and high quality patient care
Test Questions and Correct Answers
HIPAA (Health Insurance Portability and Accountability Act) ✅Designated the code
sets for healthcare services reporting to public and private insurers.
HITSP (Health Information Technology Standards Panel) ✅identified standards for the
electronic exchange of health information
NCHS (National Center for Health Statistics) ✅A division of the CDC responsible for
developing and publishing ICD-10 CM in the USA
The clinical modification of ICD has several uses: ✅-Classifying morbidity and mortality
information for statistical purposes
-Classifying diagnosis and procedure information for epidemiological and clinical
research
-Indexing Hospital records by disease and surgical procedure
-Reporting information to various health care reimbursement systems
-Analyzing resource consumption patterns
-Analyzing adequacy of reimbursement for health services
Providers use the clinical modification of ICD coding to determine payment categories
for various PPSs including the following: ✅-Hospital inpatient: Medicare severity
diagnosis related groups (MS-DRGs)
-Hospital rehabilitation: case mix groups (CMGs)
-Long term care: long-term care Medicare severity diagnosis related groups (LTC-MS-
DRGs)
-Home health: home health resource groups (HHRGs)
ICD-10-CM Diagnosis Codes ✅-The first three characters are a category code
-The fourth and fifth characters or subcategory codes that provide the specificity
necessary to accurately describe a patient's clinical condition
-some codes have a seventh character to further describe the circumstances of the
condition
ICD-10-CM contains two volumes: ✅-The tabular list of diseases and injuries
-The alphabetic index to diseases
ICD-10-PCS contains four sections: ✅Index, tables, code listings, and appendices
HCPCS ✅Healthcare Common Procedure Coding System-A two-tiered system of
procedural codes used primarily for ambulatory care and physician services. HCPCS
codes are frequently attached to inpatient and outpatient charge description masters for
, convenience and to facilitate communication between providers and payers about
services and supplies included in the CPT or HCPCS level II system
CPT ✅Current Procedural Terminology-used throughout the United States to report
diagnostic and surgical services and procedures
CPT has several uses: ✅-Communication vehicle for public and private reimbursement
systems
-development of guidelines for medical care review
-basis for local, regional, national use comparisons
-medical education and research
The terminology of CPT consist of the following six sections: ✅-evaluation and
management
-anesthesia
-surgery
-radiology
-pathology and laboratory
-medicine
The surgery section of CPT is further divided as follows: ✅-integumentary system
(10021-19499)
-musculoskeletal system (20005-29999)
-respiratory system (30000-32999)
-cardiovascular system (33010-39599)
-digestive system (40490-49999)
-urinary system (50010-53899)
-male genital system (54000-55980)
-female genital system (56405-58999)
-maternity care and delivery (59000-59899)
-endocrine system (60000-60699)
-nervous system (61000-64999)
-Eye and ocular adnexa (65091-68899)
-auditory system (69000-69979)
-operating microscope (69990)
CPT Category 1 codes: ✅-Describe a procedure or service that is consistent with
contemporary medical practice and that is performed by many physicians in clinical
practice in multiple locations
-represented by five character in numeric code
-unlisted codes are used to report services and procedures that are not represented by
an existing code
CPT category II codes: ✅-Were created to facilitate data collection for certain services
and to test results that contribute positive health outcomes and high quality patient care
