, Solution manual for 3-2-1 Code It! 2022
Edition, 10th Edition Michelle A. Green
Notes
1- All Chapters are step by step.
2- We have shown you 10 pages.
3- The file contains all Appendix and Excel
sheet if it exists.
4- We have all what you need, we make
update at every time. There are many new
editions waiting you.
5- If you think you purchased the wrong file
You can contact us at every time, we can
replace it with true one.
Our email:
Our website:
testbanks-store.com
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
Solution and Answer Guide
Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
Table of Contents
Exercises.............................................................................................................................................................................. 1
Exercise 1.1: Career as a Coder ................................................................................................................. 1
Exercise 1.2: Professional Associations ..................................................................................................... 2
Exercise 1.3: Coding Overview .................................................................................................................. 3
Exercise 1.4: Other Classification Systems and Databases ........................................................................ 4
Exercise 1.5: Documentation as Basis for Coding ...................................................................................... 6
Exercise 1.6: Health Data Collection .......................................................................................................... 8
Review ................................................................................................................................................................................. 9
Multiple Choice ......................................................................................................................................... 9
Exercises
Exercise 1.1: Career as a Coder
1. A coder is required to have a working knowledge of the CPT, HCPCS Level II, ICD-10-CM, and
__________ coding systems.
ANS: ICD-10-PCS
Analysis: A coder is required to have a working knowledge of the CPT, HCPCS Level II, ICD-10-CM,
and ICD-10-PCS coding systems.
2. The complexity and intensity of procedures performed and services provided during an
outpatient or physician office encounter are captured as part of __________ coding.
ANS: professional
Analysis: The complexity and intensity of procedures performed and services provided during an
outpatient or physician office encounter are captured as part of professional coding.
3. The intensity of services and severity of illness associated with inpatient care are captured as part
of __________ (or facility) coding.
ANS: institutional
Analysis: The intensity of services and severity of illness associated with inpatient care are captured
as part of institutional (or facility) coding.
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 1
website, in whole or in part.
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
4. When a multi-hospital system provides physician office services along with traditional inpatient,
outpatient, and emergency department hospital care, the concept of __________ coding is adopted
to facilitate professional and institutional billing.
ANS: single-path
Analysis: When a multi-hospital system provides physician office services along with traditional
inpatient, outpatient, and emergency department hospital care, the concept of single-path coding is
adopted to facilitate professional and institutional billing.
5. A profession that is closely related to that of a coder is health __________ specialist (or claims
examiner) who review health-related claims to determine whether the costs are reasonable and
medically necessary based on the patient’s diagnosis reported for procedures performed and
services provided.
ANS: insurance
Analysis: A profession that is closely related to that of a coder is health insurance specialist (or
claims examiner) who reviews health-related claims to determine whether the costs are reasonable
and medically necessary based on the patient’s diagnosis reported for procedures performed and
services provided.
Exercise 1.2: Professional Associations
1. Students who become members of __________ association(s) usually pay a reduced membership
fee and receive most of the same benefits as active members.
ANS: professional
Analysis: Students who become members of professional association(s) usually pay a reduced
membership fee and receive most of the same benefits as active members.
2. Attending professional association conferences and meetings provides opportunities to __________
(or interact) with other professionals, which can facilitate being placed for internship or job
placement.
ANS: network
Analysis: Attending professional association conferences and meetings provides opportunities to
network (or interact) with other professionals, which can facilitate being placed for internship or job
placement.
3. A medical assistant usually joins the American Medical Technologists (AMT) or the __________.
ANS: American Association of Medical Assistants (AAMA)
Analysis: A medical assistant usually joins the American Medical Technologists (AMT) or the
American Association of Medical Assistants (AAMA).
4. An Internet-based discussion forum that covers a variety of professional topics and issues is called
an online discussion board or __________.
ANS: listserv
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 2
website, in whole or in part.
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
Analysis: An Internet-based discussion forum that covers a variety of professional topics and issues is
called an online discussion board or listserv.
5. A coder usually joins either the American Health Information Management Association (AHIMA)
or the __________.
ANS: AAPC
Analysis: A coder usually joins either the American Health Information Management Association
(AHIMA) or the AAPC.
Exercise 1.3: Coding Systems and Processes
1. A medical nomenclature that is organized according to similar conditions, diseases, procedures,
and services, and contains codes for each is called a __________ (or classification) system.
ANS: coding
Analysis: A medical nomenclature that is organized according to similar conditions, diseases,
procedures, and services, and contains codes for each is called a coding (or classification) system.
2. All diagnoses, whether patients are treated as inpatients or outpatients, or at physician offices, are
coded using the __________ classification system.
ANS: ICD-10-CM
Analysis: All diagnoses, whether patients are treated as inpatients or outpatients, or at physician
offices, are coded using the ICD-10-CM classification system.
3. Inpatient hospital procedures and services are coded using the __________ classification system.
ANS: ICD-10-PCS
Analysis: Inpatient hospital procedures and services are coded using the ICD-10-PCS classification
system.
4. A public or private entity that processes or facilitates the processing of health information and
claims from a nonstandard to a standard format is called a health care __________.
ANS: clearinghouse
Analysis: A public or private entity that processes or facilitates the processing of health information
and claims from a nonstandard to a standard format is called a health care clearinghouse.
5. Routinely assigning lower-level CPT codes for convenience instead of reviewing patient record
documentation and the coding manual to determine the proper code to be reported is called
__________.
ANS: downcoding
Analysis: Routinely assigning lower-level CPT codes as a convenience instead of reviewing patient
record documentation and the coding manual to determine the proper code to be reported is called
downcoding.
6. Reporting codes that are not supported by documentation in the patient record for the purpose
of increasing reimbursement is called __________.
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 3
website, in whole or in part.
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
ANS: upcoding
Analysis: Reporting codes that are not supported by documentation in the patient record for the
purpose of increasing reimbursement is called upcoding.
7. Reporting codes for signs and symptoms in addition to the established diagnosis code is called
__________.
ANS: overcoding
Analysis: Reporting codes for signs and symptoms in addition to the established diagnosis code is
called overcoding.
8. Reporting multiple codes to increase reimbursement when a single combination code should be
reported is called __________.
ANS: unbundling
Analysis: Reporting multiple codes to increase reimbursement when a single combination code
should be reported is called unbundling.
9. Coders should always avoid assumption coding, and can do so by generating a physician
__________ when documentation needs clarification prior to the assignment of codes.
ANS: query
Analysis: Coders should always avoid assumption coding, and can do so by generating a physician
query when documentation needs clarification prior to the assignment of codes.
10. Software that automatically generates medical codes by analyzing clinical documentation in the
electronic health record or electronic medical record is called __________.
ANS: computer-assisted coding (CAC)
Analysis: Software that automatically generates medical codes by analyzing clinical documentation in
the electronic health record or electronic medical record is called computer-assisted coding (CAC).
Exercise 1.4: Other Classification Systems and Databases
1. The classification of neoplasms used by cancer registries throughout the world to record
incidence of malignancy and survival rates is called the __________.
ANS: International Classification of Diseases for Oncology, Third Edition (ICD-O-3)
Analysis: The classification of neoplasms used by cancer registries throughout the world to record
incidence of malignancy and survival rates is called the ICD-O-3. (The capital letter O in the
classification system’s abbreviation refers to Oncology.)
2. Specific sets of patient characteristics (or case-mix groups) on which payment determinations are
made under several prospective payment systems is represented by the __________.
ANS: Health Insurance Prospective Payment System (HIPPS)
Analysis: Specific sets of patient characteristics (or case-mix groups) on which payment
determinations are made under several prospective payment systems is represented by the Health
Insurance Prospective Payment System (HIPPS).
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 4
website, in whole or in part.
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
3. The set of files and software that allows many health and biomedical vocabularies and standards
to enable interoperability among computer systems is called the __________.
ANS: Unified Medical Language System (UMLS)
Analysis: The set of files and software that allows many health and biomedical vocabularies and
standards to enable interoperability among computer systems is called the Unified Medical
Language System (UMLS).
4. The coding system that is used to classify dental procedures and services is
called the __________.
ANS: Current Dental Terminology (CDT)
Analysis: The coding system that is used to classify dental procedures and services is called the
Current Dental Terminology (CDT).
5. The system that classifies health and health related domains to describe body functions and
structures, activities, and participation is called the __________.
ANS: International Classification of Functioning, Disability and Health (ICF)
Analysis: The system that classifies health and health related domains to describe body functions
and structures, activities, and participation is called the International Classification of Functioning,
Disability and Health (ICF).
6. The system that classifies services not included in the CPT manual to describe the service, supply,
or therapy provided and may also be assigned to report nursing services and alternative medicine
procedures is called __________.
ANS: Alternative Billing Codes (ABC codes)
Analysis: The system that classifies services not included in the CPT manual to describe the service,
supply, or therapy provided and may also be assigned to report nursing services and alternative
medicine procedures is called Alternative Billing Codes (ABC codes).
7. The nomenclature that provides normalized names for clinical drugs and links its names to many
of the drug vocabularies commonly used in pharmacy management and drug interaction software
is called __________.
ANS: RxNorm
Analysis: The nomenclature that provides normalized names for clinical drugs and links its names to
many of the drug vocabularies commonly used in pharmacy management and drug interaction
software is called RxNorm.
8. An electronic database and universal standard that is used to identify medical laboratory
observations and for the purpose of clinical care and management is called the __________.
ANS: Logical Observation Identifiers Names and Codes (LOINC)
Analysis: An electronic database and universal standard that is used to identify medical laboratory
observations and for the purpose of clinical care and management is called the Logical Observation
Identifiers Names and Codes (LOINC).
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 5
website, in whole or in part.
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
9. The American Psychiatric Association published a standard classification of mental disorders
called the __________-5.
ANS: DSM
Analysis: The American Psychiatric Association published a standard classification of mental
disorders called the DSM-5. DSM means Diagnostic and Statistical Manual of Mental Disorders, and
-5 refers to the fifth edition.
10. The system that provides a new standardized framework and a unique coding structure for
assessing, documenting, and classifying home health and ambulatory care is called the __________
System.
ANS: Clinical Care Classification (CCC)
Analysis: The system that provides a new standardized framework and a unique coding structure for
assessing, documenting, and classifying home health and ambulatory care is called Clinical Care
Classification (CCC) System.
Exercise 1.5: Documentation as Basis for Coding
1. Continuity of patient care is considered a __________ purpose of the patient record.
a. primary
b. secondary
ANS: a
Analysis:
a. Correct. Continuity of patient care is considered a primary purpose of the patient, and it
involves documenting patient care procedures and services so that others who treat the
patient have a source of information upon which to base additional care and treatment.
b. Incorrect. Secondary purposes of the record include evaluating the quality of patient care;
providing data for use in clinical research, epidemiology studies, education, public policy
making, facilities planning, and health care statistics; providing information to third-party
payers for reimbursement; and serving the medicolegal interests of the patient, facility, and
providers of care. Continuity of patient care is a primary purpose of the patient, and it
involves documenting patient care procedures and services so that others who treat the
patient have a source of information upon which to base additional care and treatment.
2. Evaluating quality of patient care is considered a __________ purpose of the patient record.
a. primary
b. secondary
ANS: b
Analysis:
a. Incorrect. The primary purpose of the patient record is to provide for continuity of care,
which involves documenting patient care services so that others who treat the patient have
a source of information on which to base additional care and treatment. Evaluating the
quality of patient care is considered a secondary purpose of the patient record. Secondary
purposes of the record include evaluating the quality of patient care; providing data for use
in clinical research, epidemiology studies, education, public policy making, facilities
planning, and health care statistics; providing information to third-party payers for
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 6
website, in whole or in part.
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
reimbursement; and serving the medicolegal interests of the patient, facility, and providers
of care.
b. Correct. Evaluating the quality of patient care is considered a secondary purpose of the
patient record. Secondary purposes of the record include evaluating the quality of patient
care; providing data for use in clinical research, epidemiology studies, education, public
policy making, facilities planning, and health care statistics; providing information to third-
party payers for reimbursement; and serving the medicolegal interests of the patient,
facility, and providers of care.
3. Which is an example of patient demographic data?
a. date of birth
b. discharge diagnosis
ANS: a
Analysis:
a. Correct. The date of birth is an example of patient demographic data. Demographic data
are patient identification information that is collected according to facility policy.
b. Incorrect. The discharge diagnosis is an example of patient clinical data. The date of birth is
an example of patient demographic data. Demographic data are patient identification
information that is collected according to facility policy.
4. Medical necessity requires providers to document procedures, services, and supplies that are
proper and needed for the
a. convenience of the physician or health care facility.
b. diagnosis or treatment of a patient’s medical condition.
ANS: b
Analysis:
a. Incorrect. Performing procedures, services, and supplies for the convenience of the physician
or health care facility is not permitted. Medical necessity requires providers to document
procedures, services, and supplies that are proper and needed for the diagnosis or treatment
of a patient’s medical condition.
b. Correct. Medical necessity requires providers to document procedures, services, and supplies
that are proper and needed for the diagnosis or treatment of a patient’s medical condition.
5. Which is the business record for a patient encounter because it documents health care services
provided?
a. demographic data collected on admission
b. patient record housed in the facility
ANS: b
Analysis:
a. Incorrect. Demographic data collected on admission is included on the face sheet of the
manual patient record or in the electronic health record; however, it is not the business
record for a patient record because it does not document health care services provided. The
patient record housed in the facility is the business record for a patient encounter because it
documents health care services provided.
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 7
website, in whole or in part.
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
b. Correct. The patient record housed in the facility is the business record for a patient
encounter because it documents health care services provided.
Exercise 1.6: Health Data Collection
1. Appointment scheduling and claims processing are processes associated with medical __________
software.
ANS: management
Analysis: Appointment scheduling and claims processing are processes associated with medical
management software, which is a combination of practice management and medical billing
software that automates the daily workflow and procedures of a physician's office or clinic. The
software automates appointment scheduling, claims processing, patient invoicing, patient
management, and generating reports.
2. Hospital coders and abstractors use automated case __________ software to collect and report
inpatient and outpatient data for statistical analysis and reimbursement purposes.
ANS: abstracting
Analysis: Hospitals (and other health care facility) coders and abstractors use automated case
abstracting software to collect and report inpatient and outpatient data for statistical analysis and
reimbursement purposes. Data is entered in an abstracting software program, and the facility's
billing department imports it to the UB-04 claim for submission to third-party payers.
3. Physicians' offices submit data to third-party payers on the __________ claim.
ANS: CMS-1500
Analysis: Physicians' offices submit data to third-party payers on the CMS-1500 claim, which is the
standard claim submitted by physicians to third-party payers for office encounters and professional
services (e.g., provided to hospital inpatients). Physician offices use medical management software
to enter claims data for electronic submission to third-party payers or clearinghouses. Some eligible
medical practices continue to print paper-based CMS-1500 claims, are mailed or faxed to
clearinghouses or third-party payers for processing.
4. Hospitals submit data to third-party payers on the __________ (or CMS-1450) claim.
ANS: UB-04
Analysis: Hospitals submit data to third-party payers on the UB-04 (or CMS-1450) claim, which is
the standard claim submitted by health care institutions to third-party payers for inpatient and
outpatient services. (UB means “uniform bill.”)
5. Claims are denied if __________ necessity of procedures or services is not established.
ANS: medical
Analysis: Claims are denied if medical necessity of procedures or services is not established. The
patient's diagnosis must justify diagnostic or therapeutic procedures or services provided to meet
medical necessity) Procedures, services, and supplies must also meet the standards of good medical
practice in the local area, are provided and needed for the diagnosis or treatment of a medical
condition, and are not mainly for the convenience of the physician or health care facility.
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 8
website, in whole or in part.
Edition, 10th Edition Michelle A. Green
Notes
1- All Chapters are step by step.
2- We have shown you 10 pages.
3- The file contains all Appendix and Excel
sheet if it exists.
4- We have all what you need, we make
update at every time. There are many new
editions waiting you.
5- If you think you purchased the wrong file
You can contact us at every time, we can
replace it with true one.
Our email:
Our website:
testbanks-store.com
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
Solution and Answer Guide
Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
Table of Contents
Exercises.............................................................................................................................................................................. 1
Exercise 1.1: Career as a Coder ................................................................................................................. 1
Exercise 1.2: Professional Associations ..................................................................................................... 2
Exercise 1.3: Coding Overview .................................................................................................................. 3
Exercise 1.4: Other Classification Systems and Databases ........................................................................ 4
Exercise 1.5: Documentation as Basis for Coding ...................................................................................... 6
Exercise 1.6: Health Data Collection .......................................................................................................... 8
Review ................................................................................................................................................................................. 9
Multiple Choice ......................................................................................................................................... 9
Exercises
Exercise 1.1: Career as a Coder
1. A coder is required to have a working knowledge of the CPT, HCPCS Level II, ICD-10-CM, and
__________ coding systems.
ANS: ICD-10-PCS
Analysis: A coder is required to have a working knowledge of the CPT, HCPCS Level II, ICD-10-CM,
and ICD-10-PCS coding systems.
2. The complexity and intensity of procedures performed and services provided during an
outpatient or physician office encounter are captured as part of __________ coding.
ANS: professional
Analysis: The complexity and intensity of procedures performed and services provided during an
outpatient or physician office encounter are captured as part of professional coding.
3. The intensity of services and severity of illness associated with inpatient care are captured as part
of __________ (or facility) coding.
ANS: institutional
Analysis: The intensity of services and severity of illness associated with inpatient care are captured
as part of institutional (or facility) coding.
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 1
website, in whole or in part.
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
4. When a multi-hospital system provides physician office services along with traditional inpatient,
outpatient, and emergency department hospital care, the concept of __________ coding is adopted
to facilitate professional and institutional billing.
ANS: single-path
Analysis: When a multi-hospital system provides physician office services along with traditional
inpatient, outpatient, and emergency department hospital care, the concept of single-path coding is
adopted to facilitate professional and institutional billing.
5. A profession that is closely related to that of a coder is health __________ specialist (or claims
examiner) who review health-related claims to determine whether the costs are reasonable and
medically necessary based on the patient’s diagnosis reported for procedures performed and
services provided.
ANS: insurance
Analysis: A profession that is closely related to that of a coder is health insurance specialist (or
claims examiner) who reviews health-related claims to determine whether the costs are reasonable
and medically necessary based on the patient’s diagnosis reported for procedures performed and
services provided.
Exercise 1.2: Professional Associations
1. Students who become members of __________ association(s) usually pay a reduced membership
fee and receive most of the same benefits as active members.
ANS: professional
Analysis: Students who become members of professional association(s) usually pay a reduced
membership fee and receive most of the same benefits as active members.
2. Attending professional association conferences and meetings provides opportunities to __________
(or interact) with other professionals, which can facilitate being placed for internship or job
placement.
ANS: network
Analysis: Attending professional association conferences and meetings provides opportunities to
network (or interact) with other professionals, which can facilitate being placed for internship or job
placement.
3. A medical assistant usually joins the American Medical Technologists (AMT) or the __________.
ANS: American Association of Medical Assistants (AAMA)
Analysis: A medical assistant usually joins the American Medical Technologists (AMT) or the
American Association of Medical Assistants (AAMA).
4. An Internet-based discussion forum that covers a variety of professional topics and issues is called
an online discussion board or __________.
ANS: listserv
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 2
website, in whole or in part.
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
Analysis: An Internet-based discussion forum that covers a variety of professional topics and issues is
called an online discussion board or listserv.
5. A coder usually joins either the American Health Information Management Association (AHIMA)
or the __________.
ANS: AAPC
Analysis: A coder usually joins either the American Health Information Management Association
(AHIMA) or the AAPC.
Exercise 1.3: Coding Systems and Processes
1. A medical nomenclature that is organized according to similar conditions, diseases, procedures,
and services, and contains codes for each is called a __________ (or classification) system.
ANS: coding
Analysis: A medical nomenclature that is organized according to similar conditions, diseases,
procedures, and services, and contains codes for each is called a coding (or classification) system.
2. All diagnoses, whether patients are treated as inpatients or outpatients, or at physician offices, are
coded using the __________ classification system.
ANS: ICD-10-CM
Analysis: All diagnoses, whether patients are treated as inpatients or outpatients, or at physician
offices, are coded using the ICD-10-CM classification system.
3. Inpatient hospital procedures and services are coded using the __________ classification system.
ANS: ICD-10-PCS
Analysis: Inpatient hospital procedures and services are coded using the ICD-10-PCS classification
system.
4. A public or private entity that processes or facilitates the processing of health information and
claims from a nonstandard to a standard format is called a health care __________.
ANS: clearinghouse
Analysis: A public or private entity that processes or facilitates the processing of health information
and claims from a nonstandard to a standard format is called a health care clearinghouse.
5. Routinely assigning lower-level CPT codes for convenience instead of reviewing patient record
documentation and the coding manual to determine the proper code to be reported is called
__________.
ANS: downcoding
Analysis: Routinely assigning lower-level CPT codes as a convenience instead of reviewing patient
record documentation and the coding manual to determine the proper code to be reported is called
downcoding.
6. Reporting codes that are not supported by documentation in the patient record for the purpose
of increasing reimbursement is called __________.
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 3
website, in whole or in part.
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
ANS: upcoding
Analysis: Reporting codes that are not supported by documentation in the patient record for the
purpose of increasing reimbursement is called upcoding.
7. Reporting codes for signs and symptoms in addition to the established diagnosis code is called
__________.
ANS: overcoding
Analysis: Reporting codes for signs and symptoms in addition to the established diagnosis code is
called overcoding.
8. Reporting multiple codes to increase reimbursement when a single combination code should be
reported is called __________.
ANS: unbundling
Analysis: Reporting multiple codes to increase reimbursement when a single combination code
should be reported is called unbundling.
9. Coders should always avoid assumption coding, and can do so by generating a physician
__________ when documentation needs clarification prior to the assignment of codes.
ANS: query
Analysis: Coders should always avoid assumption coding, and can do so by generating a physician
query when documentation needs clarification prior to the assignment of codes.
10. Software that automatically generates medical codes by analyzing clinical documentation in the
electronic health record or electronic medical record is called __________.
ANS: computer-assisted coding (CAC)
Analysis: Software that automatically generates medical codes by analyzing clinical documentation in
the electronic health record or electronic medical record is called computer-assisted coding (CAC).
Exercise 1.4: Other Classification Systems and Databases
1. The classification of neoplasms used by cancer registries throughout the world to record
incidence of malignancy and survival rates is called the __________.
ANS: International Classification of Diseases for Oncology, Third Edition (ICD-O-3)
Analysis: The classification of neoplasms used by cancer registries throughout the world to record
incidence of malignancy and survival rates is called the ICD-O-3. (The capital letter O in the
classification system’s abbreviation refers to Oncology.)
2. Specific sets of patient characteristics (or case-mix groups) on which payment determinations are
made under several prospective payment systems is represented by the __________.
ANS: Health Insurance Prospective Payment System (HIPPS)
Analysis: Specific sets of patient characteristics (or case-mix groups) on which payment
determinations are made under several prospective payment systems is represented by the Health
Insurance Prospective Payment System (HIPPS).
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 4
website, in whole or in part.
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
3. The set of files and software that allows many health and biomedical vocabularies and standards
to enable interoperability among computer systems is called the __________.
ANS: Unified Medical Language System (UMLS)
Analysis: The set of files and software that allows many health and biomedical vocabularies and
standards to enable interoperability among computer systems is called the Unified Medical
Language System (UMLS).
4. The coding system that is used to classify dental procedures and services is
called the __________.
ANS: Current Dental Terminology (CDT)
Analysis: The coding system that is used to classify dental procedures and services is called the
Current Dental Terminology (CDT).
5. The system that classifies health and health related domains to describe body functions and
structures, activities, and participation is called the __________.
ANS: International Classification of Functioning, Disability and Health (ICF)
Analysis: The system that classifies health and health related domains to describe body functions
and structures, activities, and participation is called the International Classification of Functioning,
Disability and Health (ICF).
6. The system that classifies services not included in the CPT manual to describe the service, supply,
or therapy provided and may also be assigned to report nursing services and alternative medicine
procedures is called __________.
ANS: Alternative Billing Codes (ABC codes)
Analysis: The system that classifies services not included in the CPT manual to describe the service,
supply, or therapy provided and may also be assigned to report nursing services and alternative
medicine procedures is called Alternative Billing Codes (ABC codes).
7. The nomenclature that provides normalized names for clinical drugs and links its names to many
of the drug vocabularies commonly used in pharmacy management and drug interaction software
is called __________.
ANS: RxNorm
Analysis: The nomenclature that provides normalized names for clinical drugs and links its names to
many of the drug vocabularies commonly used in pharmacy management and drug interaction
software is called RxNorm.
8. An electronic database and universal standard that is used to identify medical laboratory
observations and for the purpose of clinical care and management is called the __________.
ANS: Logical Observation Identifiers Names and Codes (LOINC)
Analysis: An electronic database and universal standard that is used to identify medical laboratory
observations and for the purpose of clinical care and management is called the Logical Observation
Identifiers Names and Codes (LOINC).
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 5
website, in whole or in part.
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
9. The American Psychiatric Association published a standard classification of mental disorders
called the __________-5.
ANS: DSM
Analysis: The American Psychiatric Association published a standard classification of mental
disorders called the DSM-5. DSM means Diagnostic and Statistical Manual of Mental Disorders, and
-5 refers to the fifth edition.
10. The system that provides a new standardized framework and a unique coding structure for
assessing, documenting, and classifying home health and ambulatory care is called the __________
System.
ANS: Clinical Care Classification (CCC)
Analysis: The system that provides a new standardized framework and a unique coding structure for
assessing, documenting, and classifying home health and ambulatory care is called Clinical Care
Classification (CCC) System.
Exercise 1.5: Documentation as Basis for Coding
1. Continuity of patient care is considered a __________ purpose of the patient record.
a. primary
b. secondary
ANS: a
Analysis:
a. Correct. Continuity of patient care is considered a primary purpose of the patient, and it
involves documenting patient care procedures and services so that others who treat the
patient have a source of information upon which to base additional care and treatment.
b. Incorrect. Secondary purposes of the record include evaluating the quality of patient care;
providing data for use in clinical research, epidemiology studies, education, public policy
making, facilities planning, and health care statistics; providing information to third-party
payers for reimbursement; and serving the medicolegal interests of the patient, facility, and
providers of care. Continuity of patient care is a primary purpose of the patient, and it
involves documenting patient care procedures and services so that others who treat the
patient have a source of information upon which to base additional care and treatment.
2. Evaluating quality of patient care is considered a __________ purpose of the patient record.
a. primary
b. secondary
ANS: b
Analysis:
a. Incorrect. The primary purpose of the patient record is to provide for continuity of care,
which involves documenting patient care services so that others who treat the patient have
a source of information on which to base additional care and treatment. Evaluating the
quality of patient care is considered a secondary purpose of the patient record. Secondary
purposes of the record include evaluating the quality of patient care; providing data for use
in clinical research, epidemiology studies, education, public policy making, facilities
planning, and health care statistics; providing information to third-party payers for
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 6
website, in whole or in part.
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
reimbursement; and serving the medicolegal interests of the patient, facility, and providers
of care.
b. Correct. Evaluating the quality of patient care is considered a secondary purpose of the
patient record. Secondary purposes of the record include evaluating the quality of patient
care; providing data for use in clinical research, epidemiology studies, education, public
policy making, facilities planning, and health care statistics; providing information to third-
party payers for reimbursement; and serving the medicolegal interests of the patient,
facility, and providers of care.
3. Which is an example of patient demographic data?
a. date of birth
b. discharge diagnosis
ANS: a
Analysis:
a. Correct. The date of birth is an example of patient demographic data. Demographic data
are patient identification information that is collected according to facility policy.
b. Incorrect. The discharge diagnosis is an example of patient clinical data. The date of birth is
an example of patient demographic data. Demographic data are patient identification
information that is collected according to facility policy.
4. Medical necessity requires providers to document procedures, services, and supplies that are
proper and needed for the
a. convenience of the physician or health care facility.
b. diagnosis or treatment of a patient’s medical condition.
ANS: b
Analysis:
a. Incorrect. Performing procedures, services, and supplies for the convenience of the physician
or health care facility is not permitted. Medical necessity requires providers to document
procedures, services, and supplies that are proper and needed for the diagnosis or treatment
of a patient’s medical condition.
b. Correct. Medical necessity requires providers to document procedures, services, and supplies
that are proper and needed for the diagnosis or treatment of a patient’s medical condition.
5. Which is the business record for a patient encounter because it documents health care services
provided?
a. demographic data collected on admission
b. patient record housed in the facility
ANS: b
Analysis:
a. Incorrect. Demographic data collected on admission is included on the face sheet of the
manual patient record or in the electronic health record; however, it is not the business
record for a patient record because it does not document health care services provided. The
patient record housed in the facility is the business record for a patient encounter because it
documents health care services provided.
© 2023 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible 7
website, in whole or in part.
, Solution and Answer Guide: Green, 3-2-1 Code It!, 2022, ISBN 9780357621226; Chapter 1: Overview of Coding
b. Correct. The patient record housed in the facility is the business record for a patient
encounter because it documents health care services provided.
Exercise 1.6: Health Data Collection
1. Appointment scheduling and claims processing are processes associated with medical __________
software.
ANS: management
Analysis: Appointment scheduling and claims processing are processes associated with medical
management software, which is a combination of practice management and medical billing
software that automates the daily workflow and procedures of a physician's office or clinic. The
software automates appointment scheduling, claims processing, patient invoicing, patient
management, and generating reports.
2. Hospital coders and abstractors use automated case __________ software to collect and report
inpatient and outpatient data for statistical analysis and reimbursement purposes.
ANS: abstracting
Analysis: Hospitals (and other health care facility) coders and abstractors use automated case
abstracting software to collect and report inpatient and outpatient data for statistical analysis and
reimbursement purposes. Data is entered in an abstracting software program, and the facility's
billing department imports it to the UB-04 claim for submission to third-party payers.
3. Physicians' offices submit data to third-party payers on the __________ claim.
ANS: CMS-1500
Analysis: Physicians' offices submit data to third-party payers on the CMS-1500 claim, which is the
standard claim submitted by physicians to third-party payers for office encounters and professional
services (e.g., provided to hospital inpatients). Physician offices use medical management software
to enter claims data for electronic submission to third-party payers or clearinghouses. Some eligible
medical practices continue to print paper-based CMS-1500 claims, are mailed or faxed to
clearinghouses or third-party payers for processing.
4. Hospitals submit data to third-party payers on the __________ (or CMS-1450) claim.
ANS: UB-04
Analysis: Hospitals submit data to third-party payers on the UB-04 (or CMS-1450) claim, which is
the standard claim submitted by health care institutions to third-party payers for inpatient and
outpatient services. (UB means “uniform bill.”)
5. Claims are denied if __________ necessity of procedures or services is not established.
ANS: medical
Analysis: Claims are denied if medical necessity of procedures or services is not established. The
patient's diagnosis must justify diagnostic or therapeutic procedures or services provided to meet
medical necessity) Procedures, services, and supplies must also meet the standards of good medical
practice in the local area, are provided and needed for the diagnosis or treatment of a medical
condition, and are not mainly for the convenience of the physician or health care facility.
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website, in whole or in part.
