CODING 3 FINAL EXAM STUDY GUIDE WITH CORRECT ANSWERS LATEST UPDATE
2026/2027
the battery in a pacemaker is called a ____________ - Answers generator
What is the first thing you need to look at when coding a CABG? - Answers identify whether an
artery or vein or both are being used
identify how many bypass grafts are being done
What is harvesting? - Answers taking a healthy vessel from somewhere in the body (saphenous
vein is often used)
How many codes should be reported for combined arterial-venous grafting? - Answers 2--the
appropriate arterial graft code and the appropriate combined arterial-venous graft add-on code
When is the TC modifier used in radiology? - Answers when only the technical component is
being billed when the technical and professional portions are in one procedure code
Ipsilateral - Answers situated or appearing on the same side, affecting the same side of the
body
contralateral - Answers pertaining to, located on, or affecting the same side of the body
antegrade - Answers Extending or moving forward
retrograde - Answers moving backward; against normal flow
What is NCD and what does it do? - Answers 1. National Coverage Determinations
2. Explains when Medicare will pay for items or services
3. sets the extent to which Medicare will cover specific services on a national level
What is the LCD? - Answers 1. Local Coverage Determinations
2. decision by an MAC whether to cover a service locally
What is Preclaims Submission responsible for in the revenue cycle? - Answers Responsible for
collecting the patient's and responsible parties' information completely and accurately to
determine:
1. Appropriate financial class (Medicare, Medicaid, etc.)
2. Educating patient as to ultimate financial responsibility for services
3. Collecting waivers when appropriate
4. Verifying data prior to procedures/services being performed and submitted for payment
,What is charge capture? - Answers the process of collecting all services, procedures and
supplies provided during inpatient care
What does Accounts Receivable do? - Answers Manages the amounts owed to a facility by
customers who received services, but whose payments will be made at a later date by the
patient or their third party payers
What are "days in accounts receivable?" - Answers average number of days the facility takes to
collect payment
What is the "aging of accounts?" - Answers monitor the number of accounts and total dollar
value in 30 day increments; longer the account remains unpaid, less likely to be reimbursed
What is Reconciliation? - Answers -Accounting process used to compare 2 sets of records to
ensure figures agree and are accurate
-Key process to determine whether the money expected was the money received
What is a remittance advice? - Answers notice sent by the insurance company that contains
payment information about a claim
What is an EOB? - Answers Explanation of Benefits. A document prepared by the insurance
carrier that provide details of how the claim was adjudicated or paid out
Physician reimbursement for PAR provider - Answers 1. Medicare allowed charge * 80% =
Medicare payment
2. Medicare allowed charge * 20% = patient responsibility
3. Physician usual charge - Medicare allowed charge = amount physician must write off
Physician reimbursement for non-PAR provider accepting assignment - Answers 1. Medicare
allowed charge - 5% = payment allowed
2. Payment allowed * 80% = Medicare payment
3. Payment allowed * 20% = patient responsibility
Physician reimbursement for Non-PAR provider - Answers 1. Medicare allowed charge - 5% =
starting point
2. Starting point * 115% = Medicare limiting amount (allowed charge)
3. Allowed charge—collected from patient at time of service
4. Starting point * 80% = amount Medicare reimburses patient
5. Patient is responsible for the rest of the bill
, When the physician is Non-PAR, how much does Medicare pay the provider? - Answers nothing;
the patient pays the entire bill at the time of service and Medicare reimburses the patient
What does a coder need to know to assign accurate codes for hernia repair? - Answers To
assign codes accurately—must specify the type/site of hernia; history of hernia; age of patient;
clinical presentation of hernia
inguinal hernia - Answers a hernia in which part of the intestine protrudes into the inguinal canal
Lumbar hernia - Answers a rare herniation in the lumbar region of the torso
Incisional hernia - Answers postoperative hernia caused by a weakness in the abdominal wall
from the incision or postoperative complications
Femoral hernia - Answers A type of hernia that causes a bulge in the upper part of the thigh near
the groin.
epigastric hernia - Answers A protrusion of internal organ through the epigastrium above the
umbilicus
umbilical hernia - Answers protrusion of part of the intestine at the navel
Spigelian hernia - Answers Rare hernia occurring between the transverse abdominis and rectus
muscles
reducible hernia - Answers is a hernia in which the contents of the hernial sac can be returned to
their normal position. (Inguinal Hernia)
Sliding hernia - Answers colon or cecum is part of the hernia sac
incarcerated hernia - Answers is an irreducible hernia in which the contents of the hernial sac
are entrapped
strangulated hernia - Answers occurs when a portion of the intestine is constricted inside the
hernia and its blood supply is cut off
Types of hernia repair - Answers -traditional
-use of mesh
-laparoscopic
-Paraesophogeal
traditional hernia repair - Answers physician pushes the bulging tissue back into the abdominal
cavity
mesh hernia repair - Answers uses mesh rather than stitches (less postoperative pain)
2026/2027
the battery in a pacemaker is called a ____________ - Answers generator
What is the first thing you need to look at when coding a CABG? - Answers identify whether an
artery or vein or both are being used
identify how many bypass grafts are being done
What is harvesting? - Answers taking a healthy vessel from somewhere in the body (saphenous
vein is often used)
How many codes should be reported for combined arterial-venous grafting? - Answers 2--the
appropriate arterial graft code and the appropriate combined arterial-venous graft add-on code
When is the TC modifier used in radiology? - Answers when only the technical component is
being billed when the technical and professional portions are in one procedure code
Ipsilateral - Answers situated or appearing on the same side, affecting the same side of the
body
contralateral - Answers pertaining to, located on, or affecting the same side of the body
antegrade - Answers Extending or moving forward
retrograde - Answers moving backward; against normal flow
What is NCD and what does it do? - Answers 1. National Coverage Determinations
2. Explains when Medicare will pay for items or services
3. sets the extent to which Medicare will cover specific services on a national level
What is the LCD? - Answers 1. Local Coverage Determinations
2. decision by an MAC whether to cover a service locally
What is Preclaims Submission responsible for in the revenue cycle? - Answers Responsible for
collecting the patient's and responsible parties' information completely and accurately to
determine:
1. Appropriate financial class (Medicare, Medicaid, etc.)
2. Educating patient as to ultimate financial responsibility for services
3. Collecting waivers when appropriate
4. Verifying data prior to procedures/services being performed and submitted for payment
,What is charge capture? - Answers the process of collecting all services, procedures and
supplies provided during inpatient care
What does Accounts Receivable do? - Answers Manages the amounts owed to a facility by
customers who received services, but whose payments will be made at a later date by the
patient or their third party payers
What are "days in accounts receivable?" - Answers average number of days the facility takes to
collect payment
What is the "aging of accounts?" - Answers monitor the number of accounts and total dollar
value in 30 day increments; longer the account remains unpaid, less likely to be reimbursed
What is Reconciliation? - Answers -Accounting process used to compare 2 sets of records to
ensure figures agree and are accurate
-Key process to determine whether the money expected was the money received
What is a remittance advice? - Answers notice sent by the insurance company that contains
payment information about a claim
What is an EOB? - Answers Explanation of Benefits. A document prepared by the insurance
carrier that provide details of how the claim was adjudicated or paid out
Physician reimbursement for PAR provider - Answers 1. Medicare allowed charge * 80% =
Medicare payment
2. Medicare allowed charge * 20% = patient responsibility
3. Physician usual charge - Medicare allowed charge = amount physician must write off
Physician reimbursement for non-PAR provider accepting assignment - Answers 1. Medicare
allowed charge - 5% = payment allowed
2. Payment allowed * 80% = Medicare payment
3. Payment allowed * 20% = patient responsibility
Physician reimbursement for Non-PAR provider - Answers 1. Medicare allowed charge - 5% =
starting point
2. Starting point * 115% = Medicare limiting amount (allowed charge)
3. Allowed charge—collected from patient at time of service
4. Starting point * 80% = amount Medicare reimburses patient
5. Patient is responsible for the rest of the bill
, When the physician is Non-PAR, how much does Medicare pay the provider? - Answers nothing;
the patient pays the entire bill at the time of service and Medicare reimburses the patient
What does a coder need to know to assign accurate codes for hernia repair? - Answers To
assign codes accurately—must specify the type/site of hernia; history of hernia; age of patient;
clinical presentation of hernia
inguinal hernia - Answers a hernia in which part of the intestine protrudes into the inguinal canal
Lumbar hernia - Answers a rare herniation in the lumbar region of the torso
Incisional hernia - Answers postoperative hernia caused by a weakness in the abdominal wall
from the incision or postoperative complications
Femoral hernia - Answers A type of hernia that causes a bulge in the upper part of the thigh near
the groin.
epigastric hernia - Answers A protrusion of internal organ through the epigastrium above the
umbilicus
umbilical hernia - Answers protrusion of part of the intestine at the navel
Spigelian hernia - Answers Rare hernia occurring between the transverse abdominis and rectus
muscles
reducible hernia - Answers is a hernia in which the contents of the hernial sac can be returned to
their normal position. (Inguinal Hernia)
Sliding hernia - Answers colon or cecum is part of the hernia sac
incarcerated hernia - Answers is an irreducible hernia in which the contents of the hernial sac
are entrapped
strangulated hernia - Answers occurs when a portion of the intestine is constricted inside the
hernia and its blood supply is cut off
Types of hernia repair - Answers -traditional
-use of mesh
-laparoscopic
-Paraesophogeal
traditional hernia repair - Answers physician pushes the bulging tissue back into the abdominal
cavity
mesh hernia repair - Answers uses mesh rather than stitches (less postoperative pain)
