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This patient was admitted for chemotherapy due to a primary hepatocellular carcinoma of the transplanted liver. What codes are assigned? a. Z51.11, C22.0 b. Z51.11, C22.0, C80.2 c. Z51.11, T86.49, C80.2, C22.0 d. T86.49, C80.2, C22.0 - Correct Answer: C Code T86.49 should be assigned for complication of liver transplant along with code C80.2 for malignancy associated with organ transplant. A malignant neoplasm of a transplanted organ should be coded as a transplant complication (CMS 2018...

For continuity of care, ambulatory care providers are more likely than providers of ACS to rely on the documentation found in the - Problem list (PCPs, pharmacy consultations and transfer summaries are likely to be found on the records of longterm care patients). All of the following organizations make up the Cooperating Parties for the approval of ICD-9-CM coding guidelines EXCEPT: - Americal Medical Association Define Status asthmaticus - An acute asthmatic attack in which the degree of b...

An insurance and coding specialist is reviewing a patient's encounter form that is documented in the medical record prior to competing a CMS-1500 form. She notices that the physician upcoded the encounter form. The specialist has the ethical obligation to first - query the physician A patient had surgery two weeks ago to repair a dislocated ankle, and returns today to have a flexor tendon in the hand repaired. Which of the following modifiers should be reported for today's service? - -79 ...

c. Edit checks Edit checks help ensure data integrity by allowing only reasonable and predetermined values to be entered into the computer (Rinehart-Thompson 2016a, 265). - A coding analyst consistently enters the wrong code for patient gender in the electronic billing system. What data quality or data integrity measures should be in place to ensure that only allowable code numbers are entered? a. Access controls b. Audit trail c. Edit checks d. Password controls b. Delinquent record A...

StartNow Implementation Methodology - Fill in the blank: 6 phases of _____ from ServiceNow 1. Plan 2. Discover 3. Prepare 4. Deploy 5. Operate 6. Transform Single-tenant- What of the unique architectural tenants of ServiceNow which allows dedicated instances and databases. - Is ServiceNow a single-tenant or multi-tenant Software as a Service (SAAS) environment? Domain separation - Fill in the blank: _____ allows organizations to: • Enforce data separation between business entities ...

107. Which of the following styles should a billing and coding specialist use to format a patient's date of birth on a CMS-1500 claim form? - O MMDDYYYY 106. A Medicare provider submits a CMS-1500 claim form that is rejected for payment. Which of the following should be a reason for the form's rejection? - O Medical coverage was cancelled In which of the following locations should a billing and coding specialist find the contract information to appeal a claim? - O Insurance company file ...

ICD 10-CM MANUAL HAS AN ESTMATED OF HOW MANY CODES - 72,000 ICD 10-CM MANUAL GUIDELINES ARE DIVIDED INTO HOW MANY SECTION(S) - FOUR (4) ICD 10-CM MANUAL DIVIDED INTO HOW MANY APPENDIX (S) - ONE (1) ICD 10-CM MANUAL SECTION (I) HAS HOW MANY PRIMARY SETS OF GUIDELINES - THREE (3) WHAT ARE THE THREE (3) PRIMARY GUIDELINES IN SECTION ONE (1) OF THE ICD 10-CM MANUAL - CONVENTIONS, GENERAL, SPECIFIC CODING (Applies to ALL ICD-10-CM code assignment unless otherwise indicated) WHAT ARE (IS) THE G...

What is the Level of Detail in Coding - ICD-10 codes are to be used and reported at their highest number of characters possible (specificity) What is the Level of Detail in Coding Example - (in this example do not stop at "Hypertension 110" go to the highest level specificity (I12.9 Hypertensive Chronic Kidney Disease) What is a guideline? - A guideline is a rule In the guidelines how many CATEGORIES are set up in the Alphabetic Index - Three In the guidelines how many SECTIONS are there...

Encounter and Visit are often used interchangeably in describing ____________ - Outpatient Service (Diagnostic Coding and Reporting Guidelines for Outpatient Services) In the outpatient setting, the term _______diagnosis is used in lieu of principal diagnosis. - FirstListed (Selection of first-listed condition) In determining the first-listed diagnosis the coding conventions of ICD-10-CM, as well as the general and disease specific guidelines take precedence over ______ - Outpatient guideli...

In order to work competently as a medical claims specialist in a physician's office, one needs - to know procedural and diagnostic coding In addition to medical data, the medical record may include - personal data, financial data, social data Medical ethics will typically address standards of - conduct Everything that a medical claims specialist learns about a patient's condition must remain - confidential Which of the following skills would NOT be required for accurate filing of claims...

Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to the NPDB? - Yes According to TJC, who may amend the medical staff bylaws? - Governing body/board. Failure to meet the established qualifications and criteria for appointment should be reported to whom? - The applicant NCQA requires the MCO to obtain a minimum of how may years of work history? - Five years According to the NCQA what policy must an organization have in place to obtain approval to...

Are limitations of the clinical privileges of a psychiatrist for more than 30 days reportable to the NPDB? - Yes According to TJC, who may amend the medical staff bylaws? - Governing body/board. Failure to meet the established qualifications and criteria for appointment should be reported to whom? - The applicant NCQA requires the MCO to obtain a minimum of how may years of work history? - Five years According to the NCQA what policy must an organization have in place to obtain approv...

Commissioner of (CBP) is filled by - presidential nomination, subject to the advice and consent of the Senate. CBP gave rise to which of the following agencies? - National Institute of Standards and Technology U.S. Coast Guard Department of Veterans Affairs not a component of the Department of Homeland Security - Bureau of the Census CBP's responsibilities do not encompass - Licensing imported firearms not a Homeland Security mission - Supporting U.S. commercial interests Mod Act 3 conc...

Coding is - the process of translating this written or dictated medical record into a series of numeric or alpha-numeric codes Proper code assignment is determined by - content of the medical record and by the unique rules that governs each code set What are 3 things that Coder must master - 1. anatomy 2. medical terminology 3. must be detail-oriented Medical coders assign a code to what - 1. Each diagnosis 2. Service/procedure 3. Supply, using the classification system when applicable ...

The symbol "O" in the Current Procedural Terminology reference is used to indicate what? - Reinstated or recycled code In the anesthesia section of the CPT manual, what are considered qualifying circumstances? - Addon codes As of April 1, 2014 what is the maximum number of diagnoses that can be reported on the CMS-1500 claim form before a further claim is required? - 12 What is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - Operative...

In order to work competently as a medical claims specialist in a physician's office, one needs - To know procedural and diagnostic coding In addition to medical data, the medical record may include: - personal data, financial data & social data Medical ethis will typically address standards of: - conduct Everything that a medical claims specialist learns about a patients condition must remain: - confidential Which of the following skills would NOT be required for accurate filing of claim...

All are eligible under Medicare health insurance except: a) retiree of the Civil Service Retirement System b) persons of 65 years or older, retired on Social Security benefits c) those diagnosed with end-stage renal disease (ESRD) d) All kidney donors - d) All kidney donors Which provider/network must accept the payer's allowable amount as 100% payment for procedures or services provided? a) Out of Network provider b) Participating provider c) Non-participating provider d) Both a & b ...

The symbol "O" in the Current Procedural Terminology reference is used to indicate what? - Reinstated or recycled code In the anesthesia section of the CPT manual, what are considered qualifying circumstances? - Addon codes As of April 1, 2014 what is the maximum number of diagnoses that can be reported on the CMS-1500 claim form before a further claim is required? - 12 What is considered proper supportive documentation for reporting CPT and ICD codes for surgical procedures? - Operative...

Diagnostic-related groups (DRGs) and ambulatory patient classifications (APCs) are similar in that they are both: a. Determined by HCPCS codes b. Focused on hospital outpatients c. Focused on hospital inpatients d. Prospective payment systems - d. Prospective payment systems ** Both are types of prospective payment systems (Casto and Forrestal 2015, 6). A patient is treated for esophageal varices with hemorrhage due to cirrhosis. The diagnostic codes that would be assigned are: I85.01 E...

One of the most important pieces of communication equipment in a medical practice is the: A. facsimile machine B. telephone C. pager D. typewriter - B. telephone the main means of communication with other doctors, hospitals, and laboratories is the: A. telephone B. adding machine C. typewriter D. photocopier - A. telephone A benefit of a voicemail system is that: A. a receptionist routes calls to the appropriate extension B. a person answers the telephone C. callers never receive a ...