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* FINAL EXAMINATION * [Version #2]

ANSWER KEY

MATCHING:

1. COMPETITIVE MEDICAL PLAN (O) 9. MEDICARE (I)

2. HEALTH MAINT ORGANIZATION (P) 10. MEDICARE/MEDICAID (B)

3. DISABILITY INCOME INS (D) 11. POINT OF SERVICE PLAN (K)

4. EXCLUSIVE PROVIDER ORG (E) 12. PREFERRED PROVIDER ORG. (G)

5. FOUNDATION FOR MED. CARE (J) 13. TRICARE (C)

6. INDEPENDENT (INDIVIDUAL) (F) 14. UNEMPLOYMENT COMP. DIS (M)

PRACTICE ASSOCIATION 15. CHAMPVA (A)

7. MATERNAL & CHILD HLTH PGM (L) 16. WORKER'S COMP. INS (H)

8. MEDICAID (N)

17. (g). Only answers "c" and "e" are correct (Medicaid & Workers Comp)

18. (c). the transfer, after an event insured against, of an individual's legal

right to collect an amount payable under an insurance contract.

19. (a). the provider agrees to accept the allowable charge as the full fee

and cannot charge the patient the difference between the provi-

ders charge and the allowable charge.

  1. List the five (5) types of presenting problems from the most risk and least recovery to the least risk and most recovery:

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  1. Minimal
  2. Self-limited
  3. Low Security
  4. Moderate Severity
  5. High Severity

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  1. List the four (4) types of medical decision making, in order of complexity from most to least complex:

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  1. High
  2. Medium
  3. Low
  4. Straightforward

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  1. (C )
  2. (A)
  3. (C )
  4. (A)
  5. (A)
  6. (D)

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  1. Describe how the name on the claim should be typed for the following patients:

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a.Apple II, James M.

b.Treebark Jr., Charles T.

c.Hurts II, David J.

d.Elbow Sr., Jake R.

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29. What are three questions that must be asked to code surgeries properly?

  1. What body system was involved.
  2. What anatomic site was involved.
  3. What type of procedure was performed.

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30. CPT divides surgical procedures into which two main groups ?

a). Minor Surgery b). Major Surgery

31. List three services/procedures included in a surgical package

a). Surgical Procedure b). Local infiltration c). Normal uncomplicated follow-up calls

32. On what basis are minor surgical procedures to be billed? Fee-for-service

33. Briefly describe “Unbundling”

Assigning multiple codes when only one is necessary; the procedure is illegal

34. Define the following:

A) Skin Lesion = Any alteration of the skin

B) Excision of a Lesion = Requires cutting through the dermal layers

C) Destruction of a Lesion = An alternate to cutting of tissues; involves complete tissue destruction (coagulation, burning)

35. List five things you must know when reporting the excision or destruction of lesions

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1) Site

2) Size of the lesion measured before excision

3) Number lesions removed

4) Benign or Malignant status

5) Method used for the removal

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  1. Layered closure requires the use of 2 codes. One is for the Excision and one for the Intermediate repair

37. If a physician reports the size of a lesion in inches, what must the coder do? ANS: Convert the inches to centimeters

38. When converting the size of a lesion, one inch = 2.54 cms

  1. When there are multiple lacerations, which repair should be listed first? The most complicated repair
  1. THE ACT OF BILLING THE PATIENT FOR THE DIFFERENCE BETWEEN THE MEDICARE CHARGES AND ACTUAL CHARGES
  1. IT IS A WRITTEN DOCUMENT PROVIDED TO THE MEDICARE BENEFICIARY BY A SUPPLIER
  1. a. ORIGINAL MEDICARE PLAN
  1. MEDICARE MANAGED CARE PLAN WHICH ARE AVAILABLE IN MANY AREAS
  2. PRIVATE FEE FOR SERVICE PLAN
  1. a. ADDITIONAL BENEFITS
  1. LOWER COST
  2. LESS PAPERWORK
  3. NO ACCEPTING ASSIGNMENT PROBLEM
  4. PREVENTATIVE CARE
  1. ( C )
  2. ( C )

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SECTION V: ADVANCED CODING: DIRECTIONS: Using the ICD or CPT, assign codes to the following:

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  1. Code(s): 20520
  2. Code(s): 19000
  3. Code(s): 60000
  4. Code(s): 15786
  5. Code(s): 17110
  6. Code(s): 27603
  7. Code(s): 25028
  8. Code(s): 60300
  9. Code(s): 38572
  10. Code(1): 601.0 Code(2): 041.00
  11. Code(1): 785.4 Code(2): 250.7
  12. Code(s): 275.3
  13. Code(1): 749.2 Code(2): V30.01
  14. Code(s): 438.21
  15. Code(1): 238.1 M-Code(2): M8000/1
  16. Code(1): 211.5 M-Code(2): M8170/0
  17. Code(s): 410.7
  18. Code(1): 648.1 Code(2): V23.0
  19. Code(1): 682.6 Code(2): 682.7 Code(3): 041.10
  20. Code(1): 749.2 Code(2): V30.01
  21. Code(1): 578.9 Code(2): E935.6
  22. Code(1): 584.9 Code(2): V45.11

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  1. Code (1): 659.71  Delivery, complicated by fetal heart rate or rhythm

Code (2): 660.41  Delivery, complicated by dystocia, shoulder girdle

Code (3): 664.11  Delivery, complicated by laceration, perineum, second degree

Code (4): 72.79  Delivery, vacuum extraction

Code (5): 73.09  Rupture, membrane, artificial

Code (6): 75.69  Repair, perineum, laceration, obstetric, current

SECTION VII: MATCHING:

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  1. Comprehensive code (F)
  2. UNBUNDLING (R)
  3. MODIFIER (G)
  4.  (P)
  5. (Q)
  6.  (T)
  7. ⊘ (O)
  8.  (K)
  9.  (M)
  10. CUSTOMARY FEE (N)
  11. REASONABLE FEE (H)
  12. INCOMPLETE CLAIM (S)
  13. DINGY CLAIM ( I )
  14. DIRTY CLAIM (J)
  15. INVALID CLAIM (C)
  16. CLEAN CLAIM (D)
  17. PIN NUMBER (E)
  18. NPI NUMBER (B)
  19. UPIN NUMBER (L)
  20. PPIN number (A)

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SECTION VIII: MATCHING

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  1. DME Number (H)
  2. DIGITAL CLAIM (G)
  3. EIN NUMBER (M)
  4. FACILITY NUMBER (N)
  5. GROUP PROVIDER NUMBER (L)
  6. ELECTRONIC CLAIM (J)
  7. OCR (B)
  8. REJECTED CLAIM (A)
  9. OTHER CLAIMS (K)
  10. PAPER CLAIM (O)
  11. PENDING CLAIM ( I )
  12. PHYSICALLY CLEAN CLAIM (E)
  13. CLEAN CLAIM (C)
  14. CMS 1500 = (D)
  15. STATE LICENSE NUMBER (F)

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SECTION IX: CASE STUDY: { ADVANCED CODING }:

MANUAL RECORDING OF CHARGES: [ GRADED COMPONENT ]

TOTALS = 142