Question 1

When an insurance carrier bases reimbursement on a code level lower than the one submitted by the provider, this is called ________.

Accepted Answer

downcoding

Question 2

The CPT considers a patient ________ if that person has not received professional services from the physician within the last three years.

Accepted Answer

new

Question 3

What symbol next to a CPT code tells you that moderate sedation is included in the procedure?

Accepted Answer

A)  Blue triangle 
B)  Green arrows 
C)  Bull's-eye 
D)  Lightning bolt 
E)  Red dot 
A)  Blue triangle 
B)  Green arrows 
C)  Bull's-eye 
D)  Lightning bolt 
E)  Red dot C

Question 4

Which of the following best describes HCPS Level II codes?

Accepted Answer

A)  The codes have five characters: numbers, letters, or a combination of both. 
B)  The codes have six characters, including two initial letters followed by four numbers. 
C)  The codes have five numeric digits. 
D)  The codes have six alphabetic characters (letters). 
E)  The codes have five alphabetic characters (letters). 
A)  The codes have five characters: numbers, letters, or a combination of both. 
B)  The codes have six characters, including two initial letters followed by four numbers. 
C)  The codes have five numeric digits. 
D)  The codes have six alphabetic characters (letters). 
E)  The codes have five alphabetic characters (letters).

Question 5

When unbundling is done intentionally to receive more payment than is allowed, the claim is likely to be considered ____.

Accepted Answer

A)  ethical 
B)  invalid 
C)  noncompliant 
D)  fraudulent 
E)  erroneous 
A)  ethical 
B)  invalid 
C)  noncompliant 
D)  fraudulent 
E)  erroneous

Question 6

In order for a service to be considered a consultation, the service must meet the 3Rs. Which of the following are the correct 3Rs?

Accepted Answer

A)  Release, record, report 
B)  Request, record, report 
C)  Release, request, record 
D)  Request, review, report 
E)  Request, review, record 
A)  Release, record, report 
B)  Request, record, report 
C)  Release, request, record 
D)  Request, review, report 
E)  Request, review, record

Question 7

The fraudulent practice of coding a procedure or service at a higher level than that provided to receive a higher level of reimbursement is known as code creep, overcoding, overbilling, or ________.

Accepted Answer

The answer of The fraudulent practice of coding a procedure...

Question 8

The extent of the patient ________ taken is a key factor in determining the level of E/M codes selected.

Accepted Answer

The answer of The extent of the patient ________ taken...

Question 9

A(n) ________ plan is a strategy for finding, correcting, and preventing fraudulent medical office practices.

Accepted Answer

The answer of A(n) ________ plan is a strategy for...

Question 10

Which of the following is not a potential reason for downcoding?

Accepted Answer

A)  The insurance carrier does not cover the services included on the claim. 
B)  The coding system used by the insurer does not match that used by the provider. 
C)  A workers' compensation carrier converts a CPT code to the lowest-paying code in the system. 
D)  The payer discovers that documentation does not back up the level of code used. 
E)  The provider uses a HCPCS code the insurer does not recognize. 
A)  The insurance carrier does not cover the services included on the claim. 
B)  The coding system used by the insurer does not match that used by the provider. 
C)  A workers' compensation carrier converts a CPT code to the lowest-paying code in the system. 
D)  The payer discovers that documentation does not back up the level of code used. 
E)  The provider uses a HCPCS code the insurer does not recognize.

Question 11

What symbol appears next to codes that are new since the last CPT revision?

Accepted Answer

A)  Red dot 
B)  Pound (#) sign 
C)  Circle with diagonal line 
D)  Blue triangle 
E)  Bull's-eye 
A)  Red dot 
B)  Pound (#) sign 
C)  Circle with diagonal line 
D)  Blue triangle 
E)  Bull's-eye

Question 12

There is a question concerning a claim for a procedure submitted last year. Where will you look to double-check the codes in question?

Accepted Answer

A)  The current CPT 
B)  Last year's CPT 
C)  ICD-9-CM for last year 
D)  ICD-9-CM for this year 
E)  ICD-10-CM 
A)  The current CPT 
B)  Last year's CPT 
C)  ICD-9-CM for last year 
D)  ICD-9-CM for this year 
E)  ICD-10-CM

Question 13

Counseling codes are used only if ____.

Accepted Answer

A)  counseling is provided during a complete physical examination 
B)  the patient is referred to a third party for counseling 
C)  a complete history and physical exam does not occur 
D)  counseling is provided by a physician assistant or nurse practitioner 
E)  the patient specifically requests a counseling referral 
A)  counseling is provided during a complete physical examination 
B)  the patient is referred to a third party for counseling 
C)  a complete history and physical exam does not occur 
D)  counseling is provided by a physician assistant or nurse practitioner 
E)  the patient specifically requests a counseling referral

Question 14

Which of the following is not one of the six main sections in the CPT manual?

Accepted Answer

A)  Anesthesiology 
B)  Physical Therapy 
C)  Pathology and Laboratory 
D)  Surgery 
E)  Evaluation and Management 
A)  Anesthesiology 
B)  Physical Therapy 
C)  Pathology and Laboratory 
D)  Surgery 
E)  Evaluation and Management

Question 15

Having a medical practice compliance plan in place ____.

Accepted Answer

A)  eliminates the risk of an audit 
B)  ensures adherence to state regulations 
C)  shows a "good-faith" effort to be compliant with coding regulations 
D)  simplifies the tasks of the medical assistant 
E)  replaces the insurance company's compliance checks 
A)  eliminates the risk of an audit 
B)  ensures adherence to state regulations 
C)  shows a "good-faith" effort to be compliant with coding regulations 
D)  simplifies the tasks of the medical assistant 
E)  replaces the insurance company's compliance checks

Question 16

A plus sign (+) is used for ________ codes, indicating procedures that are carried out in addition to a main procedure.

Accepted Answer

The answer of A plus sign (+) is used for...

Question 17

For coding purposes, which of the following is not a complexity level for medical decision making?

Accepted Answer

A)  Straightforward MDM 
B)  General-purpose MDM 
C)  Low-complexity MDM 
D)  Moderate-complexity MDM 
E)  High-complexity MDM 
A)  Straightforward MDM 
B)  General-purpose MDM 
C)  Low-complexity MDM 
D)  Moderate-complexity MDM 
E)  High-complexity MDM

Question 18

HCPCS Level II codes are called ________ codes and cover supplies and DME.

Accepted Answer

The answer of HCPCS Level II codes are called ________...

Question 19

How many codes are required for giving a patient an injection of a vaccine?

Accepted Answer

A)  Depends on who is giving the injection 
B)  1 
C)  2 
D)  3 
E)  Depends on the type of vaccine 
A)  Depends on who is giving the injection 
B)  1 
C)  2 
D)  3 
E)  Depends on the type of vaccine

Question 20

Inaccuracy in linking diagnostic codes and procedural codes will result in all of the following except ____.

Accepted Answer

A)  exclusion from payers' programs 
B)  denied claims 
C)  reduced payments 
D)  internal coding audits 
E)  prison sentences 
A)  exclusion from payers' programs 
B)  denied claims 
C)  reduced payments 
D)  internal coding audits 
E)  prison sentences

Exam 19: Procedure Coding

When an insurance carrier bases reimbursement on a code level lower than the one submitted by the provider, this is called ________.

The CPT considers a patient ________ if that person has not received professional services from the physician within the last three years.

What symbol next to a CPT code tells you that moderate sedation is included in the procedure?

Which of the following best describes HCPS Level II codes?

When unbundling is done intentionally to receive more payment than is allowed, the claim is likely to be considered ____.

In order for a service to be considered a consultation, the service must meet the 3Rs. Which of the following are the correct 3Rs?

The fraudulent practice of coding a procedure or service at a higher level than that provided to receive a higher level of reimbursement is known as code creep, overcoding, overbilling, or ________.

The extent of the patient ________ taken is a key factor in determining the level of E/M codes selected.

A(n) ________ plan is a strategy for finding, correcting, and preventing fraudulent medical office practices.

Which of the following is not a potential reason for downcoding?

What symbol appears next to codes that are new since the last CPT revision?

There is a question concerning a claim for a procedure submitted last year. Where will you look to double-check the codes in question?

Counseling codes are used only if ____.

Which of the following is not one of the six main sections in the CPT manual?

Having a medical practice compliance plan in place ____.

A plus sign (+) is used for ________ codes, indicating procedures that are carried out in addition to a main procedure.

For coding purposes, which of the following is not a complexity level for medical decision making?

HCPCS Level II codes are called ________ codes and cover supplies and DME.

How many codes are required for giving a patient an injection of a vaccine?

Inaccuracy in linking diagnostic codes and procedural codes will result in all of the following except ____.

Introduction to Medical Assisting

Healthcare and the Healthcare Team

Professionalism and Success

Interpersonal Communication

Legal and Ethical Issues

Infection Control Fundamentals

Safety and Patient Reception

Office Equipment and Supplies

Examination and Treatment Areas

Written and Electronic Communication

Medical Records and Documentation

Electronic Health Records

Managing Medical Records

Telephone Techniques

Patient Education

Schedule Management

Insurance Billing

Diagnostic Coding

Patient Collections and Financial Management

Organization of the Body

The Integumentary System

The Skeletal System

The Muscular System

The Cardiovascular System

The Blood

The Lymphatic and Immune Systems

The Respiratory System

The Nervous System

The Urinary System

The Reproductive Systems

The Digestive System

The Endocrine System

Special Senses

Infection Control Practices

Patient Interview and History

Vital Signs and Measurements

Assisting With a General Physical Exam

Assisting in Reproductive and Urinary Specialties

Assisting in Pediatrics

Assisting in Geriatrics

Assisting in Other Medical Specialties

Assisting in Eye and Ear Care

Assisting in Minor Surgery

Orientation to the Lab

Microbiology and Disease

Processing and Testing Urine and Stool Samples

Collecting, Processing, and Testing Blood Specimens

Electrocardiography and Pulmonary Function Testing

Diagnostic Imaging

Principles of Pharmacology

Math and Dosage Calculations

Medication Administration

Physical Therapy and Rehabilitation

Nutrition and Health

Practice Management

Emergency Preparedness

Preparing for the World of Work

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