Medical Billing and Coding Test 1

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Questions and Answers

What is the mandated code set for diagnosis under HIPAA?

ICD-10-CM

A code in ICD-10-CM has up to how many characters?

Seven

How many characters does an ICD-10-CM category code have?

Three

How many characters does a subcategory code in ICD-10-CM have?

Four Signup and view all the answers

What is an example of a subcategory code?

S81.2 Signup and view all the answers

The correct code set according to CMS is based on what?

Date of service Signup and view all the answers

What is the first step to begin coding?

Look in the Alphabetical Index Signup and view all the answers

To code correctly for a disease or diagnosis, where must you first look?

Alphabetical Index Signup and view all the answers

The Alphabetical Index is organized by what?

Condition Signup and view all the answers

What is another name for the Alphabetical Index in ICD-10-CM?

Disease and Injury Signup and view all the answers

Which code number is based on anatomical site and divided by description?

Subterms Signup and view all the answers

Define Subterm.

Word or phrase that describes a main term in the Alphabetical Index Signup and view all the answers

If a patient presents with blindness following an accident, what is the main term?

Blindness Signup and view all the answers

The terms acquired, congenital, and both eyes modify the main term as what?

Non-essential Modifier Signup and view all the answers

If a cross-reference appears after a main term, what must the coder do?

Look up the term that follows the word 'SEE' Signup and view all the answers

What type of code describes two diagnoses or a diagnosis with an associated complication?

Combining Code Signup and view all the answers

What letter is not used in ICD-10-CM coding?

U Signup and view all the answers

A valid code must have at least how many characters?

3 Signup and view all the answers

What does the colon punctuation indicate?

Incomplete term Signup and view all the answers

If the Tabular index has the instruction to 'code first underlying disease,' where is the selected code listed?

Second Signup and view all the answers

When is the primary diagnosis coding listed?

First Signup and view all the answers

If the patient has a co-existing condition, what must the coder do?

Use a combo code to code both diagnoses Signup and view all the answers

When an established diagnosis has been determined, what must the coder code?

The established code Signup and view all the answers

What can be coded according to the ICD-10-CM outpatient coding guidelines?

Abnormal test results Signup and view all the answers

If the medical record mentions a type or form of a condition not listed, how would the code be classified?

Other Signup and view all the answers

How many chapters does ICD-10-CM have?

21 chapters Signup and view all the answers

In an outpatient setting, what is the chief complaint referred to as?

'CC' Signup and view all the answers

What is the final step in coding?

Check compliance with any applicable official guidelines Signup and view all the answers

What must a coder verify when selecting a code in the Tabular List?

If you need to list multiple codes and if they are in the correct order Signup and view all the answers

What does ICD-10-CM offer in terms of detail compared to ICD-9-CM?

High level of specificity and an extension for expanded detail Signup and view all the answers

Level 1 codes in HCPCS are referred to as?

CPT codes Signup and view all the answers

What do CPT Category II codes report?

Performance Measures Signup and view all the answers

When a medical practice receives a revised edition of CPT, what activities should be followed?

All of the above Signup and view all the answers

In CPT, which appendix contains the summary of Modifier 51 exempt codes?

Appendix A Signup and view all the answers

In CPT, what does a '+' sign indicate?

An add-on Signup and view all the answers

In CPT, what does a triangle next to a code indicate?

The descriptor has changed Signup and view all the answers

In CPT, the code listed first for an encounter is the procedure that is what?

Most resource intensive procedure Signup and view all the answers

Study Notes

ICD-10-CM Coding

ICD-10-CM is a mandated code set for diagnoses as per HIPAA regulations.
Codes can have a maximum of seven characters.
A basic category code consists of three characters.
Subcategory codes contain four characters.

Example Codes

An example of a subcategory code is S81.2.
The ICD-10-CM code system is updated based on the date of service.

Coding Steps and Tools

Begin the coding process by consulting the Alphabetical Index.
To code accurately, always confirm findings in the Tabular List after using the Alphabetical Index.

Index Organization

The Alphabetical Index is organized by conditions and is referred to as ICD-10-CM for diseases and injuries.

Modifiers and Terminology

Subterms describe main terms based on anatomical site and description.
Non-essential modifiers include terms such as acquired, congenital, and both eyes, which modify the main term.

Cross References and Codes

When a cross-reference appears with "SEE," it indicates the need to look up the following term.
A combining code is used to describe two diagnoses or a diagnosis with a complication.

Code Structure and Validity

The letter U is not utilized in ICD-10-CM coding.
A valid code must contain at least three characters.

Punctuation and Coding Instructions

A colon (:) indicates an incomplete term.
If the Tabular Index instructs to "code first underlying disease," that code will be listed second in priority.

Diagnosis and Co-existing Conditions

The primary diagnosis code is listed first.
Use a combination code to report both the primary diagnosis and any co-existing conditions.

Established Diagnoses

Once an established diagnosis is confirmed, the established code should be used.
Outpatient coding guidelines permit coding of abnormal test results.

Medical Records and Coding Limitations

If a condition’s type or form mentioned in medical records is not listed, it may be assigned an "other" code.
ICD-10-CM organizes diseases into 21 chapters.

Coding in Outpatient Settings

The chief complaint, abbreviated as "CC," represents the main issue during a visit.
The final step in coding involves checking compliance with relevant guidelines.

Verifying Codes

Verification during code selection includes referencing the Tabular List, ensuring the correct number of codes, and their proper order.

CPT Coding

ICD-10-CM improves specificity and detail compared to ICD-9-CM.
Level 1 codes in HCPCS are known as CPT codes.
CPT Category II codes report performance measures.

Updating Medical Practices

Upon receiving a revised edition of CPT codes, practices should update encounter forms, patient billing software, and educate staff regarding changes.

CPT Appendices and Indicators

Appendix A in CPT contains a summary of Modifier 51 exempt codes.
A plus (+) sign in CPT indicates an add-on code.
A triangle next to a CPT code signifies that the descriptor has changed.

Resource Intensity in Procedures

The CPT code listed first for an encounter represents the most resource-intensive procedure performed during that visit.

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Description

Test your knowledge on ICD-10-CM coding with this quiz. Each flashcard covers essential coding terms and their definitions, helping you to prepare for medical billing and coding challenges. Dive into the nuances of diagnosis coding mandated under HIPAA!