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CIPSMT The International Classification of Diseases Question
1. The International Classification of Diseases, published by the World Health Organization, is used to classify __________ data from death certificates.
a.
moratory
b.
morbidity
c.
morphology
d.
mortality
2. ICD-10-CM was developed in the United States and is used to classify __________ data from inpatient and outpatient records, including provider-based office records.
a.
moratory
b.
morbidity
c.
morphology
d.
mortality
3. ICD-9-CM is a(n) __________ classification system because of ICD-10-CM and ICD-10-PCS implementation.
a.
contemporary
b.
legacy
c.
optional
d.
updated
4. Physician office __________ codes are submitted for reimbursement purposes.
a.
ICD-10-CM, CPT, and HCPCS level II
b.
ICD-10-PCS, CPT, and HCPCS level II
5. Hospital inpatient __________ codes are submitted for reimbursement purposes.
a.
CPT, and HCPCS level II
b.
ICD-10-CM, CPT, and HCPCS level II
c.
ICD-10-CM and ICD-10-PCS
d.
ICD-10-CM, ICD-10-PCS, CPT, and HCPCS level II
6. Hospital outpatient __________ codes are submitted for reimbursement purposes.
a.
CPT and HCPCS level II
b.
ICD-10-CM, CPT, and HCPCS level II
c.
ICD-10-CM and ICD-10-PCS
d.
ICD-10-PCS, CPT, and HCPCS level II
7. General equivalency mappings are __________ of codes that can be used to roughly identify ICD-10-CM codes for their ICD-9-CM equivalent codes (and vice versa).
a.
crosswalks
b.
details
c.
indexes
d.
registers
8. ICD-10-CM codes require up to __________ characters, are entirely alphanumeric, and have unique coding conventions, such as Excludes1 and Excludes2.
a.
five
b.
six
c.
seven
d.
eight
9. ICD-10-CM and ICD-10-PCS incorporate much greater specificity and clinical information, which results in __________.
a.
decreased sensitivity when refining grouping and reimbursement methodologies.
b.
enhanced ability to conduct public health surveillance
c.
increased need to include supporting documentation with claims
d.
reduced ability to measure health care services
10. The ICD-10-CM and ICD-10-PCS classifications include updated medical terminology and classification of diseases, provide codes to allow for the comparison of mortality and morbidity data, and provide __________ for the purpose of conducting research, designing payment systems, identifying fraud and abuse, and more.
a.
clinical decisions
b.
improved data
c.
measurement of care
d.
public health tracing
11. Which of the following will best assist medical coding staff as ICD-10-CM and ICD-10-PCS classifications are implemented?
a.
ability to document information in patient records
b.
basic knowledge of anatomy and physiology
c.
effective communication with medical staff
d.
reporting ICD-10-CM/PCS codes from indexes
12. When coders have questions about documented diagnoses or procedures/services, they should use a __________ process to contact the responsible physician to request clarification about documentation and the code(s) to be assigned.
a.
medical coordination
b.
physician query
c.
quality assurance
d.
utilization management
13. ICD-10-CM far exceeds ICD-9-CM in the number of codes provided, having been expanded to __________.
a.
delete fifth digits for some codes
b.
include health-related conditions
c.
mandate assignment of just three characters
d.
reduce specificity at the sixth-digit level
14. The ICD-10-CM/PCS Coordination and Maintenance Committee is responsible for overseeing all changes and modifications to ICD-10-CM and ICD-10-PCS codes, including the creation and update of general equivalency mappings. ICD-10-CM codes are reported for __________, while ICD-10-PCS codes are reported for __________.
a.
diagnoses; procedures
b.
diagnoses; conditions
c.
procedures; diagnoses
d.
services; procedures
15. Matching ICD-10-CM diagnosis codes to CPT and HCPCS level II procedure and service codes on a claim submitted for a patient encounter ensures that services and procedures are reasonable and necessary for the diagnosis or treatment of an illness or injury. This concept is called __________.
a.
advance beneficiary notice of nonpayment
b.
medical necessity
c.
quality assurance
d.
utilization management
16. According to Medicare, if it is possible that scheduled tests, services, or procedures may be found medically unnecessary, the patient must sign an advance beneficiary notice, which __________.
a.
acknowledges the patient’s responsibility for payment if Medicare denies the claim
b.
ensures that the provider will receive reimbursement from another third-party payer
c.
guarantees that Medicare will deny payment for the claim, and the patient must pay
d.
improves the chances that Medicare will approve the submitted claim for payment
17. Which is the face-to-face contact between a patient and a health care provider who assesses and treats the patient’s condition?
a.
benefit period
b.
encounter
c.
episode of care
d.
spell of illness
18. Which of the following criteria is used to determine medical necessity?
a.
Costly treatment is provided when compared with alternative methods.
b.
Least expensive service is provided to patient, regardless of outcome.
c.
Procedure or service is performed to treat a health care condition.
d.
Treatment has a 50 percent chance of being effective for health outcome.
19. Which is a condition that occurs as the result of another condition and for which the codes are always reported as secondary codes?
a.
manifestation
b.
sign
c.
symptom
d.
syndrome
20. The subterm due to is located in the ICD-10-CM index in alphabetical order below a main term to indicate the presence of a __________ relationship between two conditions.
a.
cause-and-effect
b.
either/or
c.
inclusionary
d.
mutually exclusive
21. A code listed next to a main term in the ICD-10-CM index is referred to as a(n) __________ code..
a.
category
b.
default
c.
etiology
d.
unspecified
22. The ICD-10-CM Diagnostic Coding and Reporting Guidelines for Outpatient Services — Hospital-Based Outpatient Services and Provider-Based Office Visits were developed by the federal government and approved for use by hospitals and providers for coding and reporting __________ services and provider-based office visits.
a.
ambulatory surgical center
b.
home health care/hospice
c.
hospital-based outpatient
d.
skilled nursing facility
23. The Uniform Hospital Discharge Data Set definition of principal diagnosis applies to __________.
a.
clinics
b.
inpatients
c.
outpatients
d.
skilled nursing care
24. An outpatient is treated in which of the following settings?
a.
acute inpatient admission
b.
domiciliary care facility
c.
hospital observation unit
d.
nursing home
25. Which is a concurrent condition that coexists with the first-listed diagnosis, has the potential to affect treatment of the first-listed diagnosis, and is an active condition for which the patient is treated and/or monitored?
a.
comorbidity
b.
complication
c.
qualified diagnosis
d.
sign/symptom
Chapter 07: CPT Coding
1. Procedures and services submitted on a claim must be linked to the __________ that justifies the need for the service or procedure.
a.
CPT code
b.
HCPCS code
c.
ICD-10-CM code
d.
HCPCS level I code
2 The Evaluation and Management section is located at the beginning of CPT because these codes describe __________.
a.
encounters that have unusual circumstances
b.
health care rendered by nonphysicians only
c.
procedures performed by anesthesiologists
d.
services most frequently provided by physicians
3. The Evaluation and Management __________ of service reflects the amount of work involved in providing health care to a patient.
a.
complexity
b.
level
c.
place
d.
type
4. The __________ of service refers to the physical location where health care is provided to patients.
a.
complexity
b.
level
c.
place
d.
type
5. The __________ of service refers to the kind of health care services provided to patients.
a.
complexity
b.
level
c.
place
d.
type
6. A new patient is one who has not received any professional services from the physician, or from another physician of the same specialty who belongs to the same group practice, within the past __________ year(s).
a.
one
b.
two
c.
three
d.
four
7. An established patient is one who has received professional services from the physician, or from another physician of the same specialty who belongs to the same group practice, within the past __________ years.
a.
one
b.
two
c.
three
d.
four
8. Concurrent care is the provision of similar services, such as hospital inpatient visits, to __________ on the same day.
a.
different patients by more than one provider
b.
different patients by the same provider
c.
the same patient by more than one provider
d.
the same patient by the same provider
9. Transfer of care occurs when a physician who is managing some or all of a patient’s problems releases the patient to the care of another physician who is __________.
a.
consulting on the case in the office
b.
not providing consultative services
c.
providing consultative services
d.
terminating all care provided
10. CMS developed Evaluation and Management Documentation Guidelines, which explain how CPT evaluation and management codes are assigned according to __________ associated with comprehensive multisystem and single-system examinations.
a.
documentation
b.
elements
c.
office visits
d.
reimbursement
11. The __________ components of history, examination, and medical decision making are required when selecting an evaluation and management level of service code.
a.
collaborative
b.
key
12. The __________ components include counseling, coordination of care, nature of presenting problem, and time.
a.
collaborative
b.
key
13. A history is an interview of the patient that includes which of the following elements?
a.
chief complaint, history of present illness, past/family/social history
b.
chief complaint, history of present illness, past/family/social history, physical examination
c.
chief complaint, history of present illness, past/family/social history, review of systems
d.
chief complaint, past/family/social history, physical examination, review of systems
14. The CPT __________ of history is categorized according to four levels.
a.
extent
b.
level
c.
range
d.
type
15. The CPT problem-focused history includes the __________.
a.
chief complaint and brief history of present illness or problem
b.
chief complaint, brief history of present illness or problem, and problem-pertinent system review
c.
chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient’s problem
d.
chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a review of all additional body systems, and complete PFSH
16. The CPT expanded problem-focused history includes the __________.
a.
chief complaint and brief history of present illness or problem
b.
chief complaint, brief history of present illness or problem, and problem-pertinent system review
c.
chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient’s problem
d.
chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a review of all additional body systems, and complete PFSH
17. The CPT detailed history includes the __________.
a.
chief complaint and brief history of present illness or problem
b.
chief complaint, brief history of present illness or problem, and problem-pertinent system review
c.
chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient’s problem
d.
chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a review of all additional body systems, and complete PFSH
18. The CPT comprehensive history includes the __________.
a.
chief complaint and brief history of present illness or problem
b.
chief complaint, brief history of present illness or problem, and problem-pertinent system review
c.
chief complaint, extended HPI, problem-pertinent system review extended to include a limited number of additional systems, and pertinent PFSH directly related to the patient’s problem
d.
chief complaint, extended HPI, ROS directly related to the problem(s) identified in the HPI in addition to a view of all additional body systems, and complete PFSH
19. Which is an assessment of the patient’s body areas and organ systems?
a.
physical examination
b.
review of systems
20. The CPT problem-focused examination includes a(n) __________.
a.
extended examination of the affected body areas and other symptomatic or related organ systems
b.
general multisystem examination or a complete examination of a single organ system
c.
limited examination of the affected body area or organ system
d.
limited examination of the affected body areas or organ systems and other symptomatic or related organ systems
21. The CPT expanded problem-focused examination includes a(n) __________.
a.
extended examination of the affected body areas and other symptomatic or related organ systems
b.
general multisystem examination or a complete examination of a single organ system
c.
limited examination of the affected body area or organ system
d.
limited examination of the affected body areas or organ systems and other symptomatic or related organ systems
22. The CPT detailed examination includes a(n) __________.
a.
extended examination of the affected body areas and other symptomatic or related organ systems
b.
general multisystem examination or a complete examination of a single organ system
c.
limited examination of the affected body area or organ system
d.
limited examination of the affected body areas or organ systems and other symptomatic or related organ systems
23. The CPT comprehensive examination includes a(n) __________.
a.
extended examination of the affected body areas and other symptomatic or related organ systems
b.
general multisystem examination or a complete examination of a single organ system
c.
limited examination of the affected body area or organ system
d.
limited examination of the affected body areas or organ systems and other symptomatic or related organ systems
24. CPT medical decision making refers to the complexity of __________ as measured by the number of diagnoses or management options, amount and/or complexity of data to be reviewed, and risk of complications and/or morbidity or mortality.
a.
assessing patient data in a group or single practice
b.
completing a comprehensive history and physical examination
c.
establishing a diagnosis and/or selecting a management option
d.
ordering ancillary tests and interpreting their results
25. CPT defines counseling as it relates to evaluation and management coding as a(n) __________ concerning areas that involve diagnostic results, impressions, recommended diagnostic studies, and so on.
a.
assessment that impacts patient care
b.
discussion with a patient and/or family
c.
order for further ancillary testing
d.
way to guarantee quality patient care
Chapter 08: HCPCS Level II Coding
1. Medicare defines __________ as equipment that can withstand repeated use in the patient’s home and not in the absence of illness or injury.
a.
durable medical equipment
b.
durable medical equipment and supplies
c.
durable medical equipment, prosthetics, and orthotics
d.
durable medical equipment, prosthetics, orthotics, and supplies
2. Which includes artificial limbs, braces, medications, surgical dressings, and wheelchairs?
a.
durable medical equipment
b.
durable medical equipment and supplies
c.
durable medical equipment, prosthetics, and orthotics
d.
durable medical equipment, prosthetics, orthotics, and supplies
3. Which supply patients with durable medical equipment?
a.
carriers
b.
fiscal intermediaries
c.
DMEPOS dealers
d.
Medicare administrative contractors
4. The CMS HCPCS Workgroup maintains __________, permanent national codes, miscellaneous codes, temporary codes, and modifiers.
a.
HCPCS level I codes
b.
HCPCS level II codes
c.
HCPCS level III codes
d.
HCPCS level IV codes
5. HCPCS level II __________ codes are reported when a DMEPOS dealer submits a claim for
a product or service for which there is no existing HCPCS level II code.
a.
miscellaneous
b.
permanent
c.
temporary
d.
unlisted
Chapter 09: CMS Reimbursement Methodologies
1. Reimbursement according to a __________ means that hospitals reported actual charges for inpatient care to payers after discharge of the patients from the hospital.
a.
prospective cost-based rate
b.
prospective price-based rate
c.
retrospective reasonable cost system
d.
site-of-service differential
2. Which is established in advance and based on reported health care charges from which a predetermined per diem rate is determined?
a.
prospective cost-based rate
b.
prospective price-based rate
c.
retrospective reasonable cost system
d.
site-of-service differential
3. Which is associated with a particular category of patient and is established by the payer prior to the provision of health care services?
a.
prospective cost-based rate
b.
prospective price-based rate
c.
retrospective reasonable cost system
d.
site-of-service differential
4. The federal government administers several health care programs, some of which require services to be reimbursed according to predetermined reimbursement methodologies, which are established as __________.
a.
cost-based rates
b.
price-based rates
c.
payment systems
d.
reasonable cost systems
5. Which is a facility’s measure of the types of patients treated and reflects patient utilization of varying levels of health care resources?
a.
case mix
b.
cost basis
c.
discharge status
d.
resource utilization
Chapter 10: Coding for Medical Necessity
1. A provider often considers diagnoses that do not receive direct treatment during an encounter because they impact treatment of other conditions. It is appropriate to report codes for such diagnoses on the CMS-1500 claim because they have been __________.
a.
discounted by the payer
b.
included in coverage
c.
medically managed
d.
treated during the visit
2. The procedure or service provided is linked with the _________ that provided medical necessity for performing the procedure or service.
a.
diagnosis
b.
procedure
c.
service
d.
supply
3. Which is a form required by Medicare for all outpatient and physician office procedures/services that are not covered by the Medicare program?
a.
advance beneficiary notice
b.
assignment of benefits
c.
fee-rendered schedule
d.
patient waiver form
4. The Medicare coverage database (MCD) is used by Medicare administrative contractors,
providers, and other health care industry professionals to determine whether a procedure or service is __________ for the diagnosis or treatment of an illness or injury.
a.
billed at the appropriate level
b.
preauthorized by the contractor
c.
reasonable and necessary
d.
usual, customary, and reasonable
5. Local coverage determinations specify under which __________ a service is covered and coded correctly.
a.
clinical circumstances
b.
health care settings
c.
medical necessity
d.
service conditions
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