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hospital facilities be especially interested in? October If a surgeon performs more than one procedure on the same patient on the same day, and discounts were made on all subsequent procedures, Medicare would pay what percentages for the first, second, third, fourth, and fifth procedures? 100%, 50%, 50%, 50%, 50% Medicare sets the payment level for assistant surgeons at a percentage of the fee schedule amount for the ____ surgical service global What edition of the Federal Register would outpatient facilities be especially interested in? November or December ____ are activities involving the transfer of health care information and ____ means the movement of electronic data between two entities and the technology that supports the transfer. transactions, transmission Who handles the day-to-day operation of the Medicare program for the CMS? MACs Which of the following is NOT a stated goal of the Physician Payment Reform? limit provider liabilities Medicare Part A pays for hospital/facility care Medicare pays for what percentage of covered charges? 80% The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 established these new benefits available under the Medicare program. Part D Who is the largest third-party payer in the nation? the government The incentives to Medicare participating providers are: direct payment on all claimes, a 5% higher fee schedule, faster processing The Medicare program was established in 1965 If a QIO provider renders a covered service that costs $100 and bills Medicare for the service and Medicare allowed $58, the provider would bill this amount to the patient. $0 CMS handles the daily operation of the Medicare program through the use of ____ ____ ____, formerly Fiscal Intermediaries. Medicare Administrative Contractors Medicare Part B pays for physician services and durable medical equipment What are the three items that the Medicare beneficiaries are responsible to pay before Medicare will begin to pay for services? deductibles, premiums, and coinsuranceA major change took place in Medicare in ____ with the enactment of the Omnibus Budget Reconciliation Act 1989 This program is also known as Medicare Advantage. Part C Medicare funds are collected by:Social Security Administration All ICD-10-CM codes have seven characters False There are 10 times more codes in the ICD-10-CM than in ICD-9-CM. False The pre-release draft of the ICD-10-CM was released in June of 2003 and replaced with a revision in July of 2007 True ICD-10-CM codes have a maximum of five characters. False There are 21 chapters in the ICD-10-CM. True ICD-10-CM codes are alphanumeric, with all codes beginning with a number. False The maximum number of characters in an ICD-10-CM code is: 7 The National Center for Health Statistics is responsible for developing the procedure classification ICD-10-PCS False The letter N is assigned as a fifth character placeholder for certain six-character codes False Are there combination diagnosis/symptom codes in ICD-10-CM Yes What are characteristics of the ICD-10-CM index Main terms are in bold type, subterms are indented under the main term, only the first four characters of some codes are given This is a type of crosswalk for mapping ICD-9-CM codes to ICD-10-CM codes GEMs Notable improvements in the content and format of the ICD-10-CM include expansion of signs and symptoms codes False Which organization has been responsible for the development of ICD-10-CM? NCHS The ICD-10-CM, the WHO version, does not include a procedure classification (Volume 3) True Identify the first-listed diagnosis in the following outpatient encounters (using words and NOT codes).An established patient is seen for management of diabetes and hypothyroidism and the physician spends equal time on each diagnosis. ____________________ Diabetes and/or Hypothyroidism Section IV of the Official Guidelines for Coding and Reporting applies to both the inpatient and outpatient settings False Identify the first-listed diagnosis in the following outpatient encounters (using words and NOT codes). Initial office visit for patient with nausea and vomiting. Physician documented the nausea and vomiting were due to acute appendicitis. ____________________ Acute Appendicitis In the inpatient hospital setting, proable, suspected, and rule-out diagnoses cannot be reported by the facility as though the condition exists False Identify the first-listed diagnosis in the following outpatient encounters (using words and NOT codes). Established patient presents with chest pain. He has a history of previous myocardial infarction and coronary artery bypass surgery. Chest pain A patient is admitted to an observation unit for a medical condition that has worsened and is then admitted as an inpatient to the same hospital for the same medical condition. The primary diagnosis would be the medical condition that led to the admission. True If the pre- and postoperative diagnosis are different, the preoperative diagnosis should be reported False Identify the first-listed diagnosis in the following outpatient encounters (using words and NOT codes). Established patient seen for redness and sensitivity to light in her right eye. The documentation states the diagnosis is iritis Iritis The term "primary diagnosis" is the same as the first-listed diagnosis True Z codes may be assigned as first-listed or a secondary diagnosis TrueIn the outpatient setting, a diagnosis that is documented as "rule out" should not be reported True A patient may have an unconfirmed diagnosis for more than three visits if a definitive diagnosis has not been stated by the physician in the medical documentation True Identify the first-listed diagnosis in the following outpatient encounters (using words and NOT codes). An established patient is seen for migraines and seizures, to rule out the possibility of a brain tumor. Seizures and Migraines Code all the documented conditions that coexist at the time of an encounter/visit and require or affect patient care, treatment, or management True When an encounter is for a therapeutic service, the first-listed code is the diagnosis, condition, or problem shown to be chiefly responsible for the therapeutic service. True Using the Alphabetic Index for ICD-10-CM or ICD-9-CM, identify the MAIN TERM for the following. Acute and chronic respiratory failure. Failure Using the Alphabetic Index for ICD-10-CM or ICD-9-CM, identify the MAIN TERM for the following. Acute and chronic prostatitis due to Escherichia coli bacterial infection. Prostatitis, Infection Using the Alphabetic Index for ICD-10-CM or ICD-9-CM, identify the MAIN TERM for the following. Bilateral carotid stenosis Stenosis It is important to follow any cross-reference instructions in the Alphabetic Index, such as see also. True Using the Alphabetic Index for ICD-10-CM or ICD-9-CM, identify the MAIN TERM for the following.Rubella meningoencephalitis. Meningoencephalitis A late effect is the residual effect after the acute phase of an illness or injury has passed True Multiple codes are often required for late effects, complication codes, and obstetric codes.True A combination code is a single code used to classify what?two diagnoses (or procedures), a diagnosis with an associated secondary process (manifestation), or a diagnosis with an associated complication Using the Alphabetic Index for ICD-10-CM or ICD-9-CM, identify the MAIN TERM for the following. Acute and chronic systolic (congestive) heart failureFailure Section IV of the Official Guidelines for Coding and Reporting contains information regarding outpatient coding True Using the Alphabetic Index for ICD-10-CM or ICD-9-CM, identify the MAIN TERM for the following. Pseudocyst of the pancreas Pseudocyst Using the Alphabetic Index for ICD-10-CM or ICD-9-CM, identify the MAIN TERM for the following. Chronic osteomyelitis with draining sinuses of right first toe due to Staphylococcus aureus Osteomyelitis, infection Assign codes as directed in the Index, only after verifying the code in the Tabular True Are the following statements about late effects true or false There is no time limit for the development of a residual A patient may develop more than on residualA residual may occur months after an injury True It is unacceptable to report an impending condition as if it exists in an outpatient facility. True Using the Alphabetic Index for ICD-10-CM or ICD-9-CM, identify the MAIN TERM for the following. Primary hypertension. hypertension Using the Alphabetic Index for ICD-10-CM or ICD-9-CM, identify the MAIN TERM for the following. Hypertensive heart disease NOS. Disease Using the Alphabetic Index for ICD-10-CM or ICD-9-CM, identify the MAIN TERM for the following. Right and left inguinal hernia. Hernia Using the Alphabetic Index for ICD-10-CM or ICD-9-CM, identify the MAIN TERM for the following. Osteoarthritis of both knees with pain and swelling. Osteoarthritis Using the Alphabetic Index for ICD-10-CM or ICD-9-CM, identify the MAIN TERM for the following. Arteriosclerosis of native arteries of the left leg with gangrene. Arteriosclerosis If a patient is seen for a pathological fracture due to a neoplasm, the neoplasm should be the first-listed diagnosis. False If a patient is admitted for dehydration due to chemotherapy, the dehydration is the first-listed diagnosis. True Identify the main termPleural plaque without asbestos.Plaque Identify the main term Acute lower respiratory infection (Streptococcus, group A) in a patient with a chronic respriatory condition. Infection Septic shock does not indicate the presence of severe sepsis. False Identify main term Encounter for screening for HIV due to high-risk heterosexual behavior. Encounter (for) If the type of diabetes mellitus is not documented in the medical record, the default is Type 2 diabetes mellitus. Ttrue The secondary cancer should be listed before the primary cancer if the secondary cancer is the reason for the visit. True Identify main term Post-traumatic acute headache Headache Identify main term Arthritis due to Lyme disease. Arthritis If a patient with coronary artery disease is admitted due to an acute myocardial infarction (AMI), the AMI should be sequenced before the coronary artery disease. True Identify main term Acute suppurative otitis media without rupture of eardrum, of the left ear. Otitis Identify main term Melkersson-Rosenthal syndrome. MelkerssonIdentify main term Admission for pain control for liver cancer. Pain When the reason for the encounter is to determine the extent of the malignancy, or for a procedure such as paracentesis or thoracentesis, the primary malignancy or appropriate metastatic site is designated as the first-listed diagnosis. True Identify main term Treatment for anemia due to non-Hodgkin lymphoma. Anemia Identify main term Acute lymphangitis of left upper arm. Lymphangitis or Abscess Identify main term Infectious colitis. Colitis Identify main term Retinal migraine. migraine If the patient has documented HIV, the HIV must be the first-listed diagnosis even if the patient is seen for a condition unrelated to HIV. False Staphylococcus aureus arthritis of the left ankle is an example of when the organism is reported first, followed by a code to report the pyogenic arthritis. False For certain conditions, the bone may be affected at the upper or lower end such as with avascular necrosis of the femur in the knee joint. When the site is at the joint, report the condition of the joint, not the bone. False Identify the main terms Patient who habitually chews tobacco is diagnosed with leukoplakia of the tongue, nicotine induced. Leukoplakia of the tongue, nicotine abuseIdentify main and sub terms Ruptured popliteal cyst. Cyst, popliteal, ruptured There are two types of direct infections; reactive arthropathy and postinfective arthropathy. False Identify the main terms Staphylococcal aureus arthritis of the left hip.Arthritis (left hip), Infectious organism (S. aureus) Pressure ulcers develop when the circulation to an area is decreased by the application of pressure to the area. True Identify the main terms Osteopathy of right lower leg following poliomyelitisOsteopathy (R lower leg), Late effect of poliomyelitis For hemorrhage to be reported there does not have to be active bleeding; however, there must be documentation in the medical record indicating active bleeding has occurred and the source of the bleeding must be identified. True A stage II pressure ulcer is considered a full thickness loss of skin. False Many conditions reported in the musculoskeletal chapter are a result of previous injury or trauma to a site, or are recurrent conditions. True A symptom code should not be assigned when it is considered to be routinely associated with a disease process True A stress fracture is the same as a pathologic fracture False The Includes and Excludes of a code are only listed in the Tabular; therefore, it is imperative that you reference the Tabular before selecting a code. True Identify the main terms Patient with alcohol dependence is found to have chronic gastric atrophy. Gastric atrophy, Alcohol dependenceOsteoporosis is a systemic condition, meaning that all bones of the musculoskeletal system are affected. True Superficial injuries such as an abrasion or contusion are reported when associated with more severe injuries of the same site False A congenital anomaly is an abnormality one was born with. True Gestational (pregnancy induced) diabetes mellitus occurs during the first trimester of pregnancy False The postpartum period begins immediately after delivery and continues for twelve weeksFalse A surgical complication is one that takes place as a result of a procedure. True The perinatal period extends before birth through 28 days after birth. True An adverse effect occurs when a drug has been correctly prescribed and properly administered and the patient develops a reaction. True Codes from Chapter 16, the perinatal codes, should be used on the mother's record to identify fetal conditions. False The outcome of delivery is indicated on the mother's medical record only. True Malignant hydatidiform moles are reported as a neoplasm of uncertain behavior of the placenta. True Words contained within the brackets "[ ]" provide the coder with synonyms, alternative wording, explanatory phrases NEC is the acronym for Not Elsewhere Classifiable To correctly code neoplasms, it is necessary to know whether the tumor is benign or malignant, as well as whether the tumor is primary, secondary, or carcinoma in situ. True The colon ":" in the Tabular List indicates the terms below complete the term to make it assignable to a given category A symbol used to denote all exclusion notes and to identify those codes that are not usually sequenced as the first-listed diagnosis is the italicized type The "Includes" notes further define or provide examples to clarify assignment TrueItalicized type codes cannot be assigned as a first-listed diagnosis, because they are always listed after another code. True Is the following code a category, subcategory, or subclassification 436 category Another name for the Supplementary Classification of Factors Influencing Health Status and Contact with Health Services is V codes There are three types of cross-references in ICD-9-CM—see, see also, see category True The acronym ICD-9-CM means International Classification of Diseases, 9th Revision, Clinical Modification Is the following a procedure or diagnosis code 540.0 diagnosis code What volume of the ICD-9-CM is used by hospitals to report inpatient procedures? Volume 3 Is the following code a category, subcategory, or subclassification 723.0 subcategory Is following as a procedure or diagnosis code. 486 Diagnosis The three volumes of ICD-9-CM are Volume 1-Diseases: Tabular List, Volume 2- Diseases: Alphabetic Index, Volume 3-Procedures: Tabular List and Alphabetic Index The classification not included in the Table of Drugs and Chemicals primary neoplasm Is the following a category, subcategory, or subclassification code. 524.01 SubclassificationIs following as a procedure or diagnosis code 51.10 Procedure code When a code is listed inside the slanted brackets, you must sequence that code after the underlying condition code. True In the Alphabetic Index of Volume 2, ICD-9-CM, nonessential modifiers are terms enclosed in parentheses that have no effect on the selection of the code All ICD-9-CM codes must be supported by physician documentation in the medical record Is following as a procedure or diagnosis code 277.00 diagnosis code Codes that have mandatory fifth digits are codes that always require a 5th digit to fully describe them What is defined as transforming written descriptions into numerical designations? coding V codes are located in Volume 1, ICD-9-CM ICD-9-CM codes are updated at least annually The Table of Drugs and Chemicals is located in: Volume 2 Procedure or diagnosis code? 54.0 Procedure E codes are used to report external causes of injury and poisoning What organization, in conjunction with the National Centers for Health Statistics, is responsible for maintenance of the diagnosis classifications of ICD-9-CM, Volume 3? Centers for Medicare and Medicaid Services (CMS) procedure or diagnosis code? 250.00 DiadnosisIf the pre- and postoperative diagnosis are different, the preoperative diagnosis should be coded False Using words, identify the first-listed diagnosis in the following outpatient encounters or visits. Initial office visit for patient with diarrhea. Physician documented gastroenteritis Gastroenteritis Using words, identify the first-listed diagnosis in the following outpatient encounters or visits. An established patient is seen for amenorrhea and galactorrhea, to rule out pituitary tumor amenorrhea, galactorrhea Using words, identify the first-listed diagnosis in the following outpatient encounters or visits. Established patient presents with chest pain and has a history of previous myocardial infarction. Chest pain In the outpatient setting a diagnosis that is documented as "rule out" should be coded as if it exists. False The first-listed diagnosis is the diagnosis that the physician lists first. False The Official Guidelines for Coding and Reporting are updated every year True The routinely associated signs and symptoms should not be coded in addition to a code for the particular disease or condition. TRue When sequencing codes for residuals and late effects, the residual code is generally sequenced first followed by the late effect code. True It is important to follow any cross-reference instructions, such as see also. True Always verify the code from the Alphabetic Index in the Tabular List to assure accurate coding. True Multiple coding should not be used when there is a combination code that identifies all the elements documented in the diagnosis. TrueThe correct code for impending shock is No code is assigned The words that follow a code number in the CPT manual are called procedure/service descriptor The correct order from the largest to smallest division of the CPT hierarchy in the CPT manual is section, subsection, subheading, category Category I CPT codes have how many digits? 5 What modifier would be used when two surgeons work together as primary surgeons performing distinct parts of a procedure, each surgeon would report modifie 62 What must accompany claims when using an unlisted procedure code? A special report A list of the unlisted procedures for use in a specific section of the CPT manual is contained in Guidelines What is the function of an add-on code? identifies a code that is never used alone Health care providers are ____ based on the codes submitted on a claim form for procedures and services rendered. reimbursed How many main sections are in the CPT manual? 6 According to the E/M Guidelines, time is not a descriptive component for the ____ department levels of E/M service. emergency Who requires a special report with the use of unlisted codes? third-party payers The ____________________ section Guidelines contain the definition of the chief complaint. Evaluation and Management According to the Radiology Guidelines, these are the methods that qualify as "with contrast." intravascularly, intra-articularly, intrathecally Which punctuation mark between codes in the index of the CPT manual indicates two codes are available? comma A code that has all of the words that describe the code that follows is what type of code? Stand alone What provides additional information to the third-party payer? A modifier Who publishes CPT? AMAAccording to the notes preceding the Category III codes in the CPT manual, the digits of the Category III codes are not intended to reflect the placement of the code in the Category I section of the CPT nomenclature Appendix C of the CPT manual contains examples of ____________________ codes. Evaluation and Management The universal health insurance paper form for submission of outpatient services is the CMS-1500 What does two triangles pointing at each other mean? Revised text What does a triangle pointing up mean? Revised code What does a circle icon mean? New code What does a plus sign mean? Add-on code What does a circle with a line through it mean? Modifier -51 exempt These codes are Category I procedure codes that are considered unusual, experimental, or new and do not have a specific code to be assigned. Unlisted procedure The ____________________ section Guidelines contain the definition of a separate procedure Surgery What does the -50 modifier mean? Bilateral procedure What does the -76 modifier mean? Repeat procedure by the same individual What does the -54 modifier mean? Surgical care only What does the -51 modifier mean? Multiple procedures In which CPT appendix would additions, deletions, and revisions be found? Appendix B Level II codes are not used in which setting? inpatient CPT stands for Current Procedural Terminology