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Medical Coding Exam
Preparation for Medical Coding Certification Exam
159
Medical
01/12/2012

Additional Medical Flashcards

 


 

Cards

Term
For hemiplegia and hemiparesis and other paralytic syndromes, report the ______ side as dominant if the documentation does not specify which side is dominant.
Definition
affected
Term
Diabetes mellitus codes are __________ codes that include the type of diabetes as well as the body system involved and complications affecting the body system.
Definition
combination
Term
For reporting purposes, urosepsis is not considered _______.
Definition
sepsis
Term
T/F - Multiple coding is when it takes more than one code to fully describe the condition, circumstance, or manifestation.
Definition
True
Term
SIRS is the diagnosis when all of the following are diagnosed
Definition
hypothermia or fever
tachycardia
tachypnea
increased or decreased WBC
Term
combination code
Definition
single ICD-9-CM code used to identify etiology and manifestation of a disease.
Term
When reporting an infection that is antibiotic resistant, report the _________________ first, followed by _____, _________________________________.
Definition
infection
Z16, infection with drug resistant microorganisms.
Term
If the medical documentation indicates the patient has 2 conditions that are both included in one diagnosis code, ____________________________________________________.
Definition
report that diagnosis code only once.
Term
multiple coding is also known as
Definition
dual coding
Term
multiple coding
Definition
also known as dual coding, use of more than one ICD-9-CM code to identify both etiology and manifestation of a disease, as contrasted with combination coding.
Term
When the histological type of neoplasm is documentated, reference the __________________ _____________ first.
Definition
Alphabetical Index
Term
Viral hepatitis codes are divided based on
Definition
type of hepatitis
if condition is with or without hepatic coma
Term
If a patient is admitted with pneumonia and while hospitalized develops severe sepsis, report the __________________ first, followed by the ________________.
Definition
pneumonia
severe sepsis
Term
When an encounter is for treatment of anemia due to malignancy, the first-listed diagnosis would be the _______________, followed by the ____________.
Definition
malignancy
anemia
Term
When a neoplasm is not clearly benign or malignant, it is considered
Definition
uncertain
Term
septic shock is considered
Definition
organ failure
Term
hepatitis A was formerly known as
Definition
infectious or epidemic hepatitis
Term
When reporting hyptertensive chronic kidney disease, an additional code to report the type of chronic kidney disease
Definition
is required.
Term
The _______, or transmural myocardial infarction, also known as STEMI, is the most severe type of infarction.
Definition
Q-wave
Term
Sepsis is classified as severe sepsis when there is _____ _______ _______.
Definition
Multiple organ dysfunction (MOD).
Term
AHA
Definition
American Hospital Association
Term
AHIMA
Definition
American Health Information Management Association
Term
APC
Definition
Ambulatory Payment Classification
a patient classification that provides a payment system for outpatients
Term
Debridement techniques include:
Definition
sharp and blunt dissection
curettement
scrubbing
forceful irrigation
others
Term
debridement of burned surface code range
Definition
16000-16036
Term
Codes 11042-11047 are based on depth of tissue removed and surface area for wound.
How is reporting for one wound different from reporting for multiple wounds?
Definition
One wound: report depth of the deepest level of the tissue removed.
Multiple wounds: sum the surface area of the wound at the same depth. Do not combine sums of different depths.
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
The care of minor wounds, either postoperative, traumatic, or otherwise, is ___________ to other covered services.
Definition
incidental
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
the only service provided is the non-surgical cleansing of the wound or ulcer with or without the application of a surgical dressing, the provider should....
Definition
bill this service with an appropriate E/M code and not the debridement code(s).
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
there is no necrotic, devitalized, fibrotic, or other tissue or foreign matter present, the debridement service is
Definition
not medically necessary.
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
of devitalized tissue from wounds, non-selective debridement, without anesthesia, including topical application(s), is part of a
Definition
active wound care management.
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
CPT code selected should report the level of debrided tissue, not the
Definition
extent, depth, or grade of the ulcer or wound.
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
Select the most specific ICD-9-CM code that describes the _______________________________________ as the diagnosis on the claim
Definition
primary reason for the service, at its highest level of specificity,
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
When the patient has required 5 or more debridement services (11043 and/or 11044), per pt, per wound, in the outpatient setting, the claim form must also include, as secondary diagnoses
Definition
ICD-(-CM codes reflecting neuropathic, vascular, metabolic, or other comorbid conditions that have resulted in in excessive frequency of service.
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
The medical record should include an operative note for the debridement service, describing

Definition
the anatomical location treated, the instruments used, anesthesia used if required, type of tissue removed, the depth and area of the wound and the immediate post procedure care and follow-up instructions.
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:

________________ ____________ is recommended for prolonged or repetitive debridement services.
Definition
Photographic documentation
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
Use of CPT codes 11000-11047 is not appropriate for the following services:
Definition
washing bacterial or fungal debris from feet
paring or cutting of corns or calluses
incision and drainage of abscess including paronychia
trimming or debridement of nails
avulsion of nail plates
acne surgery
destruction of warts
burn debridement
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:

An E/M service may be billed on the same day as the procedure if _____________________
What modifier must be used?
Definition
the E/M service represents a significant separately identifiable service.
Modifier -25
Term
According to Medicare LCD for Debridement Services L27373, 8/1/10, the following is considered when reporting debridement:
Local infiltration, metacarpal/digital block, or topical anesthesia are _________ in the reimbursement for debridement services and are not ______ ___________.
Definition
included

separately payable.
Term
Skin Lesion excision and destruction methods: To code these procedures properly, you must know the
Definition
site, number, and size of the excised lesion (s)s, as well as whether the lesion is malignant or benign.
Term
The pathology report following skin lesion excision is used to identify the size of the lesion only if
Definition
no other record of the size can be documented because the solution the lesion is stored in shrinks the lesion.
Term
All skin lesions excised will have a ______ report
Definition
pathology
Term
Since the codes for excision of skin lesions are divided based on whether the excised lesion is ______________ or _________, the billing for the excision is not submitted to the 3rd party payer until the _______ ______ has been completed.
Definition
malignant
benign
pathology report
Term
Why is there no pathology report for lesions that have been destroyed by laser, chemicals, electrocautery, or other methods?
Definition
Destruction of lesions destroys the lesion, leaving no available tissue for biopsy. In these cases you will have to take the type of lesion from the physician's notes only, as there is no pathology report.
Term
If multiple skin lesions are treated, code the ___ ___ ____ ___ first, followed by ______ using modifier _____ to indicate that multiple procedures were performed.
Definition
most complex lesion procedure
others
-51
Term
3 types of closures included in the codes for lesion excision
Definition
direct,
primary
simple.
Term
You would not report both a biopsy and an excision performed at the same time as the
Definition
biopsy is bundled into the excision service.
Term
When closure is required following biopsy, ______ closure is bundled into the biopsy codes.
Definition
simple
Term
If closure of the biopsy site is more than a simple closure, you would report
Definition
the more extensive closure separately.
Term
On the CMS-1500 claim form, report the number of lesions treated in column
Definition
25G, Days or Units
Term
11100 reports a single lesion, and 11101 is an add-on code for each additional lesion.
The correct coding for 3 lesions would be
Definition
11100 for lesion one and 11101X2 for lesions 2 and 3

Do not assign modifier -51 with these biopsy codes
Term
Do not use modifier -51 with skin tag codes, as the codes are based on the
Definition
number of lesions removed.
Term
If electrocautery is the main method by which the lesion was removed, you would assign codes from the
Definition
Destruction, Benign or premalignant lesions category (17000-17250), not from the shaving category.
Electrosurgery used in shaving a superficial lesion burns (destroys) the lesion, so the destruction code would be reported.
Term
Shaving of a skin lesion - Shaving codes are defined according to ___ and __ of the lesion.
If more than one lesion was removed,
Definition
location, size

add modifier -51 to any codes after the first code, placing the more intensive procedure first.
Term
The codes in the Excision, Benign Lesions category (11400-11471) are assigned for all benign lesions, with the exception of
Definition
skin tags
Term
Codes in the Excision, Malignant Lesions subheading (11600-11646) are assigned for malignant lesions that includes _____ _____and _____ ____.
Definition
local anesthesia
simple closure
Term
Procedures included within the nails category (11719-11765)
Definition
trimming of fingernails and toenails
debridement of nails
removal of nails
drainage of hematomas
biopsies of nails
repair of nails
reconstruction of the nail bed
Term
Do not use modifier -51 with nail removal codes, as there are 2 codes available:
Definition
11730 for a single nail
11732 for each additional nail

if 3 nails removed: 11730 for first nail and 11732X2 for second and third nails.
Term
lesion injection codes are divided
Definition
according to the number of lesions injected (1-7 or 8+)
Term
tattooing codes
Definition
located in the introduction category
reported on the basis of square cm covered
Term
Codes for subcutaneous injection of filling material (11950-11954) are
Definition
located in the Introduction category
are reported for services such as collagen or silicone injections
are based on amount of material injected
Term
Tissue expander codes (11960-11971)
Definition
located in the Introduction category
not to be reported for a temporary expander used after a mastectomy. Code 19357 from reconstruction section of the Integumentary subsection
Term
Implantable Contraceptive capsules
Definition
found in the Introduction Category
Term
Subcutaneous hormone pellet implantation codes
Definition
found in the Introduction category (11980)
Term
A pilonidal cyst is considered complicated when it is larger than ___ cm.
Definition
2
Term
3 factors to consider when reporting wound repair
Definition
length of wound in cm
complexity of the repair
site of the wound repair
Term
wound repair is classified by
Definition
the type of repair necessary to repair the wound.
three types:
simple: superficial wound repair (12001-12021) involves epidermis, dermis and subcutaneous tissue
Term
Simple wound repair
Definition
superficial wound repair (12001-12021)
involves epidermis, dermis and subcutaneous tissue and requires only simple, one-layer suturing
Term
intermediate wound repair
Definition
requires closure of one or more layers of subcutaneous tissue and superficial (non-muscle) fascia, in addition to the skin closure.
Term
you can report intermediate closure (12031-12057)
Definition
when the wound has to be extensively cleaned, even if the closure was a single-layer (simple) closure
Term
complex wound closure
Definition
involves complicated wound closure including revision, debridement, extensive undermining, stents or retention sutures, and more than layered closure (13100-13160)
Term
3 types of wound repair
Definition
simple
intermediate
complex
Term
3 things are considered components of wound repair and are not reported separately
Definition
simple ligation: tying of small vessels

simple exploration of surrounding tissue, nerves, vessels and tendons

normal debridement
Term
Types of grafting procedures
Definition
adjacent tissue transfers or rearrangements
skin replacement surgery and skin substitutes
flaps
Term
Types of adjacent tissue transfer or rearrangement (14000-14350)
Definition
Z-plasty
W-plasty
V-Y plasty
rotation flaps
advancement flaps
Term
Adjacent tissue transfers are reported according to
Definition
size of the recipient site in square cm.
Term
Adjacent Tissue Transfer or Rearrangement (1400-14350) in the CPT manual is divided based on
Definition
the location of the defect and the size of the defect.
Term
Pertaining to: Adjacent Tissue Transfer or Rearrangement (1400-14350) in the CPT manual

When skin grafting is required to cover both the primary defect and the secondary defect, the measurement s of each defect
Definition
are added together to determine the code selection for the graft.
Term
Skin Replacement Surgery and Skin Substitutes (15002-15431).
Describe
Definition
these codes report site preparation using a variety of grafting materials and repair methods using skin or skin substitutes.
Term
Pertaining to: Skin Replacement Surgery and Skin Substitutes (15002-15431).

The site of the defect may require surgical preparation before repair, and is reported with 15002-15005 based on
Definition
the size of the repair and site.
Term
Pertaining to: Skin Replacement Surgery and Skin Substitutes (15002-15431).

Free skin grafts are reported by
Definition
recipient site,
size of defect,
and type of repair
Size is measured in cm.
Term
Pertaining to: Skin Replacement Surgery and Skin Substitutes (15002-15431).

Square Cm is applied to ___________
Percentage of body area is applied to _____________
Definition
adults and children over the age of 10 years

infants and children under the age of 10 years
Term
A split thickness skin graft is often referred to on the pt record as
Definition
STSG
Term
A full thickness skin graft is often referred to on the pt record as
Definition
FTSG
Term
Epidermal autografts (15110-15116) and dermal autografts (15130-15136) are reported based on
Definition
graft depth
location
size
Term
Tissue cultured epidermal autografts (15150-15157) are grafts that are
Definition
cultured from the pt's own skin cells, to reduce the chances of rejection
Term
Acellular dermal replacement (15170-15176) is the
Definition
use of skin replacement products based on the location and size of repair.
Term
Temporary allografts are reported with 15300-15321 based on
Definition
the location and size of repair
Term
Codes for skin graft flaps do not include _____ or ______
Definition
extensive immobilization that may be necessary, such as a large plaster cast, or
the closure of the donor site
These must be reported in addition to the flap procedure.
Term
How is the percentage of body area calculated in adults for reporting burns?
Definition
Rule of Nines
Term
How are burn dressing and/or debridement areas defined?
Definition
Small = >5% of total body surface
Medium = whole face or whole extremity, or 5% - 10% of total body surface area
Large = more than one extremity or > 10% of total body area
Term
Mohs micrographic surgery requires a single physician to act in 2 integrated but separate and distinct capabilities:
Definition
surgeon
pathologist
Term
There is no tissue remaining for pathological examination after which method has been used?
ablation
destruction
excision
Mohs
Definition
destruction
Term
What 2 items are needed to correctly code for local treatment of burns?
Definition
Percentage of body surface and depth of burn
Term
When an excision is being performed, the "margins" refer to the ______ ______ required to adequately excise the lesion based on the physician's judgement.
Definition
narrowest margin
Term
Using the "Rules of Nines," one adult leg is what percentage of the human body?
Definition
18%
Term
The removal of a lesion by transverse incision that did not require sutured closure is reported using codes from which subsection?
Definition
Shaving of Epidermal or Dermal Lesions
Term
The repaired wound should be measured or converted to:
Definition
centimeters
Term
Incision and drainage codes are divided into subcategories according to the
Definition
condition for which the procedure is performed
Term
To properly code lesion excision, you must know the behavior and the narrowest margin about the lesion in addition to which of the following?
Definition
Site, number and size
Term
Excision defined as full thickness would be through the
Definition
dermis.
Term
Which of the following is a type of crosswalk to find corresponding diagnosis codes between ICD-9-CM and ICD-10-CM?
Definition
GEMs
Term
The maximum number of characters in an ICD-10-CM code is
Definition
7
Term
T/F - Section IV of the Official Guidelines for Coding and Reporting applies to both the inpatient and outpatient settings.
Definition
False
Term
Z codes may be assigned as
Definition
first listed or a secondary diagnosis
Term
If there are separate codes for the the acute and chronic condtion, code for the _____ condition first as long as both codes are listed at the same indentation level of the Index.
Definition
acute
Term
A ____ ____ is the residual effect after the acute phase of an illness or injury has passed.
Definition
late effect
Term
If the type of diabetes mellitus is not documented in the medical record, the default is ______ _____ diabetes mellitus.
Definition
type 2
Term
Osteoporosis is a _____ condition, meaning that all bones of the musculoskeletal system are affected.
Definition
systemic
Term
A major change took place in Medicare in ____ with the enactment of the Omnibus Budget Reconciliation Act.
Definition
1989
Term
Who is the largest third-party payer in the nation?
Definition
The government
Term
_________ 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.
Definition
transactions
transmission
Term
Which of the following models are used to deliver managed health care?

Health Maintenance Organizations (HMO)
Preferred Provider Organizations (PPO)
Individual Practice Associations (IPA)
All choices apply
Definition
all choices apply
Term
Fraud is an intentional deception or misrepresentation that an individual knows to be false or does not believe to be true and makes knowing that the deception could result in some unauthorized benefit to himself/herself or some other person. (T/F)
Definition
True
Term
Medicare Part B services are billed using:

RBRVS, GPCI, and RVUs.
ICD-9-CM, CPT, and HCPCS.
MS-DRGs.
APCs.
Definition
ICD-9-CM, CPT and HCPCS
Term
Medicare Part A pays for
Definition
hospital/facility care
Term
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%, 100%, 100%, 100%, 100%
100%, 50%, 50%, 50%, 25%
100%, 50%, 50%, 25%, 25%
100%, 50%, 50%, 50%, 50%
Definition
100%, 50%, 50%, 50%, 50%
Term
Definition
Term
What edition of the Federal Register would outpatient facilities be especially interested in?  
   
Definition
November or December
Term
The Medicare program was established in
Definition
1965
Term
ICD-9-CM
Definition
International Classification of Diseases, 9th Revision, Clinical Modification
Term
The Table of Drugs nd Chemicals is located in
Definition
Volume 2
Term
In ICD-9-CM, NOS means
Definition
Not otherwise specified
Term
What volume of the ICD-9-CM is used by hospitals to report inpatient procedures?
Definition
Volume 3
Term

Volume 3 contains _______

surgical codes and the remaining are

_______ diagnostic codes.

Definition
90%, 10%
Term
Definition
Term
Words contained within the brackets “[ ]” provide the coder with:
Definition

synonyms,

alternative wording

or

explanatory phrases

Term
Symbols, abbreviations, punctuation, and notations in ICD-9-CM are termed:
Definition
conventions
Term
Definition
Term
ICD-9-CM contains ____ active appendices in the Tabular List of Volume 1.
Definition
5
Term
The three volumes of ICD-9-CM are:

Definition
Volume 1-Diseases: Tabular List, Volume 2-Diseases: Alphabetic Index, Volume 3-Procedures: Tabular List and Alphabetic Index.
Term

If a patient presents for a routine outpatient prenatal visit

with no complications, codes V22.0 or V22.1 should be

used as the principal diagnosis.

Definition
True
Term
V codes can be assigned as first-listed or secondary diagnoses.
Definition
True
Term
If a patient is admitted for observation for a medical condition, a code is assigned for the medical condition as the first-listed diagnosis
Definition
True
Term
The same coding guidelines apply to both the inpatient and outpatient settings
Definition
False
Term
In the outpatient setting, the term first-listed diagnosis is used in lieu of principal diagnosis.
Definition
True
Term
If the pre- and postoperative diagnoses are different, the preoperative diagnosis should be coded.
Definition
False
Term
Definition
Term
In the outpatient setting, a diagnosis that is documented as “rule out” should be coded as if it exists.
Definition
False
Term
The first-listed diagnosis is the diagnosis that the physician lists first.
Definition
False
Term
In the outpatient setting the term “first-listed diagnosis” is used instead of “principal diagnosis.”
Definition
True
Term
It is acceptable to use codes that describe signs or symptoms when a definitive diagnosis has not been established by the provider.
Definition
True
Term
It is acceptable to assign codes directly from the Alphabetic Index of the ICD-9-CM
Definition
false
Term
It is important to follow any cross-reference instructions, such as see also.
Definition
True
Term
The routinely associated signs and symptoms should not be coded in addition to a code for the particular disease or condition.
Definition
true
Term
Multiple coding should not be used when there is a combination code that identifies all the elements documented in the diagnosis
Definition
true
Term
If there are separate codes for both the acute and chronic forms of a condition, the code for the chronic condition is sequenced first
Definition

False

 

Term
Terms that may be used to describe a threatened condition include:
Definition
threatening and impending
Term

A combination code is a single code used to classify


Definition
  • 2 diseases
  • a dx with an associated secondary process (manifestation)
  • a dx with an associated complication
Term
A late effect is the residual condition that is still present 2 months after the acute illness or injury
Definition
false
Term
Definition
Term
Status asthmaticus is a term used for a very severe type of asthmatic attack.
Definition
True
Term

ICD-9-CM presumes a cause-and-effect relationship between hypertension and heart disease.

T/F

Definition
FALSE
Term

HIV infection can be reported if documented as “suspected” or “possible.”

T/F

Definition
FALSE
Term

HIV infection can be reported if documented as “suspected” or “possible.”

T/F

Definition
FALSE
Term

Assignment of diabetes codes are not affected by whether the patient is on insulin

T/F

Definition
FALSE
Term

If a physician documents that the patient’s diabetes is poorly controlled, a fifth digit for “out of control” should be assigned

T/F

 

Definition
FALSE
Term

A fifth digit of 3 (in remission) should be assigned to 305.0X for someone who has abused alcohol in the past but no longer drinks alcohol

T/F

Definition
TRUE
Term

The site to which a malignant neoplasm has spread is the primary site

T/F

Definition
FALSE
Term
Definition