HCM 425 TESTBANK QUESTIONS WITH
100% CORRECT ANSWERS
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. - Answer-physician
query
ICD-10-PCS is an entirely new procedure classification system that was developed by
CMS for use in __________ settings only, replacing Volume 3 of ICD-9-CM. - Answer-
inpatient hospital
ICD-10-PCS uses a __________ seven-character alphanumeric code structure (e.g.,
047K04Z) that provides a unique code for all substantially different procedures, and it
allows new procedures to be easily incorporated as new codes. - Answer-multitaxial
Private companies publish __________, which automate the coding process so that
computerized or web-based software is used instead of coding manuals. - Answer-
encoders
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 __________. -
Answer-diagnoses;procedures
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 __________. - Answer-medical necessity
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 __________. - Answer-acknowledges the patient's responsibility for
payment if Medicare denies the claim
Which is the face-to-face contact between a patient and a health care provider who
assesses and treats the patient's condition? - Answer-encounter
, Which are diseases or syndromes that are named for people and are listed in
appropriate alphabetical sequence as main terms in the ICD-10-CM index? - Answer-
eponyms
Procedures and services submitted on a claim must be linked to the __________ that
justifies the need for the service or procedure. - Answer-ICD-10-CM code
With what type of codes are procedures/services identified by a five-digit CPT code and
descriptor nomenclature (these are codes traditionally associated with the CPT and
organized within six sections)? - Answer-Category I codes
Which are "performance measurements" tracking codes that are assigned an
alphanumeric identifier with a letter in the last field? - Answer-Category II codes
Calculate the amounts paid by the payer and the patient and the amount the provider
must "write off."
The patient is seen by his family physician for follow-up treatment of recently diagnosed
asthmatic bronchitis. The physician's fee is $75. The patient's copayment is $20, and
the patient is not required to pay any additional amount to the provider. The payer
reimburses the physician $28.
a). Enter the amount the patient pays to the provider
b.) Enter the amount the payer reimburses the provider
c). Enter the amount the provider "writes off" the account - Answer-a). $20
b). $28
c). $27
Calculate the amounts paid by the payer and the patient and the amount the provider
must "write off."
The patient undergoes chemical ablation of one facial lesion in her physician's office.
The physician's fee is $240. The patient's copayment is $18, and the patient is not
required to pay any additional amount to the provider. The payer reimburses the
physician $105.
a). Enter the amount the patient pays to the provider
b.) Enter the amount the payer reimburses the provider
c). Enter the amount the provider "writes off" the account - Answer-a). $18
b). $105
c). $117
Calculate the amounts paid by the payer and the patient and the amount the provider
must "write off."
The patient undergoes arthroscopic surgery at an ambulatory surgical center. The
surgeon's fee is $890. The patient's coinsurance is 20 percent of the $700 fee schedule,
and the patient is not required to pay any additional amount to the provider. The payer
reimburses the surgeon 80 percent of the $700 fee schedule.
a). Enter the amount the patient pays to the provider
b.) Enter the amount the payer reimburses the provider
100% CORRECT ANSWERS
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. - Answer-physician
query
ICD-10-PCS is an entirely new procedure classification system that was developed by
CMS for use in __________ settings only, replacing Volume 3 of ICD-9-CM. - Answer-
inpatient hospital
ICD-10-PCS uses a __________ seven-character alphanumeric code structure (e.g.,
047K04Z) that provides a unique code for all substantially different procedures, and it
allows new procedures to be easily incorporated as new codes. - Answer-multitaxial
Private companies publish __________, which automate the coding process so that
computerized or web-based software is used instead of coding manuals. - Answer-
encoders
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 __________. -
Answer-diagnoses;procedures
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 __________. - Answer-medical necessity
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 __________. - Answer-acknowledges the patient's responsibility for
payment if Medicare denies the claim
Which is the face-to-face contact between a patient and a health care provider who
assesses and treats the patient's condition? - Answer-encounter
, Which are diseases or syndromes that are named for people and are listed in
appropriate alphabetical sequence as main terms in the ICD-10-CM index? - Answer-
eponyms
Procedures and services submitted on a claim must be linked to the __________ that
justifies the need for the service or procedure. - Answer-ICD-10-CM code
With what type of codes are procedures/services identified by a five-digit CPT code and
descriptor nomenclature (these are codes traditionally associated with the CPT and
organized within six sections)? - Answer-Category I codes
Which are "performance measurements" tracking codes that are assigned an
alphanumeric identifier with a letter in the last field? - Answer-Category II codes
Calculate the amounts paid by the payer and the patient and the amount the provider
must "write off."
The patient is seen by his family physician for follow-up treatment of recently diagnosed
asthmatic bronchitis. The physician's fee is $75. The patient's copayment is $20, and
the patient is not required to pay any additional amount to the provider. The payer
reimburses the physician $28.
a). Enter the amount the patient pays to the provider
b.) Enter the amount the payer reimburses the provider
c). Enter the amount the provider "writes off" the account - Answer-a). $20
b). $28
c). $27
Calculate the amounts paid by the payer and the patient and the amount the provider
must "write off."
The patient undergoes chemical ablation of one facial lesion in her physician's office.
The physician's fee is $240. The patient's copayment is $18, and the patient is not
required to pay any additional amount to the provider. The payer reimburses the
physician $105.
a). Enter the amount the patient pays to the provider
b.) Enter the amount the payer reimburses the provider
c). Enter the amount the provider "writes off" the account - Answer-a). $18
b). $105
c). $117
Calculate the amounts paid by the payer and the patient and the amount the provider
must "write off."
The patient undergoes arthroscopic surgery at an ambulatory surgical center. The
surgeon's fee is $890. The patient's coinsurance is 20 percent of the $700 fee schedule,
and the patient is not required to pay any additional amount to the provider. The payer
reimburses the surgeon 80 percent of the $700 fee schedule.
a). Enter the amount the patient pays to the provider
b.) Enter the amount the payer reimburses the provider
