HCM 425 EXAM QUESTIONS AND
ANSWERS ALL CORRECT
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-multiaxial
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
What type of codes contain "emerging technology," are temporary codes assigned for
data collection, and are still used by some third-party payers? - Answer-Category III
Codes
Most CPT procedures and services are classified as __________ codes, which include
a complete description of the procedure or service. - Answer-Stand-alone
Which party signs a contract with a health insurance company and thus, owns the
health insurance policy? - Answer-policy holder
Which has as its goal access to health coverage for every individual, regardless of the
system implemented to achieve that goal? - Answer-universal health insurance
The terms electronic health record (EHR) and electronic medical record are often used
interchangeably, but the ______ is a more global concept that includes the collection of
patient information documented by a number of providers at different facilities regarding
one patient. - Answer-electronic health record (EHR)
Total practice management software (TPMS) is used to generate the EMR, automating
which of the following medical practice functions? - Answer-Patient Registration
If a veteran is rated as 100 percent permanently and totally disabled as a result of a
service-connected condition, which program will provide benefits to the veteran's
dependents? - Answer-CHAMPVA
A new fee schedule for Medicare services was implemented as part of OBRA in 1989
and 1990, replacing the regional "usual and reasonable" payment basis with a fixed fee
schedule called: - Answer-RBRVS
Quality standards for all laboratory testing to ensure the accuracy, reliability, and
timeliness of patient test results regardless of where the tests are performed were
established specifically by __________ legislation. - Answer-CLIA
ANSWERS ALL CORRECT
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-multiaxial
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
What type of codes contain "emerging technology," are temporary codes assigned for
data collection, and are still used by some third-party payers? - Answer-Category III
Codes
Most CPT procedures and services are classified as __________ codes, which include
a complete description of the procedure or service. - Answer-Stand-alone
Which party signs a contract with a health insurance company and thus, owns the
health insurance policy? - Answer-policy holder
Which has as its goal access to health coverage for every individual, regardless of the
system implemented to achieve that goal? - Answer-universal health insurance
The terms electronic health record (EHR) and electronic medical record are often used
interchangeably, but the ______ is a more global concept that includes the collection of
patient information documented by a number of providers at different facilities regarding
one patient. - Answer-electronic health record (EHR)
Total practice management software (TPMS) is used to generate the EMR, automating
which of the following medical practice functions? - Answer-Patient Registration
If a veteran is rated as 100 percent permanently and totally disabled as a result of a
service-connected condition, which program will provide benefits to the veteran's
dependents? - Answer-CHAMPVA
A new fee schedule for Medicare services was implemented as part of OBRA in 1989
and 1990, replacing the regional "usual and reasonable" payment basis with a fixed fee
schedule called: - Answer-RBRVS
Quality standards for all laboratory testing to ensure the accuracy, reliability, and
timeliness of patient test results regardless of where the tests are performed were
established specifically by __________ legislation. - Answer-CLIA
