Medical Coding 300+ questions with
answers to study ICD-10 coding
Coding is - ANS the process of translating this written or dictated medical record into a series of numeric
or alpha-numeric codes
Proper code assignment is determined by - ANS content of the medical record and by the unique rules
that governs each code set
What are 3 things that Coder must master - ANS 1. anatomy
2. medical terminology
3. must be detail-oriented
Medical coders assign a code to what - ANS 1. Each diagnosis
2. Service/procedure
3. Supply, using the classification system when applicable
The classification system determines ______ - ANS the amount health care providers will be reimbursed
if the patient is covered by Medicare, Medicaid, or other insurance programs using the system
A coder must evaluate the medical record for - ANS 1. completeness and accuracy
2. communicate regularly with physicians and the health care professional to clarify DX or obtain
additional PT info.
Techicians who speciallize in coding inpatient hospital services are referred as - ANS 1. Health
information coders
2. medical record coders
,3. Coder/abstractors
4. Coding Specialist
What is MS-DRGs and what does it do? - ANS 1. Medicare Severity-Diagnosis Related Groups
2. Determines the amt the hospital will be reimbursed if the PT is covered by Medicare or other
insurance programs
What is EHR - ANS Electronic health record
Skilled coders may become - ANS consulatants, educators or medical auditors
What is the difference between Hospital and Physican Services - ANS 1. Outpatient coding (physician
services)- learning CPT, HCPCS, LEVEL II, ICD-9 CM codes Volume 1 and 2
2. Inpatient coding (Hospital services)- Learning CPT, ICD-9 CM codes Volumes 1,2,3 and MS-DRGS
What is APC and who uses it - ANS Ambulatory Payment Classification- outpatient facility coders
(physician services
What is the coder's role in a physician's office - ANS Extremely important for the proper reimbursement
of services and the livelihood of the physician
What is a physican degree of education - ANS 4 years of college, 4 years of medical school plus 3 to 5
years of residency.
What are mid-level providers and who can be classified as one? - ANS 1. Mid-level providers are know as
physician extenders
2. Physician assistants (PA) and Nurse Practitioners (NP)
,What are the requirement for a PA and what - ANS 1. 26 1/2 month program to complete
2. Licensed to practice medicine under physician supervision
NP must have - ANS A Master's Degree in Nursing
In simplest terms, how many payers are there? - ANS 2
Private insurance plans and government insurance plans
Commercial carriers are considered what - ANS Private payers that offer both group and individual
plans.
Private Payers contracts may vary but may include _____ - ANS hospitalization, basic, and major medical
coverage.
What is the most significant government insurer - ANS Medicare
What is Medicare - ANS Federal health insurance program- Administered by the Center for Medicare &
Medicaid Services (CMS)
What is CMS and what does it provide - ANS Center for Medicare & Medicaid Services (CMS) provides
coverage for people over the age of 65, blind, or disabled individuals, people with end -stage renal
disease
CMS regulations often serves as the____ word in coding requirement for Medicare and Non-Medicare
payers alike - ANS Last
What are the parts of Medicare - ANS Medicare A
Medicare B
, Medicare C
Medicare D
What is Medicare Part A? - ANS Covers inpatient hospital care, as well as care provided in skilled nursing
facilites, hospice care, and home health care
What is Medicare Part B? - ANS Covers medically necessary doctors' services, outpatient care, other
medical services (including some preventive service not covered under Medicare Part A)
Medicare Part B is considered what? - ANS A optional benefit for which the patient must pay a premium
and which generally requires a yearly copay
Where is Medicare Part B usually used - ANS Physician offices (Outpatient Facility)
What is Medicare Part C - ANS Combines the benefits of Medicare Part A, Part B, and sometimes Part D.
What is Medicare Part C also called - ANS Medicare Advantage
What is PPO - ANS Preferred Provider Organizations
What is HMO - ANS Health Maintenace Organizations
Which plan covers PPO and HMO - ANS Medicare Part C
What is the CMS-HCC - ANS Center for Medicare & Medicaid Services-Hierarchical condition category
answers to study ICD-10 coding
Coding is - ANS the process of translating this written or dictated medical record into a series of numeric
or alpha-numeric codes
Proper code assignment is determined by - ANS content of the medical record and by the unique rules
that governs each code set
What are 3 things that Coder must master - ANS 1. anatomy
2. medical terminology
3. must be detail-oriented
Medical coders assign a code to what - ANS 1. Each diagnosis
2. Service/procedure
3. Supply, using the classification system when applicable
The classification system determines ______ - ANS the amount health care providers will be reimbursed
if the patient is covered by Medicare, Medicaid, or other insurance programs using the system
A coder must evaluate the medical record for - ANS 1. completeness and accuracy
2. communicate regularly with physicians and the health care professional to clarify DX or obtain
additional PT info.
Techicians who speciallize in coding inpatient hospital services are referred as - ANS 1. Health
information coders
2. medical record coders
,3. Coder/abstractors
4. Coding Specialist
What is MS-DRGs and what does it do? - ANS 1. Medicare Severity-Diagnosis Related Groups
2. Determines the amt the hospital will be reimbursed if the PT is covered by Medicare or other
insurance programs
What is EHR - ANS Electronic health record
Skilled coders may become - ANS consulatants, educators or medical auditors
What is the difference between Hospital and Physican Services - ANS 1. Outpatient coding (physician
services)- learning CPT, HCPCS, LEVEL II, ICD-9 CM codes Volume 1 and 2
2. Inpatient coding (Hospital services)- Learning CPT, ICD-9 CM codes Volumes 1,2,3 and MS-DRGS
What is APC and who uses it - ANS Ambulatory Payment Classification- outpatient facility coders
(physician services
What is the coder's role in a physician's office - ANS Extremely important for the proper reimbursement
of services and the livelihood of the physician
What is a physican degree of education - ANS 4 years of college, 4 years of medical school plus 3 to 5
years of residency.
What are mid-level providers and who can be classified as one? - ANS 1. Mid-level providers are know as
physician extenders
2. Physician assistants (PA) and Nurse Practitioners (NP)
,What are the requirement for a PA and what - ANS 1. 26 1/2 month program to complete
2. Licensed to practice medicine under physician supervision
NP must have - ANS A Master's Degree in Nursing
In simplest terms, how many payers are there? - ANS 2
Private insurance plans and government insurance plans
Commercial carriers are considered what - ANS Private payers that offer both group and individual
plans.
Private Payers contracts may vary but may include _____ - ANS hospitalization, basic, and major medical
coverage.
What is the most significant government insurer - ANS Medicare
What is Medicare - ANS Federal health insurance program- Administered by the Center for Medicare &
Medicaid Services (CMS)
What is CMS and what does it provide - ANS Center for Medicare & Medicaid Services (CMS) provides
coverage for people over the age of 65, blind, or disabled individuals, people with end -stage renal
disease
CMS regulations often serves as the____ word in coding requirement for Medicare and Non-Medicare
payers alike - ANS Last
What are the parts of Medicare - ANS Medicare A
Medicare B
, Medicare C
Medicare D
What is Medicare Part A? - ANS Covers inpatient hospital care, as well as care provided in skilled nursing
facilites, hospice care, and home health care
What is Medicare Part B? - ANS Covers medically necessary doctors' services, outpatient care, other
medical services (including some preventive service not covered under Medicare Part A)
Medicare Part B is considered what? - ANS A optional benefit for which the patient must pay a premium
and which generally requires a yearly copay
Where is Medicare Part B usually used - ANS Physician offices (Outpatient Facility)
What is Medicare Part C - ANS Combines the benefits of Medicare Part A, Part B, and sometimes Part D.
What is Medicare Part C also called - ANS Medicare Advantage
What is PPO - ANS Preferred Provider Organizations
What is HMO - ANS Health Maintenace Organizations
Which plan covers PPO and HMO - ANS Medicare Part C
What is the CMS-HCC - ANS Center for Medicare & Medicaid Services-Hierarchical condition category
