Certified Coding Associate Clinical Flashcards
16 cards from real Certified Coding Associate Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 16 Certified Coding Associate Clinical flashcards as text
The following are the names of the most recent Medicare claims processing payment contract entities:
Answer: Medicare administrative contractors (MACs)
Medicare Administrative Contractors (MACs) are private healthcare insurers that have been awarded a contract by the Centers for Medicare & Medicaid Services (CMS) to process Medicare Part A and Part B (and Durable Medical Equipment) claims. They serve as the primary contact for providers and handle claims processing, payment, and other administrative functions for specific geographic regions. They replaced the previous system of fiscal intermediaries and carriers.
Determine the punctuation mark that is used to augment any additional words or explanatory information that may or may not be included in the ICD-9-CM coding statement of diagnosis or procedure. The case's code number is unaffected by the punctuation. The punctuation is used in all three volumes of ICD-9-CM and is regarded as a nonessential modifer.
Answer: Parentheses ( )
In ICD-9-CM, parentheses ( ) are used to enclose nonessential modifiers. These are supplementary words or explanatory information that may or may not be present in the diagnostic statement but do not affect the code assignment. They provide additional detail without changing the fundamental meaning of the code.
The following entities have established messaging standards for electronic data interchange in healthcare:
Answer: HL7
HL7 (Health Level Seven International) is a not-for-profit organization that develops international standards for the transfer of clinical and administrative data between healthcare software applications. Its standards are widely used for electronic data interchange in healthcare, facilitating interoperability and communication between different systems.
The Joint Commission's ORYX program and HEDIS are both made to gather data for .
Answer: Performance improvement programs
Both The Joint Commission's ORYX program and HEDIS (Healthcare Effectiveness Data and Information Set) are designed to collect and report data on the quality of healthcare services. This data is then used to evaluate and drive performance improvement initiatives within healthcare organizations. Their goal is to enhance patient care, safety, and efficiency by identifying areas for improvement.
Written or oral authorization to move forward with caution is categorized as:
Answer: Informed consent
Informed consent is a legal and ethical principle that requires a healthcare provider to obtain permission from a patient before performing a medical procedure or treatment. This authorization must be given after the patient has received and understood all relevant information, including the nature of the procedure, its risks, benefits, and alternatives. It signifies a patient's autonomous decision-making regarding their care.
What's the most procedure codes that can be included on a paper UB-04 claim form for a hospital inpatient?
Answer: six (6)
On a paper UB-04 claim form, which is used by hospitals for inpatient and outpatient billing, there are typically fields to report up to six procedure codes. While electronic claims can accommodate more, the standard paper form has this limitation for procedure reporting. This ensures a standardized format for manual processing.
what standard language is used to code medical procedures and services?
Answer: cpt
CPT (Current Procedural Terminology) is a standardized medical coding system maintained by the American Medical Association (AMA). It is used to describe medical, surgical, and diagnostic services performed by physicians and other healthcare providers. CPT codes are essential for billing and reimbursement of these procedures and services.
what are the names of the five-digit icd9cm diagnostic codes
Answer: subclassification codes
In ICD-9-CM, the five-digit diagnostic codes are referred to as subclassification codes. These codes provide the highest level of specificity within the diagnostic classification system, allowing for detailed reporting of conditions. They follow the three-digit category and four-digit subcategory codes.
The coder records that the patient is taking Haldol as directed. The ultimate diagnoses listed on the progress notes are acute pharyngitis, malnutrition, and diabetes mellitus. What illness would the coder be suspicious the patient has and should ask the doctor about?
Answer: Schizophrenia
Haldol (haloperidol) is an antipsychotic medication primarily used to treat schizophrenia and other psychotic disorders. If a patient is taking Haldol, it strongly suggests they have a condition like schizophrenia, even if it's not explicitly listed in the diagnoses. The coder should query the physician to clarify the patient's psychiatric diagnosis for accurate coding.
The "newborn period" according to ICD-9-CM is the time period from birth to the ___ day after birth.
Answer: 28th
According to ICD-9-CM guidelines, the 'newborn period' or 'perinatal period' is defined as the time from birth up to and including the 28th day following birth. This specific timeframe is important for accurate coding of conditions affecting newborns, as certain codes are only applicable during this period.
What is the name of the federal initiative to identify and address erroneous payments made through Medicare's Fee-for-Service (FFS) programs?
Answer: Recovery audit contractors (RACs)
Recovery Audit Contractors (RACs) are third-party organizations contracted by the Centers for Medicare & Medicaid Services (CMS) to identify and recover improper Medicare payments. They review claims to detect overpayments and underpayments made to healthcare providers, playing a crucial role in ensuring the integrity of the Medicare Fee-for-Service program.
What kind of company carries out Medicare and Medicaid certification surveys for hospitals under contract with the CMS?
Answer: State licensure agencies
State licensure agencies, often departments of health, are typically contracted by the Centers for Medicare & Medicaid Services (CMS) to conduct certification surveys for hospitals. These surveys ensure that hospitals meet the federal 'Conditions of Participation' necessary to receive Medicare and Medicaid payments, thereby maintaining quality and safety standards.
How are codes assigned when categorizing a selective catheterization in CPT?
Answer: One code for the final vessel entered
When coding selective catheterization procedures in CPT, the general rule is to code only for the most distal vessel accessed. This means that if a catheter passes through several vessels to reach a specific target, only the code for the final, most selective vessel entered is reported, as it implicitly includes the less selective catheterizations.
In a doctor's progress note, a diabetic patient is noted as having "FBS 110 mg%, urine sugar, no acetone." Where would this notation be placed in a POMR progress note?
Answer: Objective
In a Problem-Oriented Medical Record (POMR) using the SOAP (Subjective, Objective, Assessment, Plan) format, 'Objective' refers to measurable and observable data. Blood sugar readings (FBS 110 mg%) and urine test results (urine sugar, no acetone) are clinical findings obtained through examination or testing, making them objective data. This section provides factual information that can be verified.
what are the names of the four-digit icd9cm diagnostic codes
Answer: subcategory codes
In ICD-9-CM, the four-digit diagnostic codes are known as subcategory codes. These codes provide a more specific breakdown of conditions within a three-digit category. They are further refined by five-digit subclassification codes for the highest level of detail.
The creation of standards for electronic medical records was required by the .
Answer: Health Insurance Portability and Accountability Act (HIPAA) of 1996
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 mandated the establishment of national standards for electronic healthcare transactions and identifiers for providers, health plans, and employers. A key component of HIPAA was the requirement to create standards for the security and privacy of electronic medical records (EMRs) to protect patient health information.