MEDICAL CODING CHAPTER 1
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
What type of profession might a skilled coder enter - ANSWER Consultants, Educators or Medical Auditor
What coding is used in Outpatient Coding - ANSWER CPT, HCPCS Level II, ICD-9Cm Vol 1 & 2
What coding is used in Inpatient Coding - ANSWER ICD-9CM Vol 1, 2, 3; MS-DRG
What is a Midlevel Provider - ANSWER Physician Assistants and Nurse Practitoner's that work under the
supervision of the Physician
What is covered under Medicare A - ANSWER Covers inpatient services, nursing facilities, hospice and
home health care
What is covered under Medicare B - ANSWER Covers Doctors services, outpatient care; Optional benefit
What is covered under Medicare C - ANSWER Combines Medicare A,B and D. Is managed by private
insurers
What is cover under Medicare D - ANSWER Prescription drug coverage
What does SOAP represent - ANSWER S:Subjective(the patients complaint) O:Objective(the providers
observations) A:Assessment(evaluation & conclusion) P:Plan (course of action)
What are 5 tip for coding operative reports - ANSWER 1 Diagnosis code reporting; use post-operative
diagnosis
2 Start with Procedures listed; look in the header
3 Look for key words
4 Highlight unfamiliar words; research them
, 5 Read the body
What is a medical necessity - ANSWER The procedure or service considered appropriate in the
circumstance
What tool should you refer to for a medical necessity - ANSWER NCDM: The National Coverage
Determination Manual
What are some common reasons Medicare may deny a procedure or service - ANSWER Medicare does
not pay for a patients condition
Medicare does not pay for procedures or services as frequently as proposed
Medicare does not pay for experimental procedures or services
Under the Privacy Rule; the minimum necessary standard does not apply to what type of disclosures -
ANSWER For treatment purposes; By the patients request; Signed by the patient; In compliance with
HIPAA; In compliance with HHS(Department of Health & Human Services); Required by Law
What are 7 key action of an internal compliance plan - ANSWER 1 Conduct internal monitoring
2 Written standards & procedures
3 Designate a compliance officer
4 Conduct appropriate training
5 Respond appropriately to violations
6 Develop open lines of communication
7 Enforce disciplinary standards
Physician standard billing through a insurance carrier uses which form - ANSWER CMS-1500
A PA program takes approximately how long to complete - ANSWER 26 1/2 months
What are the two types of payers - ANSWER Private insurance and Government insurance plans
QUESTIONS AND ANSWERS WITH
SOLUTIONS 2024
What type of profession might a skilled coder enter - ANSWER Consultants, Educators or Medical Auditor
What coding is used in Outpatient Coding - ANSWER CPT, HCPCS Level II, ICD-9Cm Vol 1 & 2
What coding is used in Inpatient Coding - ANSWER ICD-9CM Vol 1, 2, 3; MS-DRG
What is a Midlevel Provider - ANSWER Physician Assistants and Nurse Practitoner's that work under the
supervision of the Physician
What is covered under Medicare A - ANSWER Covers inpatient services, nursing facilities, hospice and
home health care
What is covered under Medicare B - ANSWER Covers Doctors services, outpatient care; Optional benefit
What is covered under Medicare C - ANSWER Combines Medicare A,B and D. Is managed by private
insurers
What is cover under Medicare D - ANSWER Prescription drug coverage
What does SOAP represent - ANSWER S:Subjective(the patients complaint) O:Objective(the providers
observations) A:Assessment(evaluation & conclusion) P:Plan (course of action)
What are 5 tip for coding operative reports - ANSWER 1 Diagnosis code reporting; use post-operative
diagnosis
2 Start with Procedures listed; look in the header
3 Look for key words
4 Highlight unfamiliar words; research them
, 5 Read the body
What is a medical necessity - ANSWER The procedure or service considered appropriate in the
circumstance
What tool should you refer to for a medical necessity - ANSWER NCDM: The National Coverage
Determination Manual
What are some common reasons Medicare may deny a procedure or service - ANSWER Medicare does
not pay for a patients condition
Medicare does not pay for procedures or services as frequently as proposed
Medicare does not pay for experimental procedures or services
Under the Privacy Rule; the minimum necessary standard does not apply to what type of disclosures -
ANSWER For treatment purposes; By the patients request; Signed by the patient; In compliance with
HIPAA; In compliance with HHS(Department of Health & Human Services); Required by Law
What are 7 key action of an internal compliance plan - ANSWER 1 Conduct internal monitoring
2 Written standards & procedures
3 Designate a compliance officer
4 Conduct appropriate training
5 Respond appropriately to violations
6 Develop open lines of communication
7 Enforce disciplinary standards
Physician standard billing through a insurance carrier uses which form - ANSWER CMS-1500
A PA program takes approximately how long to complete - ANSWER 26 1/2 months
What are the two types of payers - ANSWER Private insurance and Government insurance plans
