Question

QUESTION 33

1. An electrolyte panel (80051) consists of test for carbon dioxide (82374), chloride (82435), potassium (84132), and sodium (84295). If a physician's office bills each component individually on the claim form, this would be an example of which of the following?

   	A.	Unbundling
   	B.	Optimization
   	C.	Sequencing
   	D.	Balance billing

10 points   

QUESTION 34

1. Of the following classification systems, which would be used to locate supply codes for durable medical equipment (DME) and surgical implants?

   	A.	ICD-10-PCS
   	B.	APCs
   	C.	HCPCS
   	D.	ICD-10-CM

10 points   

QUESTION 35

1. A family practitioner requests the opinion of a physician specialist in endocrinology. This specialist reviews the patient's health record and examines the patient. This physician specialist records findings, impressions and recommendations. Which service and type of report are being supplied by the specialist?

   	A.	Consultation
   	B.	Follow-up
   	C.	Interpretation
   	D.	Peer review

10 points   

QUESTION 36

1. All of the following items are packaged into an APC under OPPS, EXCEPT FOR:

   	A.	Recovery room
   	B.	Anesthesia drugs
   	C.	Professional charges
   	D.	Surgical supplies

10 points   

QUESTION 37

1. This means that a service or procedure is reasonable and necessary for the diagnosis or treatment of illness or injury consistent with generally accepted standards of care:

   	A.	Covered charge
   	B.	Excluded service
   	C.	Capitated amount
   	D.	Medical necessity

10 points   

QUESTION 38

1. Once all data are posted to a patient's account, the claim can be reviewed for accuracy and completeness. Many facilities have internal auditing systems. The auditing systems run each claim through a set of edits specifically designed for the various payers. The auditing system identifies data that have failed edits and flags the claim for correction. These internal auditing systems are called what?

   	A.	Scrubbers
   	B.	Clearinghouses
   	C.	Encoders
   	D.	Groupers

10 points   

QUESTION 39

1. Select the official ICD recommendations concerning the coding of secondary ("other") diagnoses for physician and outpatient services.

   	A.	Code all documented conditions that coexist at the time of the encounter, require or affect patient care treatment or management, or have an impact on current care.
   	B.	Code all conditions which coexist at the time of encounter, followed by the appropriate code from the V72 series (Special Investigations and Examinations).
   	C.	Code every condition documented on the encounter form or superbill, regardless of whether or not it has any impact on current health care needs.
   	D.	Do not code secondary diagnoses for physician or hospital outpatient reporting purposes.

10 points   

QUESTION 40

1. In determining which diagnosis code to sequence as first-listed (Primary) for physician or hospital outpatient services, the coder utilizes general coding guidelines, as well as chapter-specific guidelines and sequencing requirements of the tabular section. In addition, which other determinant helps the coder identify which code to list first for such encounters?

   	A.	The condition, diagnosis, problem, or other reason shown in the medical record to be chiefly responsible for the services provided.
   	B.	That condition, diagnosis, problem or other reason listed first in the medical record by the attending provider of service.
   	C.	That condition, diagnosis or problem determined to be most resource-intensive, severe, or acute in the set of diagnoses listed in the medical record.
   	D.	The condition established after study to be chiefly responsible for occasioning the admission the admission to the hospital.

10 points   

QUESTION 41

1. Of the following, which statement is true concerning the use of uncertain diagnoses for physician and hospital outpatient reporting?

   	A.	Follow internal policy on matters of coding uncertain diagnoses for outpatient or physician services.
   	B.	Query the provider on whether to code uncertain diagnoses for physician or outpatient services.
   	C.	Code uncertain diagnoses as if they actually exist.
   	D.	Do not code uncertain diagnoses, but code to the highest degree of certainty.

Answer 1

QUESTION 33

1. An electrolyte panel (80051) consists of a test for carbon dioxide (82374), chloride (82435), potassium (84132), and sodium (84295). If a physician's office bills each component individually on the claim form, this would be an example of which of the following?

A.Unbundling

B.Optimization

C.Sequencing

D.Balance billing

Answer :

Unbundling is an example of the above-given question.

Why option A?

The cost for each item is separately applied rather than as part of a package as mention in the above question.

Why not option B?

The efforts are taken to make the best use of resources. So, it is not related to the billing or cost of any resource mentioned in the question.

Why not option C?

Sequencing is the arrangement of resources in a particular order. So, it is also not related to billing.

Why not option D?

Balance Billing. When a provider bills you for the difference between the provider's charge and the allowed amount.

As mention in the above question, the physician office bill charged for each item separately instead of any difference between provider charges and allowed amount, it won't be an answer for the above question.

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