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Step-By-Step Medical Coding Chapter 4: Using ICD-10-CM Flashcards

7957754633	Patient has Rheumatoid Arthritis and Anemia. The Anemia is integral to the Rheumatoid Arthritis.	FALSE	0
7957762467	Patient has Dyspnea due to Congestive Heart Failure. Dyspnea should be assigned as an additional code.	FALSE	1
7957786643	Multiple coding should be used when the classification provided the classification code that identifies all of the elements documented in the diagnosis.	FALSE	2
7957794076	The code for the acute phase of an illness or injury that led to the sequela can be used with a code for the late effect.	FALSE	3
7957799242	The residual effect is reported as a secondary code.	FALSE	4
7957805826	In sequela effect, the code is either a current injury or a condition caused by a prior injury. It cannot be both.	TRUE	5
7957811871	Although each diagnosis code may be reported only once per encounter, each code can be reported more than once per patient.	TRUE	6
7957819700	In an outpatient setting, an impending condition should be coded as if it actually exists.	FALSE	7
7957824443	Additional signs and symptoms that may not routinely be associated with the disease process being reported should be coded when present.	TRUE	8
7957839827	An example of a late effect is hemorrhage after a surgery requiring a return to the operating room.	FALSE	9
7957842973	You may report a code from the Index without verifying in the Tabular when there is no indication that the code requires additional characters.	FALSE	10
7957858310	If a patient has a confirmed diagnosis, the signs and symptoms related to that condition should also be reported.	FALSE	11
7957871514	If the same condition is described as both acute and chronic, and separate subentries exist in the Alphabetic Index at the same indentation level, report both codes and sequence the acute code first.	TRUE	12
7957883582	A dash (-) at the end of an Index entry indicates that an additional character or characters is/are required.	TRUE	13
7957895789	Cholelithiasis with chronic cholecystitis without obstruction (K80.10) is an example of a dual code.	FALSE	14
7957904697	A code is invalid if it has not been reported to the full number of characters available, including the 7th character, if applicable.	TRUE	15
7957904698	In most cases the manifestation codes will have in the code title, "in disease classified elsewhere."	TRUE	16
7957919191	A late effect usually occurs within 1 month of the illness or injury.	FALSE	17
7957925656	In diabetic retinopathy, the retinopathy is the etiology and the diabetes is the manifestation.	FALSE	18
7957937382	In the outpatient setting, it is correct to report a "probable" condition as if it exists, such as probable appendicitis as appendicitis.	FALSE	19
7957948482	When sequencing codes for residuals and late effects, the late effect code is sequenced first followed by a code describing the residual condition.	FALSE	20
7957955996	Section II of the ICD-10-CM Official Guidelines for Coding and Reporting includes instructions on outpatient coding and reporting.	FALSE	21
7957961451	Diagnosis codes are always reported to the highest number of characters available.	TRUE	22
7957970701	The cooperating parties for the development and approval of the Official Guidelines for Coding and Reporting are CMS, AMA, and NCHS.	FALSE	23
7957979908	List 5 common symptoms associated with acute myocardial infarction.	1. Chest pain 2. Shortness of breath 3. Nausea and/or vomiting 4. Palpitations 5. Lightheadedness	24
7957995359	List 5 common symptoms associated with gastroesophageal reflux.	1. Heartburn 2. Acid regurgitation 3. Belching 4. Hoarseness in the morning 5. Reflux 6. Pain in chest 7. Trouble swallowing 8. Choking feeling 9. Dry cough	25
7958018636	List 4 common symptoms associated with seasonal allergies.	1. Runny nose 2. Itchy and/or watery eyes 3. Sneezing 4. Coughing	26
7958027362	List 4 symptoms of a broken nose.	1. Swelling 2. Pain 3. Discoloration 4. Disfiguration	27
7958035004	Acute renal failure due to previous viral encephalitis.	Residual: Acute renal failure Cause: Viral encephalitis	28
7958043749	Constrictive pericarditis due to old tuberculosis infection.	Residual: Constrictive pericarditis Cause: Tuberculosis infection	29
7958055722	Hemiplegia/hemiparesis affecting right dominant side due to cerebrovascular accident 4 months ago.	Residual: Hemiplegia/hemiparesis of right dominant side Cause: Cerebrovascular accident 4 months prior	30
7958416755	List the four cooperating parties that agree on coding principles.	1. AHA 2. AHIMA 3. CMS 4. NCHS	31
7958420014	ICD-10-CM Section I Guidelines covers what guidelines?	Structure and conventions, general guidelines, & chapter specific guidelines	32
7958424177	ICD-10-CM Section II Guidelines covers what guidelines?	Selection of principal diagnosis for non-outpatient (hospital) settings	33
7958429226	ICD-10-CM Section III Guidelines covers what guidelines?	Reporting additional diagnoses in non-outpatient settings	34
7958433553	ICD-10-CM Section IV Guidelines covers what guidelines?	Outpatient coding and reporting	35
7958440444	List the steps for accurate coding in order:	1. Identify the main term(s) in the diagnostic statement 2.Locate the main terms in the Alphabetic Index 3. Review any subterms under the main terms in the Tabular 4. Follow any cross-reference instructions, such as see 5. Verify the code(s) selected from the Index in the Tabular List 6. Refer to any instructional notations in the Tabular 7. Assign codes to the highest level of specifity 8. Code the diagnosis until all elements are completely identified	36
7958444224	Which guideline goes over the steps to coding?	Section I.B 1. Locating a code in the ICD-10-CM	37
7958447521	What is used at the end of an Alphabetic entry to indicated that additional characters are required?	Dash (-)	38
7958450972	It is necessary to refer to the Tabular list to verify that no _______ is required.	7th character	39
7958454826	ICD codes are composed of codes with ________ characters.	3, 4, 5, 6, or 7	40
7958460875	Codes with three characters are included in the ICD-10-CM as the heading of a ______ of codes that may be further subdivided by the use of 4th, 5th, 6th, and 7th characters, which provide greater detail.	Category	41
7958463571	A code is _____ if it has not been coded to the full number of characters required for that code, including 7th character, if applicable.	Invalid	42
7959008154	A patient presents with the chief complaint of headache of three days duration and frequent urination. Would you report both the headache and urination?	Yes	43
7959008155	If the patient's medical record stated SOB due to asthma, would you report the SOB?	No	44
7959022187	What cross-reference is used when notes are found in the Tabular List at codes that are not part of an etiology/ manifestation pair where a secondary code is useful to fully describe a condition or a secondary code should be added?	Use additional codes	45
7959029112	What should be sequenced first when there is a "code first" note and an underlying disease is present?	The underlying condition	46
7959033023	What note indicates that a code may be assigned as a principal diagnosis when the casual condition is unknown or not applicable?	Code, if applicable, any casual condition first	47
7959042268	What would you code first if the same condition is described as both acute (subacute) and chronic, and separate subentries exist in the Alphabetic Index at the same indentation level?	Code both and sequence the acute (subacute) code first	48
7959045032	What is the term for a single code used to classify two diagnoses?	Combination Code	49
7959049118	A combination code is a single code used to classify _______.	1. two diagnoses 2. a diagnosis with an associated manifestation 3. a diagnosis with an associated complication	50
7959061681	When the combination code lacks necessary specificity in describing the manifestation or complication, a(n) __________ code should be used as a(n) _______ code.	Additional; Secondary	51
7959067513	What is the residual effect (condition produced) after the acute phase of an illness or injury has terminated called?	Sequela (late effects)	52
7959071502	What is generally coded first when coding Sequela effects?	The condition or nature of the sequela is sequenced first. The sequela code sequenced second	53
7959080153	An exception to the Sequela rule are those instances where the code for the sequela is followed by a ________ code identified in the ______ _____ and title or the sequela code has been expanded (at the fourth, fifth, or sixth character levels) to include the manifestations.	Manifestation; Tabular List	54
7959112568	The code for the acute phase of an illness or injury that led to the sequela is never used with a code for the _____ _____.	Late effect	55
7959120726	Many codes have a ________ to identify the sequela within the Tabular. What is used to identify the sequela in the Tabular?	7th character, character S	56
7959123408	If the medical documentation indicates that the patient has two different conditions that are both included in one diagnosis code, how many times would you report the diagnosis code?	Once	57
7959129917	What term is used to specify whether the condition occurs on the left, right, o bilateral side?	Laterality	58
7959133536	How would you assign codes if no bilateral code is provided and the condition is bilateral?	Assign the code for the unspecified side	59
7959137266	In some cases, bilaterally can be reported with a ______ code.	Single	60
7959142273	How often are the Official Guidelines for Coding and Reporting updated?	Annually	61
7959144640	The diagnostic statement in the medical record indicates that the patient has a history of diabetes mellitus. In this example, the coder should assign the code for	Diabetes Mellitus	62

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MOA 183 Medical Billing and Coding - Chapter 10 Common UB-04 (CMS-1450) Completion Guidelines - Key Terms Flashcards

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6259598511	Accommodation Code	A two-character code that identifies the type of hospital bed the patient occupies.	0
6259598512	Admitting Diagnosis	The condition that caused the patient to seek treatment.	1
6259598513	Ambulatory Payment Classification(APC)	A payment calculation method based on grouping procedures that have similar clinical characteristics and similar costs by CPT/HCPCS codes.	2
6259598514	Ancillary services code	A two-character code that identifies services not included in the room and board charges related to an inpatient episode of care.	3
6259598515	Assignment of Benefits	Identifies who actually receives the insurance payment.	4
6259598516	Attending Physician	The physicians responsible for the patient's care while in the hospital.	5
6259598517	Centers for Medicare and Medicaid Services(CMS)	A division of the Department of Health and Human Services responsible for managing Medicare and Medicaid health insurance programs; one of the Cooperating parties that maintains and updates ICD-9-CM procedure codes.	6
6259598518	Chargemaster	A computer program or database that contains the charges and medical codes for services and supplies provided to patients.	7
6259598519	Clean Claim	Claim paid on the first submission.	8
6259598520	Clearinghouse	A service that distributes claims to the correct insurance carrier.	9
6259598521	CMS 1450 or UB- 04	Alternate name for the UB-04, a universal claims submission form.	10
6259598522		For hospital use.	11
6259598523	Co-insurance days	Covered days of care that require the patient to pay part of the charges for services rendered.	12
6259598524	Complication/co-morbidity(CC)	A condition that substantially increases the use of hospital resources.	13
6259598525	Condition code	A two-character code that relates to the patient's insurance eligibility and primary and secondary payer status; part of UB-04.	14
6259598526	Covered days	The number of hospital days eligible for reimbursement by a health insurance plan.	15
6259598527	Critical Access Hospital (CAH)	A special designation for Medicare participating hospitals that are a part of a rural health plan.	16
6259598528	Current Procedural Terminology (CPT)	The coding system used to report physician and ambulatory services and procedures.	17
6259598529	Department of Health and Human Services (HHS)	Government department that plays an active role in investigating health insurance fraud and abuse.	18
6259598530	Diagnosis Related Group(DRG)	A payment method that pays a fixed amount based on the patient's diagnosis rather than on services provided.	19
6259598531	Dirty Claim	Claim that has been denied or rejected.	20
6259598532	Electronic Claims submission (ECS)	Submission of a claim via computer, tape, diskette, modem, fax or personal computer upload or download.	21
6259598533	Electronic Health Record (E H R)	A medical record that is maintained in an electronic format.	22
6259616460	Electronic Health Record (E H R)	An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.	23
6259598534	Electronic Medical Record (EMR)	An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff within one healthcare organization.	24
6259598535	Encoder	A computer assisted medical coding software program.	25
6259598536	Florida shared system (FSS)	Medicare database that includes the number of covered days remaining for each Medicare beneficiary.	26
6259598537	Form Locator	UB-04 data field that captures information needed for insurance reimbursement.	27
6259598538	Healthcare common Procedure Coding system (HCPCS)	System used to code the procedures or treatments a patient receives at a physician or provider's office, at an ambulatory surgery center, or as hospital outpatient.	28
6259598539	Health Care Finance Administration (HCFA)	Former name of the Centers for Medicare and Medicaid Services(CMS)	29
6259598540	Health Insurance claim number (HICN)	A unique identifier assigned to Medicare beneficiaries.	30
6259598541	Health Insurance Portability and Accountability Act (HIPAA)	A federal regulation that provides extensive protection for the confidentiality and security of an individual's health information; also makes health insurance billing fraud a federal offense.	31
6259598542	Inpatient Prospective payment system (IPPS)	Prospective payment system that applies to inpatient hospital services.	32
6259598543	Insured or policyholder	An individual covered by a health insurance policy or plan.	33
6259598544	Intermediate care facility (ICF)	A nonhospital facility that provides inpatient services.	34
6259598545	International Classification of diseases, Ninth Revision, Clinical Modification (ICD-9-CM)	The coding system for medical diagnoses.	35
6259598546	Length of Stay (LOS)	The number of hospital inpatient days from admission to discharge.	36
6259598547	Lifetime reserve days	Specific number of days covered by Medicare Part A when a beneficiary is hospitalized for more than 90 days during the benefit period.	37
6259598548	Major complications/co-morbidity(MCC)	A more severe complication/co-morbidity.	38
6259598549	Medicare severity diagnosis-related group (MS-DRG)	Prospective payment system for hospital inpatient care that replaced the original diagnosis related groups.	39
6259598550	National Provider Identification Number (NPI)/National Provider identifier(NPI)	A unique identifier number assigned to providers who submit claims to government -sponsored health insurance programs.	40
6259598552	National uniform Billing Committee (NUBC)	A committee of health care professional responsible for revising the UB-04.	41
6259598553	Occurrence code	A two-character code for a specific event that affects the payment of an insurance claim.	42
6259598554	Outpatient prospective payment system (OPPS)	An outpatient/ambulatory services payment system that establishes a preset reimbursement rate for related procedures and services.	43
6259598555	Primary payer or primary insurance	The insurance company that is billed first.	44
6259598556	Principal diagnosis	The diagnosis determined after study to be the reason for the patient's admission to a hospital.	45
6259598557	Principal Procedure	The procedure that is closely related to the principal diagnosis and is performed for a definitive treatment rather than for diagnostic purposes.	46
6259598558	Prospective payment system(PPS)	A hospital reimbursement system based on the diagnosis, procedure, and treatments provided to the patient.	47
6259598559	Secondary payer or Secondary Insurance or Supplemental Insurance	An insurance company that is billed after receiving payment from the primary insurance company	48
6259598562	Skilled nursing facility(SNF)	A facility that meets specific regulatory certification requirements and primarily provided inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital	49
6259598563	Subscriber or enrollees	Individuals enrolled in a health insurance plan.	50
6259598564	Taxonomy code	A code assigned to a hospital that identifies services provided by the hospital; associated with UB-04.	51
6259598565	Tertiary payer	The insurance company that is billed after payment is received from the primary and secondary payers.	52
6259598566	Uniform Hospital Discharge data set (UHDDS)	A standard set of data that must be reported for all hospital based insurance claims.	53
6259598567	Value Code	A code associated with a charge for a service provided in an inpatient setting; part of UB-04 claim form.	54

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MBC10 Lesson 5 Study Guide: Hospital Billing/UB-04 Ch. 12 Flashcards

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8883847477	How many diagnosis can be listed on the UB-04 claim form?	Ten	0
8883884344	What is listed on a Charge Description Master?	All services and items provided to the patient, hospital charges.	1
8883888226	What are revenue codes?	They describe the specific accommodation and/or ancillary charges.	2
8883898866	What is an Ambulatory Surgical Unit?	A designated center where outpatient services are offered to patients.	3
8883912614	Define Cost Outlier	A case that cannot be assigned an appropriate DRG because of an atypical situation.	4
8883925531	What is the software program that allows a facility to calculate its Diagnosis Related Group (DRG) payment group?	Grouper	5
8883930866	Who maintains the Ambulatory Payment Classification (APC) list?	The CMS	6
8883938582	Ambulatory Payment Classification (APC) system bases payment on ______	Procedures	7
8883942781	What is a Prospective Payment System?	Established payment rates to hospitals prospectively, before services are rendered.	8
8883955153	How often is a patient control number (PCN) assigned to a patient in the hospital?	Each hospital admission.	9
8883958771	Define comorbidity	One or more diseases that presents in addition to the primary disease or disorder.	10
8883977602	What are the types of facilities that would use the UB-04 claim form?	Inpatient care, hospice, skilled nursing facility, outpatient care, ASC, ASU, emergency care, and urgent care.	11
8884094532	Majority of hospital reimbursement comes from _____	Insurance companies	12
8884113027	When will a hospital bill for patient services?	After the patient is discharged.	13
8884123615	What is the method of reimbursement that pays hospitals a fixed rate per day for all services?	Per Diem type	14
8884126833	What does OPPS stand for?	Outpatient Prospective Payment System	15
8884135083	Diagnosis Related Group (DRG) system is a type of _____	Prospective Payment System	16
8884148649	What physician is primarily responsible for patient's care while in the hospital?	An attending physician	17
8884154962	Referring to Diagnosis Related Group, what is CC used to indicate?	Complications or Comorbidities	18
8884162919	If the time that the patient was admitted to the hospital is unknown, which code would be used?	Code 99	19

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Week 5 Hospital Billing/UB-04 Flashcards

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10403348744	How many diagnosis can be listed on the UB-04	10 diagnosis	0
10403348745	What is listed on a Charge Description Master	-All services and items provided to the patient -procedure code -hospital charges	1
10403348746	What are revenue codes	They describe the specific accommodation and/or providing necessary support to the primary actives or operation charges	2
10403348747	What is Ambulatory Surgical Unit	A designated center where outpatient services are offered to patient	3
10403348748	Define Cost Outlier	A case that cannot be assigned an appropriate DRG because of an atypical situation	4
10403348749	What are the types of of facilities that would use UB-04 claim	Rehab Center, Outpatient/Inpatient Care, Skill Nursing Facility, Emergency Care, Urgent Care, Ambulatory Center	5
10403348750	Who maintains the ambulatory payment classification (APC) list	The Centers of Medicare and Medicaid (CMS)	6
10403348751	Ambulatory Payment Classifications (APC) system bases payment on	Procedure	7
10403348752	What is Prospective Payment System	Establish payment rates to hospitals prospectively before services are rendered	8
10403348753	How often is a patient control number (PCN) assigned to patient in the hospital	Each hospital admission	9
10403348754	Define comorbidity	-The simultaneous presence of toe chronic diseases or condition in a patient -one or more diseases that presents in addition to the primary disease or disorder	10
10403348755	Define comorbidity	-The simultaneous presence of two chronic diseases or condition in a patient -one or more diseases that presents in addition to the primary disease or disorder	11
10403348756	Majority of hospital reimbursement comes from	Insurance Company	12
10403348757	When will a hospital bill for patient services	After the patient is discharged and form is signed by a physician	13
10403348758	What is the method of reimbursement that pays hospitals a fixed rate per day for all services	Per Diem type	14
10403348759	What does OPPS stand for	Outpatient Prospective Payment System	15
10403348760	Diagnosis Related Group (DRG) system is a type of ...	Prospective Payment System	16
10403348761	What physician is primarily responsible for patient's care while in the hospital	An Attending Physician	17
10403348762	Referring to Diagnosis Related Group(DRG), what does CC used to indicte	Complication or Comorbidities	18
10403348763	In the time that the patient was admitted to the hospital is unknown, which code would be used (on locator 13)	Code 99	19

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Hospital Billing/ UB-04 (Week 5) Flashcards

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10377576893	How many diagnosis can be listed on the UB-04 claim form?	10 diagnosis	0
10377577867	What is listed on a Charge Description Master?	Procedure code, Procedure of Services description, charge	1
10377579523	What are revenue codes?	Codes that identify the hospital performs outpatient services	2
10377580236	Define Cost Outlier	Case that cannot be assigned an appropriate DRG	3
10377583244	What is the software program that allows a facility to calculate its Diagnosis Related Group payment group?	Grouper	4
10377583894	Who maintains the Ambulatory Payment Classification list?	[CMS] Centers for Medicare and Medicaid services	5
10377586305	Ambulatory Payment Classification system bases payment on.....	Procedures	6
10377587029	What is Prospective Payment System?	The method of reimbursement that establishes the rat of payment to a hospital before service are rendered	7
10377589623	How often is a patent control number assigned to a patent in the hospital?	At each admission	8
10377590149	Define comorbidity	Preexisting condition that will require intensive therapy	9
10377593683	What are the types of facilities that would use UB-04 claim form?	Hospitals, Rehabilitation centers, outpatients surgical centers	10
10377597008	Majority of hospital reimbursement comes from?	Insurance companies	11
10377599447	What is an Ambulatory surgical Unit	A department within the hospital performs outpatient service	12
10377600674	When will a hospital bill for patient services?	After the discharge paperwork is completed and signed by the physician	13
10377603929	What is the method of reimbursement that pays hospitals a fixed rate day for all services?	Per Diem	14
10377604600	What does OPPS stand for?	Outpatients prospective payment system	15
10377605573	Diagnosis Related Group system is a type of?	Prospective payment system	16
10377608054	What physician primarily responsible for patients care while int he hospital?	Attending Physician	17
10377609227	Referring to Diagnosis Related Group, what does CC used to indicate?	Complications and commodities	18
10377610316	IF the time that the patient was admitted tot he hospital is unknown, which code would be used.	Code 99	19

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Flashcards

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Claims Forms - UB Flashcards

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7288758361	UB CLAIM	IP AND OP HOSPITAL. CRITICAL ACCESS HOSPITALS AND COMPREHENSIVE REHAB FACILITIES. FL IS A FORM LOCATOR	0
7288765479	FL1	BILLING PROVIDERS NAME, ADDRESS AND #	1
7288767076	FL2	BILLING PROVIDERS DESIGNATED PAY TO NAME, ADDRESS AND SECONDARY IDENTIFICATION FLS. FLS ARE NOT REQUIRED.	2
7288772523	FL3A	PATIENT CONTROL NUMBER. ACCOUNT NUMBER AKA.	3
7288774628	FL3B	MEDICAL RECORD NUMBER. ASSIGNED BY FACILITY	4
7288778362	FL4	TYPE OF BILL. 4 DIGIT NUMBER. STARTS WITH A LEADING 0	5
7288782539	TYPE OF BILL SEQUENCE	1ST DIGIT IS 0- CMS IGNORES 2ND DIGIT IS TYPE OF FACILITY - TYPE OF FACILITY 3RD DIGIT IS BILL CLASSIFICATION - TYPE OF CARE 4TH DIGIT IS FREQUENCY -INDICATED SEQUENCE OF BILL IN THIS EPISODE OF CARE	6
7288800499	FL5	TAX ID NUMBER	7
7288804404	FL6	FROM THROUGH DATES. MMDDYY	8
7288806766	FL7	NOT USED	9
7288806767	FL8	PATIENT NAME/ID	10
7288809364	FL9	PATIENTS ADDRESS	11
7288809365	FL10	DOB MMDDCCYY	12
7288810532	FL11	PATIENT SEX. M OR F	13
7288811990	FL12	ADMISSION START OF CARE DATE. REQUIRED FOR INPATIENT AND HOME HEALTH	14
7288814787	FL13	ADMISSION HOUR. NOT REQUIRED	15
7288814788	FL14	PRIORITY TYPE OF ADMISSION OR VISIT.	16
7288817507	FL15	POINT OF ORIGIN FOR ADMISSION OR VISIT. SOUR OF THE REFERRAL FOR THIS VISIT. EX: 7 INDICATED ER	17
7288822374	FL16	DISCHARGE HOUR. NOT REQUIRED	18
7288822375	FL17	PATIENT DISCHARGE STATUS. 01 MEANS DISCHARGE TO HOME OR SELF CARE	19
7288824989	FL18-28	CONDITION CODES	20
7288827707	FL29	ACCIDENT STATE. NOT USED	21
7288828885	FL30	UNTITLED. NOT USED	22
7288830593	FL 31-34	OCCURRENCE CODES AND DATES. EVENT CODES ARE 2 ALPHA-NUMERIC DIGITS AND DATES ARE 6 NUMERIC DIGITS MMDDYY WHEN OCCURRENCE CODES 01-04 AND 24 ARE USED THE PROVIDER MUST MAKE SURE THE ENTRY INCLUDES THE APPROPRIATE VALUE CODE IN FLS 39-41 IF ANOTHER PAYER IS INVOLVED	23
7288843970	FL35-36	SPAN CODES AND DATES. INPATIENT ONLY	24
7288846019	FL37	NOT USED	25
7288846020	FL38	RESPONSIBLE PARTY NAME AND ADDRESS. NOT USED	26
7288848098	FL39-41	VALUE CODES AND AMOUNTS. 2 ALPHA NUMERIC DIGITS. NO NEGATIVE AMTS EXCEPT FL41.	27
7288858189	FL42	REV CODES	28
7288863739	FL43	REV CODE DESCRIPTION. NOT REQUIRED	29
7288868172	FL44	HCPCS/FOR OUTPATIENT ENTER CPT AND HCPCS LEVEL 2. UP TO FOUR MODIFIERS	30
7288871711	FL45	SERVICE DATE.	31
7288874709	FL46	UNITS OF SERVICE	32
7288876580	FL47	TOTAL CHARGES	33
7288876581	FL48	NON COVERED CHARGES.	34
7288879049	FL49	NOT USED	35
7288879050	FL50	PAYER ID. IF MC IS PRIMARY, PROVIDER MUST ENTER MEDICARE ON LINE A. LISTING MC IS SAYING THAT MC IS PRIMARY. IF OTHER INSURANCE IS PRIMARY ENTER ON LINE A AND THEN PUT MC ON LINE B OR C AS APPROPRIATE	36
7288886547	FL51 A-C	HEALTH PLAN ID. REPORT THE NPI	37
7288888133	FL 52A, B AND C	RELEASE OF INFORMATION CERTIFICATION INDICATOR. Y MEANS SOF TO RELEASE DATA. I CODE MEANS INFORMED CONSENT TO RELEASE MEDICAL INFO. REQUIRED WHEN DR HAS NOT COLLECTED A SIGNATURE AND STATE/FEDERAL LAWS DO NOT SUPERSEDE THE HIPPA RULE	38
7288899454	FL 53A, B AND C	ASSIGNMENT OF BENEFITS. NOT USED.	39
7288900931	FL 54 A B AND C	PRIOR PAYMENT..ALL SERVICES BESIDES INPATIENT OR SNF. DEDUCTIBLES OR COPAYS	40
7288907978	FL55 A, B AND C	ESTIMATED AMT DUE FROM PT. NOT REQUIRED	41
7288909796	FL 56	NPI	42
7288911154	FL 57	NOT USED	43
7288911155	FL 58 A, B AND C	INSURED'S NAME.	44
7288913073	FL 59 A, B AND C	PT'S RELATIONSHIP TO INSURED.	45
7288915044	FL 60 A-C	POLICY ID NUMBER	46
7288916469	FL 61 A-C	GROUP NAME	47
7288918419	FL 62 A-C	GROUP NUMBER	48
7288920622	FL 63	AUTHORIZATION OR REFERRAL NUMBER	49
7288921732	FL 64	DOCUMENT CONTROL NUMBER.	50
7288923332	FL 65	EMPLOYER NAME. IF WC IS INVOLVED	51
7288934736	FL 66	DIAGNOSIS AND PROCEDURE CODE QUALIFIER	52
7288936938	FL 67	PRINCIPAL DIAGNOSIS	53
7288939056	FL67 A-Q	OTHER DIAGNOSIS CODES	54
7288940808	FL68	RESERVED. NOT USED	55
7288942161	FL69	ADMITTING DIAGNOSIS. REQUIRED FOR INPATIENT	56
7288943808	FL 70 A-C	REASON FOR VISIT - READ BOOK FORE MORE DETAILS	57
7288947230	FL 71	NOT USED. PROSPECTIVE PAYMENT SYSTEMS CODE	58
7288948482	FL 72	EXTERNAL CAUSE OF INJURY CODES. USUALLY NOT USED UNLESS PAYER REQUIRES	59
7288951435	FL 73	RESERVED. NOT USED	60
7288951436	FL 74	PRINCIPAL PROCEDURE CODE AND DATE. REQUIRED FOR INPATIENT	61
7288984402	FL 75	RESERVED. NOT USED	62
7288991001	FL76	ATTENDING PROVIDER NAME AND IDENTIFIERS INCLUDING NPI. IF NOT REQUIRED, DO NOT SEND.	63
7288994945	SECONDARY IDENTIFIER QAULIFIERS	0B STATE LICENSE 1G PROVIDER UPIN G2 PROVIDER COMMERCIAL NUMBER	64
7288997883	FL77	OPERATING PROVIDER AND IDENTIFIERS INCLUDING NPI, SAME AS ABOVE	65
7288999995	FL 78-79	OTHER PROVIDER NAMES - SAME AS ABOVE DN- REFERRING PROVIDER ZZ- OTHER OPERATING PHYSICIAN	66
7289005850	FL 80	REMARKS. SPECIAL ANNOTATIONS. REMARKS NEEDED TO PROVIDE INFO THAT IS NOT SHOWN ELSEWHERE ON THE BILL BUT IS NECESSARY FOR PROPER PAYMENT	67
7289010584	FL 81	USED TO REPORT ADDL CODES RELATED TO FL OR TO REPORT EXTERNAL CODE LIST	68

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Hospital billing/ UB-40 chp 12 Flashcards

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7086969215	How many diagnosis can be listed in the UB-04 claim Form?	10	0
7090142927	What is listed on a Charge Description Master?	Procedure code, procedure description, service description, revenue code and charge amounts	1
7090149108	What are revenue codes?	The 3 digit code representing a specific accommodation ancillary service or billing calculation related to that service, identifies the hospital department that provided services	2
7090164888	What is Ambulatory Surgical Unit?	A department in a hospital that performs outpatient services for patients, day surgeries, minor procedures	3
7090172836	Define Cost Outlier	a case that cannot be assigned an appropriate DRG because of a rare condition, long length of stay or unique or unusual combination of diagnosis and surgeries	4
7090185687	What is the software program that allows a facility to calculate its Diagnosis Related Group (DRG) payment group?	grouper	5
7090187975	Who maintains the Ambulatory Payment Classification (APC) list?	CMS Centers of Medicare and Medicaid Services	6
7090191377	Ambulatory Payment Classification (APC) system bases payment on	procedures	7
7090194884	What is Prospective Payment System?	pay before service is rendered	8
7090200886	How often is a patient control number (PCN) assigned to a patient in the hospital?	with each admission and listed on a UB-04 claim form	9
7090202670	Define comorbidity	one or more diseases that presents in addition to the primary disease	10
7090210879	What are the different types of facilities that would use UB-04 claim form?	inpatient care, hospice	11
7090216178	Majority of hospital reimbursement comes from??	insurance companies	12
7090217813	When will a hospital bill for patient services?	when a patient is discharged, after discharge papers are signed by physician	13
7090226480	What is the method of reimbursement that pays hospitals a fixed rate per day for all services?	The Per Diem type	14
7090228744	What does OPPS stand for?	Outpatient Prospective Payment System	15
7090230742	Diagnosis Related Group (DRG) system is a type of?	Prospective payment system	16
7090239388	What physician is primarily responsible for patient's care while in the hospital?	attending physician	17
7090243424	Referring to Diagnosis Relayed Group (DRG) what does CC used to indicate?	complications or comorbidity	18
7090272000	If the time that the patient was admitted to the hospital is unknown, which code would be used, on form locator 13?	99	19

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AP World History Chapter 21 Flashcards

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11854506345	Arms Race	A competition between superpowers to develop new, more deadly nuclear and conventional weapons.	0
11854506346	Berlin Airlift	The massive relief effort of food and fuel to democratic West Berlin following the cut off by the Soviets.	1
11854506347	Berlin Wall	Wall constructed by East German authorities in 1961 to seal off East Berlin from the West; it was breached on November 9, 1989.	2
11854506348	Blockade	Shutting off of a port to keep people or supplies from moving in or out.	3
11854506349	Bolsheviks	Russian revolutionary party led by Vladimir Lenin and later renamed the Communist party; the name "Bolshevik" means "the Majority."	4
11854506350	Brezhnev, Leonid	The Soviet leader who arrested and imprisoned dissidents and claimed the rights to interfere with the Warsaw Pact.	5
11854506351	Building Socialism	Euphemistic expression of the often-forcible transformation of society when a communist regime came to power in a state.	6
11854506352	Castro, Fidel	Revolutionary Leader of Cuba from 1959 to 2008 who gradually turned to Soviet communism and engendered some of the worst crises of the cold war.	7
11854506353	Chinese Revolution	Long revolutionary process in the period 1912-1949 that began with the overthrow of the Chinese imperial system and ended with the triumph of the Communist Party under the leadership of Mao Zedong.	8
11854506354	Cold War	The state of tension and hostility between the United States and the Soviet Union after 1945 without large scale armed conflict between the major powers.	9
11854506355	Collectivization	Process of rural reform undertaken by the communist leadership of both the USSR and China in which private property rights were abolished and peasants were forced onto larger and more industrialized farms to work and share the proceeds as a community rather than as individuals.	10
11854506356	Comintern	In full, "Communist International"; Soviet organization intended to control the policies and actions of other communist states.	11
11854506357	Containment	The Cold War policy that limited the spread of Communism.	12
11854506358	Cuban missile crisis	Major standoff between the United States and the Soviet Union in 1962 over Soviet deployment of nuclear missiles in Cuba' the confrontation ended in compromise, with the USSR removing its missiles in exchange for the United States agreeing not to invade Cuba.	13
11854506359	Cultural Revolution	China's great Proletarian Cultural Revolution was a massive campaign launched by Mao Zedong in the mid 1960s to combat the capitalist tendencies that he believed reached into even the highest ranks of the Communist Party; the campaign threw China into chaos.	14
11854506360	Deng Xiaoping	Leader of China from 1976 to 1997 whose reforms essentially dismantled the communist elements of the Chinese economy.	15
11854506361	Detente	Easing of tensions between the United States and the Soviet Union in the 1970s.	16
11854506362	Domino Theory	Belief that if one nation fell to communism, neighboring nations would also fall.	17
11854506363	Dubova, Anna	Born to a Russian peasant family in 1916 she lived though the communist experience of her country. Her life illustrates the complexities that ordinary citizens faced as they sought to navigate the communist system.	18
11854506364	Four Mondernizations	The Chinese economic reform program under Deng Xiaoping that emphasized agriculture, industry, science and defense.	19
11854506365	glasnost	Mikhail Gorbachev's policy of "openness," which allowed greater cultural and intellectual freedom and ended most censorship of the media; the result was a burst of awareness of the problems and corruption of the Soviet system.	20
11854506366	Gorbachev, Mikhail	Leader of the Soviet Union from 1985 to 1991 whose efforts to reform the USSR led to its collapse.	21
11854506367	Great Leap Forward	Major Chinese initiative (1958-1960) led by Mao Zedong that was intended to promote small-scale industrialization and increase knowledge of technology; in reality, it caused major crisis and exacerbated the impact of a devastating famine.	22
11854506368	Great Proletarian Cultural Revolution	Mao Zedong's great effort in the mid 1960s to weed out capitalist tendencies that he believed had developed in China.	23
11854506369	Great Purges/Terror	Also called the Terror, the Great Purges of the late 1930s were a massive attempt to cleanse the Soviet Union of supposed "enemies of the people"; nearly a million people were executed between 1936 and 1941, and 4 million of 5 million more were sentenced to forced labor in the gulag.	24
11854506370	Gulag	Acronym for the Soviet government agency that administered forced labor camps.	25
11854506371	Guomindang	The Chinese Nationalist Party led by Jiang Jieshi (formally Chiang Kai-shek) from 1928 until its overthrow by the communists in 1949.	26
11854506372	Ho Chi Minh	Vietnamese nationalist who brought communism to North Vietnam during the latter part of the 20th century.	27
11854506373	Iron Curtain	The imaginary line through Europe that divided the democracies of the West from the communist countries of the East.	28
11854506374	Khrushchev, Nikita	Leader of the Soviet Union from 1953 to 1964.	29
11854506375	Lenin	Adopted name of Vladimir Ilyich Ulyanov (1870-1924), the main leader of Russia's communist revolution and head of the Soviet state from 1917 until his death.	30
11854506376	Mao Zedong	Chairman of China's Communist Party and de facto ruler of China from 1949 until his death in 1976.	31
11854506377	McCarthyism	Wave of anti communist fear and persecution that took place in the United States in the 1950s national security state: Form of government that arose in the United States in response to the cold war and in which defense and intelligence agencies gained great power and power in general came to be focused in the executive branch.	32
11854506378	perestroika	Bold economic program launched in 1987 by Mikhail Gorbachev with the intention of freeing up Soviet industry and businesses.	33
11854506379	Red Guard	Group of radical students formed in China during the Cultural Revolution.	34
11854506380	Russian Revolution	Massive revolutionary upheaval in 1917 that overthrew the Romanov dynasty in Russia and ended with the seizure of power by communists under the leadership of Lenin.	35
11854506381	Satellites	A dependent state.	36
11854506382	Solidarity	An independent trade union that worked for political change in Poland.	37
11854506383	Stalin	Name assumed by Joseph Vissarionovich Jugashvili (1878-1953), leader of the Soviet Union from 1924 until his death; "Stalin" means "made of steel."	38
11854506384	Superpower	a nation strong enough to influence the acts and policies of other nations.	39
11854506385	Tiananmen Square Massacre	In 1989, demonstrators peacefully assembly to push for greater democracy in China and were attacked by government troops and tanks.	40
11854506386	Warsaw Pact	Military alliance of the USSR and the communist states of Eastern Europe during the cold war.	41
11854506387	Walesa, Lech	Leader of Solidarity that helped Poland gain independence from the Soviet Union, later became president of Poland in 1990.	42
11854506388	Zhenotdel	Women's Department of the Communist Party in the Soviet Union from 1919 to 1930; Zhenotdel worked strongly to promote equality for women.	43