CCS-P Study Set

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1. 4 cooperating NCHS (national center for health 10. CAC- computer AHIMA defines as the use of computer
parties of ICD-9 statistics): maintaines dx classifications in assisted coding software that automatically generates a set
and Vol 1&2 of medical codes for review , validation,
responsibilities of CMS: maintains procedural classification and use based upon the documentation
each in Vol 3 provided by the various providers of
AHIMA & AHA: give advice & assistance healthcare.
on coding guidelines in conjunction with
11. charge aka office service report
health information management
summary
practitioners, physicians, & other users of
contains summary of all billing data
ICD-9
entered for the practice each day
2. ABN: advanced waiver required by Medicare for all
12. claim first step in claims appeal process
beneficiary physician office procedures when there is
redetermination
notice a question as to whether or not the
claims are reviewed by an individual who
service will be paid for by Medicare
was not involved in the initial claim review
determination
issued each time each questionable
service is provided
request must be make within 120 days of
3. abnormal are not coded unless indicated there receiving the initial claim determination
laboratory clinical significance by the physician
13. clinical data relates to diagnosis and treatment
findings
documentation in the health record
4. According to 1. number of dx or management options
14. clustering practice of coding/charging one or two
AMA medical 2. amount and complexity of data review
middle levels of service exclusively for all
decision making 3. risk of complications
patient encounters
is measured by
15. Coding Clinic Published quarterly by the Central Office
5. adverse effect hypersensitivities or allergic reactions that
on ICD-9-CM Coding of the American
occur as qualitatively different responses
Hospital Association-AHA providing office
to a drug, which are acquired only after
ICD-9 coding guidelines
re-exposure to the drug is the definition of
an adverse effect 16. coding residual condition is sequenced first,
guideline for followed by the cause of the late effect
6. aspiration caused by inhaled food, liquid, or oil by
late effects is
pneumonia a patient with pneumonia
17. common staphylococcus aureus
7. A barrier to wide poor quality of documentation
bacterial staphylococci
spread use of
diseases streptococci
automated code
streptococcus pyogenes
assignments is
streptococcus pneumonia
8. benefits of email to clarify treatment instructions or gonorrhea
medication administration for patients and meningitis
healthcare providers salmonella
E. coli
9. best report to operative report
cholera
use in
mycoplasma
determination of
bacillus
the size of a
C. perfringens
removed
chlamydia trachomatius
malignant lesion
bubonic plague
clostridium
tuberculosis
hansens disease
syphilis
lyme disease
18. Common forceps or vacuum extractor delivery 28. Data Quality accuracy
Complication of without mention of indication Analysis accessibility
Labor and comprehensives
Delivery renal sphincter tear, not associated with consistency
3rd degree peritoneal laceration currency
definition
trauma to perineum and vulva during granularity
delivery integrity
precision
19. Common Viral Epstein-Barr
relevancy
diseases adenoviridae
timeliness
adenovirus
arbovirus 29. Depro- birth control
encephalitits Provera and
aseptic meningitis estrogen replacement
cytomegalovireus (CMV)
30. discounted provider charges full rate to insurance carrier
Hepatitis
charges but has an arrangement with the insurance
Herpes simplex
carrier to pay at a discounted rate. Physicians
HIV
usually write off the discount but may bill the
influenza A & B
patient for all of the portion of remaining
measles
balance.
mumps
papilloma viruses 31. disease list diagnostic codes in order
paralytic poliomyelitis index
respiratory syncytial virus 32. documenting both the time spent counseling or
rubella varicella zoster time coordinating care and the total tiem of the
rabies according to visit must be documented
20. Consultation used for obscure diagnoses. patients that E/M service
Report physicians are not sure of the best guidelines
therapeutic action and / or question of 33. Effective random sample of records for all physicians
criminal activity o patient. ways to in a group
21. contraceptive V25.2 select an
sterilization audit sample all services provided on a randomly selected
day
22. Cost Sharing formulary for drugs
Provision of co-pay
all rejected claims during a specific time
Health Ins. benefit limitations
period
23. CPT Assistant provides official guidance in CPT coding
34. elderly women giving birth to her first child after the
primigravida age of 35
published by the AMA
35. Encoder used to aid in the coding function in a
24. CPT counseling
physicians office
contributing coordination of care
Components nature of presenting problem 36. facility data includes security levels for each form field
time dictionary and definitions for all entities

25. CPT Key history 37. Federal published by CMS. Contains both proposed
components exam Register and final notes for Conditions of Participation
medical decision making for hospitals

26. criteria for age 38. Fee should occur at least annually unless practice
assigning CPT Evaluations has 100% negotiated and / or capitated rates
preventative
medicine codes evaluate codes that provide 80% of revenue
for the practice
27. Database computerized record of all patients
including basic demographic and 39. Fetal Death state law determines weight and weeks of
encounter data gestation, normal parameters are 500 + grams
or 22 + weeks of gestation
40. following a coding provide education about the results 53. Management of a How the practice is reimbursed for
audit, the manager and then perform a follow-up audit Fee Schedule services
should requires
basic value of services provided
41. Freedom Information send letter to request answers to
Unit questions regarding coding
going rates of services in the market
policies payment rates, or payment
place
policies from Medicare

signals indicating fees need adjustment

only 1 specific request per letter for
a quick and accurate response
DO NOT charge less than the payer
42. Haldol Schizophrenia will pay.
43. hard coding refers to CPT/HCPCS codes that 54. master patient cross reference patient name and
appear in the hospitals index medical record number
chargemaster and will be included
55. MDS Minimum Data Set- used to collect
automatically on the patient's bill.
assessment data elements on Nsg
44. HCPCS Modifies A1 required for initial hospital service home episodes
codes when billing Medicare
56. Medical Staff By H&P Exam completed documentation is
45. HIPAA does not allow oral information Laws, Rules, and due within 24 hours after admission
the following Regulations prior to surgery.
information to be psychotherapy notes
57. Medicare stipulates that IC-9-CM diagnosis and
shared with the patient
Prescription Drug, procedure codes will be issued twice a
themselves information compiled in the
Improvement and year
anticipation of, or for use in a civil,
Modernization Act
criminal, or administrative action or
of 2003 April 1st
proceeding
October 1st
46. HIPAA law in regards defers to state law on matters that
58. methicillin- SUPERBUG, a major source of hospital-
to children under 18 concern minors
resistant acquired infections
47. integrated health arranged in strict chronological staphyllococus
record order
59. minimum governed by HIPAA Privacy Rule
48. Klebsiella gram negative pneumonia necessary
49. Late Pregnancy over 40 weeks of gestation only the minimum necessary amount of
information necessary to fulfill the
50. limiting charge this is the amount a NON PAR
purpose of the request should be
Medicare provider can collect from
shared with internal users and external
a patient in excess of 15% over the
requestors
NON PAR Medicare approved
amount. 60. missed abortion fetal death prior to completion of 22
weeks gestation
51. linking explains medical necessity of a
procedure on a claim 61. modifier: A1- required for patients covered by
principle physical Medicare when reporting Initial Hospital
52. Local and National provide guidelines that cover
of record Service codes
coverage medical necessity
Determinations 62. NEC Books fault> Doctor has detail
documented, book does not contain
matching detail
63. negotiated fee created between physician and insurance 73. potassium treats Hypkalemia
schedule company replacement
74. Prion Disease family of rare progressive neuro-
agreed flat rate per procedure, visit, or
degenerative disorders. Including:
service
Creutzfeldt-Jakob disease (human)
Varient Creutzfeld-Jakob disease (human)
negotiations based on supply and
Gertsmann-Straussler-Scheinker Syndrome
demand
(human)
Fatal Familial Insomnia
negotiations normally mandate agreed
Kuru, aka TSE's transmissible spongiform
rate are
encephalopathies

considered payment in full and not 75. Progress Note contains information regarding treatment
allowed to balance bill the patient provided

64. newborn period birth through the 28th day following birth 76. Protonix treats esophagitis
defined as 77. Psychotherapy time
65. NON PAR 95% of the PAR Medicare allowed. codes are
Medicare Providers can bill up to 115% of the NON assigned based
reimbursement PAR allowed amount. on

66. NOS Doctors fault> Doctor lacks specific 78. Qui tam private citizens who may bring suit on
documentation although ICD has plaintiffs behalf of themselves and the government
detailed options against fraudulent healthcare providers

67. OBRA Omnibus Budget Reconciliation Act of 79. Radiology used to clarify an outpatient diagnosis or
1987 reports can be reason for service
used for coding
68. operation index list medical records by operative
when
procedures
80. RBRVS: national fee system used to calculate the
69. PDR-physicians authoritative source of FDA approved
resource-based approved amount for Medicare payments
desk reference information on prescription drugs
relative value
including usage, warnings and drug
scale value assigned to each CPT code based
interactions
on work involved, cost, and malpractice
70. physician index lists cases in order by physician name or expenses
number
conversion factors published Federal
71. Point of Care when clinical documentation is entered in
Register each December
Service computer at the same time and location
of service 81. reliability consistency of any data set
72. POMR- Organized by problem number 82. Required data physical findings
PROBLEM for Acute Care lab and diagnostic test results
ORIENTED Database: history and physical and ER records follow-up instructions
MEDICAL
83. Retrovir treats AIDS
RECORD Problem List: titles, numbers, dates of
problems..."Table of Contents" of the 84. revenue shows the number of times a particular
record production procedure is coded and the total revenue
report produced as a result of the coding
Initial Plan: describes diagnostic,
therapeutic, and patient education plans shows most frequently used codes in the
practice
Progress Note: documents the progress
of a patient throughout the episode of
care

Discharge Note/ Transfer Note:

summarizes episode of care and current
status of patient
85. Risk areas identified billing for noncovered services as if 94. Unlisted codes only use when there is actually no code
by the OIG (office of they are covered in CPT for the procedure
inspector general)
billing for a more expensive service DO NOT USE when the coder does not
than the one actually preformed understand the procedure or document

coding/charging one or two middle additional information MUST be

levels of service codes submitted with the claim including;
description of procedure, time/ effort
develops an annual work plan that necessary to preform procedure, type of
delineates the specific target areas equipment required, medical reason for
that will be monitored in a given procedure
year
95. Usual Customary based on usual fee submitted by that
86. SOMR-Source organized by subject matter, then Fee profile provider combined with the customary
Oriented Health chronologically within each subject; fee for that code
Record labs together, progress notes
together etc. insurance pays the lowest of; the
physician amount, area customary fee, or
87. Spreadsheet software application that will allow facilitate
schedule of benefits
data collection and analysis
beneficial because charts and 96. validity accuracy of data
graphs can be incorporated
97. V codes supplemental classification
Problem based include: need for vaccine
For example: physician to
Fact based include: history of, outcome
computerize the office budget
of delivery
including; personnel expenses,
Service based: dialysis, chemo, therapy
office expenses, and office supply
expenses 98. ventricular abnormal communication or opening in
septal defect the ventricular septum that allows blood
88. Stark Law prohibits a physician from referring
to shunt from the left ventricle to the
patients to an entity for services
right ventricle
paid for by federal or state health
benefits programs if a physician has 99. When can code When the patient meets the definition of
a financial relationship with the 99291 (E/M critical care and receives outpatient care
entity critical care) be on the same day
used in place of
89. subpeona duces ONLY reason that warrants the
a medical visit or
tecum original patient chart to leave the
ER code
premisses of the hospital
100. When does CMS when a NON PAR provider does not
90. Superbill Aka; charge ticket
send the accept assignment
91. Synthroid Rx prescribed to replace small payment
levels of thyroid hormone directly to the
patient
92. to update the office use Appendix B of CPT to reference
encounter form code additions, deletions, and 101. When is an when a patient is readmitted for the same
yearly revisions interval H&P or related problem with-in 30 days
permitted
93. Unbundling is refund over payments from a third
discovered as a party parer due to this practice 102. When should Never. If findings are out of normal range
common practice the coders assign and the physician has ordered additional
appropriate action to codes from lab testing or treatment; consult with the
be taken by the office reports alone physician as to whether the Dx should be
manager is added or if an abnormal finding should
be listed.
103. Where are payor procedure manuals, newsletters, and
specific bulletins published by the payor
guidelines found