Deck 10: Coding for Medical Necessity

Question 1

Which part of the SOAP note is the statement of the physician's intended medical management of the case?

A) Subjective
B) Objective
C) Assessment
D) Plan

Answer 1

Plan

Question 2

Local coverage determinations specify under which __________ a service is covered and coded correctly.

A) clinical circumstances
B) health care settings
C) medical necessity
D) service conditions

Answer 2

clinical circumstances

Question 3

The Medicare coverage database (MCD) is used by Medicare administrative contractors, providers, and other health care industry professionals to determine whether a procedure or service is __________ for the diagnosis or treatment of an illness or injury.

A) billed at the appropriate level
B) preauthorized by the contractor
C) reasonable and necessary
D) usual, customary, and reasonable

Answer 3

reasonable and necessary

Question 4

A provider often considers diagnoses that do not receive direct treatment during an encounter because they impact treatment of other conditions. It is appropriate to report codes for such diagnoses on the CMS-1500 claim because they have been __________.

A) discounted by the payer
B) included in coverage
C) medically managed
D) treated during the visit

Question 5

The outpatient code editor (OCE) is software that edits outpatient __________ by hospitals, community mental health centers, comprehensive outpatient rehabilitation facilities, and home health agencies.

A) claims submitted
B) payments received
C) records maintained
D) treatments provided

Question 6

Which part of the SOAP note contains the chief complaint and the patient's description of the presenting problem?

A) Subjective
B) Objective
C) Assessment
D) Plan

Question 7

Which part of the SOAP note contains the diagnostic statement and may include the physician's rationale for the diagnosis?

A) Subjective
B) Objective
C) Assessment
D) Plan

Question 8

A narrative clinic note is written in a(n) __________ format.

A) catalogue
B) itemized
C) list
D) paragraph

Question 9

Where is the first-listed diagnosis reported on the CMS-1500 claim?

A) Block 21A
B) Block 24A
C) Block 24D
D) Block 24E

Question 10

Medical practices and health care facilities should routinely participate in an auditing process, which involves reviewing patient records and CMS-1500 or UB-04 claims to __________.

A) assess coding accuracy and completeness of documentation
B) calculate the amount of money that must be sent to the payer
C) determine whether procedures and services were covered
D) follow up on payer reimbursement of the submitted claims

Question 11

The procedure or service provided is linked with the _________ that provided medical necessity for performing the procedure or service.

A) diagnosis
B) procedure
C) service
D) supply

Question 12

Which is a form required by Medicare for all outpatient and physician office procedures/services that are not covered by the Medicare program?

A) advance beneficiary notice
B) assignment of benefits
C) fee-rendered schedule
D) patient waiver form

Question 13

Which part of the SOAP note contains documentation of measurable observations made by a health care provider during the physical examination and diagnostic testing?

A) Subjective
B) Objective
C) Assessment
D) Plan

Question 14

CMS develops national coverage determinations on an ongoing basis, and __________ create(s) edits for NCD rules, which are local coverage determinations.

A) BlueCross BlueShield
B) Medicaid
C) Medicare administrative contractors
D) third-party payers

Question 15

Although it may vary from a short narrative description of a minor procedure to a more formal report dictated by surgeons, all operative reports contain __________.

A) pathology diagnosis
B) patient complete address
C) preauthorization number
D) procedure performed