Medical Coding and Classification Flashcards
7 cards from real AHIMA practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Medical Coding and Classification flashcards as text
Which of the following best describes 'upcoding' in medical billing?
Answer: Assigning a code for a higher-reimbursed service than actually performed
Upcoding is a form of fraud in which a provider bills for a more expensive service than was actually rendered.
What is the function of the National Correct Coding Initiative (NCCI) edits?
Answer: To prevent improper unbundling of CPT codes
NCCI edits are CMS-developed bundling edits that prevent unbundling of procedures that should be billed together.
Which character position in an ICD-10-PCS code defines the 'approach'?
Answer: 5th character
The 5th character in ICD-10-PCS specifies the approach, such as Open, Percutaneous, or Endoscopic.
A patient is admitted with acute systolic congestive heart failure and also has Stage 3 chronic kidney disease. Which code should be sequenced as the principal diagnosis?
Answer: The acute systolic heart failure, as it is the condition chiefly responsible for admission
The principal diagnosis is the condition chiefly responsible for the admission after study; acute systolic heart failure is the primary reason here.
Which of the following describes the 'Alphabetic Index' in ICD-10-CM?
Answer: A cross-reference tool to locate diagnosis codes by main term
The Alphabetic Index organizes diagnoses by main term and guides coders to the correct code category before verification in the Tabular List.
What does the acronym 'NEC' mean when encountered in the ICD-10-CM Tabular List?
Answer: Not Elsewhere Classifiable
NEC stands for 'Not Elsewhere Classifiable' and is used when the available codes do not fully describe a specific condition.
In CPT, which section contains codes for anesthesia services?
Answer: 00100–01999
CPT anesthesia codes are found in the range 00100–01999, organized by anatomical site.