Medical Billing Software Medical Billing Software Coding & Documentation

Question 1

What coding system is primarily used in the United States to report medical diagnoses on insurance claims?

Accepted Answer

ICD-10-CM

Answer

CPT

Answer

HCPCS Level II

Answer

DRG

Question 2

Which coding system is used to report outpatient medical procedures and evaluation and management services in the US?

Accepted Answer

HCPCS Level I (CPT)

Answer

ICD-10-PCS

Answer

DRG codes

Answer

ICD-10-CM

Question 3

What is the purpose of HCPCS Level II codes in medical billing?

Accepted Answer

To report products, supplies, equipment, and services not covered by CPT codes, including ambulance services and DME

Answer

To replace CPT codes for hospital inpatient procedures

Answer

To identify the physician's specialty for reimbursement purposes

Answer

To document secondary diagnoses on a claim

Question 4

In ICD-10-CM coding, what does the term 'principal diagnosis' refer to in an inpatient setting?

Accepted Answer

The condition determined after study to be chiefly responsible for the admission

Answer

The most common diagnosis for a given patient population

Answer

The first diagnosis listed by the provider in the chart

Answer

The chronic condition that required the most resources

Question 5

What does 'upcoding' mean in the context of medical billing compliance?

Accepted Answer

Assigning a code for a more complex or higher-reimbursing service than was actually documented or performed

Answer

Submitting claims electronically rather than on paper

Answer

Updating outdated ICD-9 codes to ICD-10 equivalents

Answer

Using modifiers to increase payment for bilateral procedures

Question 6

Which of the following best describes 'medical necessity' as it applies to coding and billing?

Accepted Answer

Services that are reasonable and necessary for the diagnosis or treatment of illness or injury as defined by the payer

Answer

Any service ordered by a licensed physician

Answer

Procedures performed in an emergency setting only

Answer

Services covered under the patient's specific insurance plan