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

ICD-10-CM (International Classification of Diseases, 10th Revision, Clinical Modification) is the standardized coding system used to report diagnoses on US insurance claims.

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

HCPCS Level I, known as CPT (Current Procedural Terminology), is published by the AMA and used to report procedures and services rendered in outpatient and physician settings.

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

HCPCS Level II codes are alphanumeric codes used to report items and services not included in CPT, such as durable medical equipment, orthotics, prosthetics, and drugs.

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 principal diagnosis is the condition established after study to be chiefly responsible for the patient's inpatient admission, as defined by the UHDDS guidelines.

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

Upcoding is fraudulent billing that assigns a higher-level or more expensive code than is supported by clinical documentation, resulting in inflated reimbursement.

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Medical Billing Software Medical Billing Software Coding & Documentation