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Exam 10: Coding for Medical Necessity

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Question 1

Multiple Choice

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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

E) C) and D)
F) A) and C)

Correct Answer

verified

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Question 2

Multiple Choice

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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

E) A) and D)
F) C) and D)

Correct Answer

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D

Question 3

Multiple Choice

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

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

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

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

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

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

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.

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

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

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

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 __________.

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

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