Domain 4

Question 1

What is the principal diagnosis?

Answer 1

The condition chiefly responsible for admission.

Question 2

What is clinical validation?

Answer 2

Review to ensure diagnoses are supported by documentation.

Question 3

What is a modifier in coding?

Answer 3

A code that provides additional detail about a procedure.

Question 4

When should modifiers be used?

Answer 4

Only when supported by documentation.

Question 5

What is ICD-10-CM used for?

Answer 5

Diagnosis coding.

Question 6

What is ICD-10-PCS used for?

Answer 6

Inpatient procedure coding.

Question 7

What is CPT used for?

Answer 7

Outpatient procedure coding.

Question 8

What is HCPCS Level II used for?

Answer 8

Supplies and services coding.

Question 9

What is a denial?

Answer 9

Refusal of payment by a payer.

Question 10

What is denial management?

Answer 10

Process of handling and reducing denials.

Question 11

What are goals of denial management?

Answer 11

Reduce denials and improve documentation.

Question 12

What is a root operation?

Answer 12

Objective of a procedure in PCS.

Question 13

What is dilation?

Answer 13

Expanding an orifice or lumen.

Question 14

What is excision?

Answer 14

Cutting out a portion of a body part.

Question 15

What is inspection?

Answer 15

Visual examination of a body part.

Question 16

What is medical necessity?

Answer 16

Services required for diagnosis or treatment.

Question 17

What is LCD?

Answer 17

Local Coverage Determination.

Question 18

What is adjudication?

Answer 18

Determining reimbursement amount.

Question 19

What is DRG?

Answer 19

Diagnosis-related group for inpatient payment.

Question 20

What is APC?

Answer 20

Ambulatory Payment Classification.

Question 21

What determines APC assignment?

Answer 21

Procedure codes.

Question 22

What is transfer case payment?

Answer 22

Adjusted payment for patient transfer.

Question 23

What is adverse effect?

Answer 23

Reaction to correctly administered drug.

Question 24

What is poisoning?

Answer 24

Incorrect drug use or overdose.

Question 25

What is coding compliance?

Answer 25

Adherence to coding guidelines.

Question 26

What is upcoding?

Answer 26

Assigning higher codes for more payment.

Question 27

What is downcoding?

Answer 27

Assigning lower codes.

Question 28

What is unbundling?

Answer 28

Separating codes improperly.

Question 29

What is charge description master?

Answer 29

List of billable services and codes.

Question 30

What is CDM modifier use?

Answer 30

Rare and must be supported by documentation.

Question 31

What is claim resubmission?

Answer 31

Submitting corrected claim after denial.

Question 32

What is coding audit?

Answer 32

Review of coding accuracy.

Question 33

What is inpatient coding review focus?

Answer 33

ICD-10-CM and PCS.

Question 34

What is outpatient coding review focus?

Answer 34

CPT and HCPCS.

Question 35

What is case mix index?

Answer 35

Measure of hospital resource use.

Question 36

What is revenue cycle?

Answer 36

Process of billing and reimbursement.

Question 37

What is encounter coding?

Answer 37

Assigning codes for patient visits.

Question 38

What is symptom coding rule?

Answer 38

Code symptoms if no diagnosis confirmed.

Question 39

What is rule-out diagnosis?

Answer 39

Not coded in outpatient setting.

Question 40

What is sequencing?

Answer 40

Order of codes.

Question 41

What is principal procedure?

Answer 41

Procedure performed for definitive treatment.

Question 42

What is coding guideline purpose?

Answer 42

Ensure consistency and accuracy.

Question 43

What is claim form?

Answer 43

Document used for billing.

Question 44

What is reimbursement?

Answer 44

Payment for services.

Question 45

What is fee schedule?

Answer 45

List of payment amounts.

Question 46

What is prospective payment?

Answer 46

Payment predetermined before service.

Question 47

What is retrospective payment?

Answer 47

Payment after service provided.

Question 48

What is medical coding?

Answer 48

Translation of healthcare into codes.

Question 49

What is encoder software?

Answer 49

Tool to assist coding.

Question 50

What is grouper software?

Answer 50

Assigns DRGs or APCs.

Question 51

What is claim scrubber?

Answer 51

Tool to detect errors before submission.

Question 52

What is denial reason code?

Answer 52

Code explaining denial.

Question 53

What is appeals process?

Answer 53

Challenging denied claims.

Question 54

What is audit trail in coding?

Answer 54

Record of coding actions

Question 55

What is documentation requirement?

Answer 55

Support for coded services

Question 56

What is coding query?

Answer 56

Request for clarification from provider

Question 57

What is DRG shift?

Answer 57

Change in DRG due to coding

Question 58

What is MCC?

Answer 58

Major complication/comorbidity

Question 59

What is CC?

Answer 59

Complication/comorbidity

Question 60

What is severity adjustment?

Answer 60

Reflects patient complexity

Question 61

What is outpatient rule for uncertain diagnoses?

Answer 61

Code symptoms

Question 62

What is inpatient rule for uncertain diagnoses?

Answer 62

Code as if confirmed

Question 63

What is NCCI edit?

Answer 63

National Correct Coding Initiative edit

Question 64

What is bundling edit?

Answer 64

Combining services into one payment