Question: Which member of the medical practice is ultimately responsible for proper documentation and correct coding?

1. registered nurse

2. B. medical coder

3. C. physician

4. D. all of these are correct

5. Answer: Ultimately, the physician is responsible for proper documentation and correct coding.

6. Question: Some possible consequences of inaccurate coding and incorrect billing in a medical practice are:

7. A. denied claims and reduced payments

8. B. prison sentences

9. C. fines

10. D. all of these are correct

11. Answer: all of these are correct

12. Possible consequences of inaccurate coding and incorrect billing are denied claims/reduced payments, prison sentences, and/or fines.

13. Question: Which is not a characteristic of correctly linked codes?

14. A. the procedure codes match the diagnosis codes

15. B. the procedure codes have three modifiers

16. C. the procedures are not elective, experimental, or nonessential

17. D. the procedures are provided at an appropriate level

18. Answer: the procedure codes have three modifiers

19. Question: In the CCI, which type of code cannot be billed together with a column 1 code for the same patient on the same day of service?

20. A. edit

21. B. exclusive

22. C. diagnostic

23. D. column 2

24. Answer: In the CCI, a column 2 code cannot be billed together with a column 1 code for the same patient on the same day of service

25. Question: In the CCI, which type of codes cannot both be billed for a patient on the same day of service?

26. A. black box

27. B. diagnostic

28. C. mutually exclusive

29. D. unbundled

30. Answer: In the CCI, mutually exclusive codes cannot both be billed for a patient on the same day of service

31. Question: The Correct Coding Initiative (CCI) is a program of:

32. A. TRICARE

33. B. CHAMPVA

34. C. workers’ compensation

35. D. Medicare

36. Answer: CCI is a Medicare program

37. Question: Medically Unlikely Edits (MUE’s) are a program of:

38. A. Blue Cross Blue Shield

39. B. Medicare

40. C. Medicaid

41. D. TRICARE

42. Answer: MUE’s have been developed as an edit by Medicare

43. Question: If a payer judges that too high a code level has been assigned by a practice for a reported service, the usual action is to:

44. A. deny the claim

45. B. downcode the reported procedure code

46. C. upcode the reported procedure code

47. D. add a modifier to the reported procedure code

48. Answer: downcode the reported procedure code

49. Question: What type of coding uses diagnoses that are not as specific as possible?

50. A. truncated coding

51. B. assumption coding

52. C. upcoding

53. D. downcoding

54. Answer: Truncated coding uses diagnoses that are not as specific as possible

55. Question: What type of coding uses a procedure code that provides a higher reimbursement rate than the correct code?

56. A. truncated coding

57. B. assumption coding

58. C. upcoding

59. D. downcoding

60. Answer: upcoding