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Physician Coding Exam Review 2018 - E-Book

Physician Coding Exam Review 2018 - E-Book

Carol J. Buck

(2017)

Additional Information

Book Details

Abstract

Prepare to succeed on your physician coding certification exam with Physician Coding Exam Review 2018: The Certification Step! From leading coding author and educator Carol J. Buck, this exam review provides complete coverage of all topics included on the physician coding certification exam — including anatomy, terminology, and pathophysiology for each body system; reimbursement issues; CPT, HCPCS, and ICD-10-CM coding; and more. Four full practice exams (answers and rationales included) simulate the testing experience and provide enough practice to reassure even the most insecure exam-taker. It’s the only physician coding exam review you need!

  • UNIQUE! Four full practice exams on Evolve simulate the experience of taking the actual physician coding exam, allowing you to assess your strengths and weaknesses in order to develop a plan for focused study.
  • Answers and rationales to the practice exams are available on Evolve to help you check your work.
  • Concise outline format helps you access key information quickly and study more efficiently.
  • Concrete "real-life" coding reports (cleared of any confidential information) simulate the reports that you will encounter on the job and challenge you to apply key coding principles to actual cases.
  • Mobile-optimized quick quizzes offer on-the-go practice with over 350 medical terminology, pathophysiology, CPT, HCPCS, and ICD-10-CM questions.
  • Success Strategies section guides you step-by-step through the entire exam process.
  • NEW! Updated content features the latest coding information available, promoting accurate coding and success on the job.

Table of Contents

Section Title Page Action Price
Front Cover cover
IFC_Evolve page IFC1
Physician Coding Exam Review 2018 i
Copyright Page iv
Dedication v
About the Author vi
Acknowledgments vii
Preface viii
Organization of This Textbook viii
About the Outpatient Certification Examinations viii
About the Practice Examinations viii
Exam Sessions Screen ix
Taking the Examination ix
Reviewing Your Results x
Supplemental Resources x
Instructor’s Electronic Resource x
Additional Evolve Resources x
Reviewers xi
Table Of Contents xii
Success Strategies xvi
The Certification Examination xvi
Date and Location xvi
Managing Your Time xvii
Schedule xvii
Using This Text xviii
Day Before the Examination xix
Day of the Examination xix
The Certification Examination xix
Days After the Examination xx
1 Anatomy, Terminology, and Pathophysiology 1
1 Integumentary System 2
Anatomy and Terminology 2
Layers 2
Two Layers Make Up Skin: Epidermis and Dermis 2
Nails 2
Glands 3
Chapter 1: Anatomy and Terminology Quiz 4
(Quiz Answers Are Located in Appendix B) 4
Pathophysiology 5
Lesions and Other Abnormalities (Fig. 1.2) 5
Macule 5
Papule 5
Nodule 5
Pustule 5
Tumor 5
Plaque 5
Wheal 5
Vesicle 5
Bulla 5
Scales 5
Crust 5
Fissure 6
Erosion 6
Scar 6
Atrophy 6
Ulcer 7
Pressure Ulcer (Decubitus Ulcer) (Fig. 1.3) 7
Result of Pressure or Force 7
Locations 7
Staging or Classification System 7
Keloids 7
Cicatrix 7
Inflammatory Disorders 7
Atopic Dermatitis 7
Exogenous (External) Causes Include 7
Endogenous (Internal) Cause Includes. 7
Results in Activation Of 7
Greater in Those With Family History Of 7
Common In 7
Results In 7
2 Reimbursement Issues 122
14 Reimbursement Issues 123
Your Responsibility 123
Population Changing = Reimbursement Change 123
Medicare 123
Those Covered 123
Basic Structure 123
Officiating Office 123
Funding for Medicare 124
Medicare Covers 124
Medical Necessity and Frequency Limitations 124
Beneficiary Pays 124
Medicare Pays 124
Participating Providers 124
National Provider Identification (NPI) 124
Good Reasons to Participate 124
Part A, Hospital Inpatient 124
Covered In-Hospital Expenses 124
Noncovered in-Hospital Expenses 124
Types of Covered Expenses 124
Part B, Supplemental 125
Types of Items Covered in Part B 125
Coding for Medicare Part B Services 125
Electronic Transactions 125
National Correct Coding Initiative (NCCI) 125
Unbundling 125
Federal Register 125
Quality Improvement Organizations (QIO) 125
Two Types of QIOs 125
Beneficiary and Family Centered Care (BFCC) 125
Quality Innovation Network (QIN) 125
Resource-Based Relative Value Scale (RBRVS) 125
National Fee Schedule (NFS) 126
Relative Value Units (RVUs) 126
Medicare Fraud and Abuse 127
Fraud 127
Fraud Can Be 127
Office of the Inspector General (OIG) 127
Complaints of Fraud or Abuse 127
Abuse 127
Kickbacks 127
Protect Yourself 127
Managed Health Care 127
Managed Care Organizations 127
Preferred Provider Organization (PPO) 127
Point of Service (POS) 127
Health Maintenance Organization (HMO) 127
Chapter 14: Reimbursement Quiz 130
(Quiz Answers Are Located in Appendix B) 130
3 CPT and HCPCS Coding 132
15 Introduction to CPT 133
Introduction to Medical Coding 133
Two Levels of Service Codes 133
Diagnosis Codes, ICD-10-CM 133
CPT 133
Types of CPT Codes 133
CPT Codes 133
Incorrect Coding 133
Outpatient Physician (Non-Hospital) Services 133
CPT Format 133
Symbols 133
CPT Sections 135
Categorized by 135
Guidelines 135
Notes 135
Two Types of Code Descriptions 135
Semicolon 135
Modifiers Add Information 135
CPT Modifier 135
Level II HCPCS Modifiers 135
Unlisted Services 135
Category II Codes—Supplemental Tracking Codes 135
Category III Codes—New Technology 136
The Index 136
Location Methods 136
Appendices of CPT 136
16 Evaluation and Management (E/M) Section (99201-99499) 137
Integral Factors When Selecting E/M Codes 137
1. Place of Service 137
2. Type of Service 137
3. Patient Status 137
New Patient 137
Established Patient 137
Outpatient 137
Inpatient 137
Levels of E/M Service Based on 137
E/M Levels Divided Based on 137
Key Components (KC) 137
Contributory Factors (CF) 138
Every Encounter Contains Varying Amount of KC and CF 138
Key Components 138
Four Elements of a History 138
Chief Complaint (CC)—Subjective 138
History of Present Illness (HPI)—Subjective 138
Physician and Patient Dialogue 138
Review of Systems (ROS)—Subjective 138
ROS Elements 138
Past, Family, and Social History (PFSH) 138
Past 138
Family History 138
Social History 138
Four History Levels 139
Problem-Focused History 139
Expanded Problem-Focused History 139
Detailed History 139
Comprehensive History 139
Four Examination Levels (Objective) 140
Problem-Focused Examination (1995 Documentation Guidelines [DG]) 140
Expanded Problem-Focused Examination (1995 DG) 140
Detailed Examination (1995 DG) 140
Comprehensive Examination (1995 DG) 140
Medical Decision Making Complexity (MDM) 140
Management Options 140
Data Reviewed 140
Risks 140
Four Levels of MDM Complexity 142
1. Straightforward MDM 142
2. Low-Complexity MDM 142
3. Moderate-Complexity MDM 142
4. High-Complexity MDM 142
Contributory Factors 142
Counseling 142
Coordination of Care 142
Nature of Presenting Problem 142
Levels of Presenting Problem 143
Minimal Presenting Problem 143
Self-Limiting or Minor Presenting Problem 143
Low-Severity Presenting Problem 143
Moderate-Severity Presenting Problem 143
High-Severity Presenting Problem 143
Time 143
Use of E/M Code 143
Selection of Level of E/M Services 143
New Patient (99201-99205) 143
Established Patient (99211-99215) 143
Hospital Observation Status (99217-99220, 99224-99226, 99234-99236) 143
Initial Observation Care 144
Hospital Inpatient Services (99221-99239) 144
Types of Physician Status 144
Types of Care 144
Three Types of Hospital Inpatient Services 144
Initial Hospital Care (99221-99223) 144
Subsequent Hospital Care (99231-99233) 144
Hospital Discharge Services (99238, 99239) 144
Final Status of Patient 144
Summary of Stay (Discharge) 144
Consultation Services (99241-99255) 144
Third-Party-Payer Consultations 144
Emergency Department Services (99281-99288) 144
4 ICD-10-CM Coding 224
24 ICD-10-CM Overview 225
Introduction 225
Uses of ICD-10-CM 225
ICD-10-CM on CMS-1500 (Fig. 24.1) 225
Ethics 225
Format 225
Diseases, Tabular List 225
Diseases, Alphabetic Index 225
Placeholder 225
7th Character 225
Abbreviations 226
Punctuation 226
[ ] Brackets 226
( ) Parentheses 226
: Colon 226
Italicized Type 226
Includes, Excludes, Use Additional Code 226
And/With 226
Code, if Applicable, Any Causal Condition First 226
Alphabetic Index 226
Terms 226
Cross References in the Index 226
Notes 226
Eponyms 226
Etiology and Manifestation of Disease 226
Index to Diseases 226
Table of Neoplasms 227
Table of Drugs and Chemicals 227
Table Headings 227
V, W, X, Y Codes 228
A Word of Caution About the Alphabetic Index 228
Tabular List 228
Major Division 228
Classification of Diseases and Injuries 228
Divisions of Classification of Diseases and Injuries 228
25 Using ICD-10-CM 229
General Guidelines 229
Steps to Diagnosis Coding 229
Remember 229
OGCR Section I.A.9. Other (NEC) and Unspecified (NOS) 229
OGCR Section I.B.2. Level of Detail in Coding 229
OGCR Section I.B.8. Acute and Chronic Conditions 229
OGCR Section I.B.9. Combination Code 229
OGCR Section I.B.7. Multiple Coding for Single Condition 229
OGCR Section I.B.11. Impending or Threatened Condition 229
OGCR Section I.B.13. Laterality 229
OGCR Section I.B.14. Documentation for BMI, Depth of Non-Pressure Ulcers, Pressure Ulcer Stages, Coma Scale, and NIH Stroke Scale 230
Selection of Primary/First-Listed Diagnosis 230
OGCR Section II.H. Uncertain Diagnosis 230
Diagnosis and Services 230
OGCR Section I.A.7. Punctuation 230
OGCR Section II.B. Two or More Interrelated Conditions 230
OGCR Section II.C. Two or More Equal Diagnoses 230
Late Effects (Sequela) 230
26 ICD-10-CM Chapters 1-10 231
Chapter 1, Certain Infectious and Parasitic Diseases 231
Multiple Codes 231
Ogcr Section I.C.1.A. Human Immunodeficiency Virus 231
Previously Diagnosed HIV-Related Illness 231
Sequencing 231
HIV and Pregnancy 231
Inconclusive Laboratory Test for HIV 231
HIV Screening 231
Caution 231
OGCR Section I.C.1.d. Sepsis, Severe Sepsis, and Septic Shock 231
Chapter 2, Neoplasms 232
OGCR Section I.C.2. Neoplasms 232
First-Listed Diagnosis, Neoplasms 232
History and Secondary Metastasis of Neoplasms 232
Anemia and Complications With/of Neoplasm 232
Z Codes and Neoplasms 232
Chapter 3, Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism 232
Chapter 4, Endocrine, Nutritional, and Metabolic Diseases 232
Disorders of Other Endocrine Glands 232
Other Metabolic and Immunity Disorders Section 233
Chapter 5, Mental, Behavioral, and Neurodevelopmental Disorders 233
Chapter 6, Diseases of Nervous System 233
Pain—Category G89 233
Chapter 7, Diseases of Eye and Adnexa 233
Chapter 8, Diseases of Ear and Mastoid Process 233
Chapter 9, Diseases of Circulatory System 233
OGCR Section I.C.9.a. Hypertension 233
OGCR Section I.C.9.a.1. Hypertension with Heart Disease 233
OGCR Section I.C.9.a.2. Hypertensive Chronic Kidney Disease 233
OGCR Section I.C.9.a.3. Hypertensive Heart and Chronic Kidney Disease 234
OGCR Section I.C.9.a.4. Hypertensive Cerebrovascular Disease for Secondary Pulmonary Hypertension 234
OGCR Section I.C.9.a.5. Hypertensive Retinopathy 234
OGCR Section I.C.9.a.6. Hypertension, Secondary 234
OGCR Section I.C.9.a.7. Hypertension, Transient 234
OGCR Section I.C.9.a.8. Hypertension, Controlled 234
OGCR Section I.C.9.a.9. Hypertension, Uncontrolled 234
OGCR Section I.C.9.a.10. Hypertensive Crisis 234
OGCR Section I.C.9.a.10. Pulmonary Hypertension 234
Chapter 10, Diseases of Respiratory System 234
Acute Respiratory Infection Section 234
27 ICD-10-CM Chapters 11-14 235
Chapter 11, Diseases of Digestive System 235
Chapter 12, Diseases of Skin and Subcutaneous Tissue 235
Skin 235
Accessory Organs 235
Chapter 13, Diseases of Musculoskeletal System and Connective Tissue 235
Sections 235
Chapter 14, Diseases of Genitourinary System 235
28 ICD-10-CM Chapters 15-21 237
Chapter 15, Pregnancy, Childbirth, and the Puerperium 237
OGCR Section I.C.15.a. General Rules 237
Trimesters 237
OGCR Section I.C.15.b.1. Complications of Pregnancy, Childbirth, and the Puerperium 237
OGCR Section I.C.15.b.1.-2. Selection of Principal or First-listed Diagnosis 237
OGCR Section I.C.15.n.1.-3. Normal Delivery 237
Postpartum Period 237
Peripartum Period 237
Abortions 237
Abortions With Liveborn Fetus 237
Chapter 16, Certain Conditions Originating in the Perinatal Period 237
Use of Codes Z00 238
Coding Additional Diagnosis 238
Prematurity and Fetal Growth Retardation 238
Chapter 17, Congenital Malformations, Deformations, and Chromosomal Abnormalities 238
Chapter 18, Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified 238
Chapter 19, Injury, Poisoning, and Certain Other Consequences of External Causes 238
Block Examples 238
When Coding Injuries 238
External Cause Codes: Index and Tabular 238
Chapter 20, External Causes of Morbidity 238
Chapter 20, General Code Guidelines 239
Table of Drugs and Chemicals 239
Late Effects of External Cause 239
Signs and Symptoms and Definitive Diagnosis 239
Burns/Corrosions Classified 239
Category 239
Debridement of Wound, Infection, or Burn 239
Coding for Multiple Injuries 239
Vessel and Nerve Damage 239
Multiple Fractures 239
Fractures 239
Chapter 21, Factors Influencing Health Status and Contact With Health Services 239
Z Codes 239
Uses of Z Codes 239
Special Note About “History of” 239
History Z Codes 239
Categories in Tabular 240
29 Outpatient Coding 241
OGCR Section IV, Diagnostic Coding and Reporting Guidelines for Outpatient Services 241
Guideline A 241
Guideline B 241
Guideline C 241
Guideline D 241
Guideline E 241
Guideline F 241
Guideline G 241
Guideline H 241
Guideline I 241
Guideline J 241
Guideline K 241
Guideline L 241
Guideline M 241
Guideline N 242
Guideline O 242
Guideline P 242
Guideline Q 242
5 Coding Challenge 243
30 Examinations 244
Pre-Examination and Post-Examination 244
Final Examination 245
Exam Format A - Final Examination 247
Subject Area: Medical Terminology 247
Subject Area: Anatomy 247
Subject Area: ICD-10-CM 247
Subject Area: HCPCS 248
Subject Area: Practice Management 248
Subject Area: Coding Guidelines 249
Subject Area: 10000 Integumentary System 249
Subject Area: 20000 Musculoskeletal System 251
Subject Area: 30000 Respiratory System and Cardiovascular System 253
Subject Area: 40000 Digestive System 254
Subject Area: 50000 Urinary, Male Genital System, Female Genital System, and Maternity Care and Delivery 256
Subject Area: 60000 Endocrine System, Hemic and Lymphatic System, Nervous System, Eye and Ocular Adnexa, Auditory System 257
Subject Area: Evaluation and Management (E/M) 259
Subject Area: Anesthesia 261
Subject Area: 70000 Radiology 262
Subject Area: 80000 Pathology and Laboratory 263
Subject Area: 90000 Medicine 264
Figure Credits 265
Appendix A Resources 266
Exam Review 266
Mobile Quick Quizzes 266
Coding Tips and Links 266
Content Updates—Student 266
Appendix B Answers 267
Part I Quiz Answers 267
Chapter 1—Integumentary System 267
Appendix C Medical Terminology 281
Appendix D Combining Forms 294
Appendix E Prefixes 297
Appendix F Suffixes 298
Appendix G Abbreviations 299
Appendix H Further Text Resources 302
Anatomy and Physiology 302
Coding 302
Pathophysiology 302
Medical Terminology 303
Computers & Electronic Health Record 303
Medical Transcription 303
Professionalism 303
Basic Math 303
Medical Billing/Insurance 304
Law and Ethics 304
Index 305
A 305
B 306
C 307
D 309
E 309
F 311
G 311
H 311
I 312
J 314
K 314
L 314
M 314
N 316
O 317
P 317
Q 318
R 318
S 319
T 320
U 321
V 322
W 322
X 322
Z 322
Ads before IBC 323
Inside Back Cover ibc1