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 |