Chapter 6 — Quiz

Twenty-two questions.

Multiple choice

1. ICD-10-CM answers the question:

  • A. What did the provider do?
  • B. What was wrong with the patient?
  • C. What was supplied?
  • D. What does it pay?

2. ICD-10-CM is updated effective:

  • A. January 1
  • B. October 1
  • C. quarterly
  • D. July 1

3. CPT is updated effective:

  • A. January 1
  • B. October 1
  • C. quarterly
  • D. as needed

4. HCPCS Level II is updated:

  • A. annually
  • B. quarterly
  • C. biennially
  • D. continuously

5. ICD-10-PCS is used in:

  • A. physician offices
  • B. inpatient hospital coding only
  • C. all outpatient settings
  • D. durable medical equipment billing

6. The part of CPT that changes the meaning of every code beneath it, and that most coders skip, is the:

  • A. index
  • B. section and subsection guidelines
  • C. appendices
  • D. Category II codes

7. An encoder:

  • A. determines whether documentation supports a code
  • B. helps locate and validate codes but has not read the note
  • C. replaces the tabular verification step
  • D. assigns the DRG

8. A grouper assigns:

  • A. a diagnosis code
  • B. a payment classification such as an MS-DRG or APC
  • C. a modifier
  • D. an allowed amount

9. The system that owns demographics, insurance, charges, claims, payments, and accounts receivable is the:

  • A. electronic health record
  • B. practice management system
  • C. clearinghouse
  • D. encoder

10. A scrubber:

  • A. routes claims to payers
  • B. checks claims before submission against format, payer rules, and edits
  • C. posts remittances
  • D. verifies eligibility

11. The chapter describes as "the highest-risk object in a billing system":

  • A. the clearinghouse
  • B. a scrubber rule that corrects claims automatically without human review
  • C. the superbill
  • D. the encoder

12. A code is assigned according to the code set in effect on the:

  • A. date of coding
  • B. date of service
  • C. date of submission
  • D. date of payment

13. The document that usually carries the list of ICD-10-CM codes supporting medical necessity under a local Medicare policy is the:

  • A. LCD itself
  • B. companion billing and coding article
  • C. NCCI Policy Manual
  • D. Medicare Summary Notice

14. Generally not permitted in a code book at a certification exam:

  • A. handwritten margin notes
  • B. highlighting
  • C. tabs
  • D. taped-in printed material

15. Which code set is not free at the source?

  • A. ICD-10-CM
  • B. CPT
  • C. HCPCS Level II
  • D. ICD-10-PCS

Short answer

16. Name the three code books, the question each answers, and when each changes.

17. List five things an encoder does not decide.

18. State the three search techniques from §6.6 and what each prevents.

19. Why does a superbill decay, and what does that produce?

20. (Chapter 5) Explain why a scrubber rule inventory is a compliance exercise, not just a housekeeping one.

21. State the tension between productivity and accuracy, and the rule from §6.9 that governs it.

22. (Chapter 4) In the Encounter's routing table, the answer to "what was wrong with the patient?" is "the note, nothing else." Explain why, and what it implies for every other row.

Answer key **1.** B. **2.** B. **3.** A. **4.** B. **5.** B. **6.** B. **7.** B. **8.** B. **9.** B. **10.** B. **11.** B. **12.** B. **13.** B. **14.** D. **15.** B. **16.** **ICD-10-CM** — what was wrong with the patient — **October 1**. **CPT** — what did the provider do — **January 1**. **HCPCS Level II** — what was supplied or administered that CPT does not cover — **quarterly**. **17.** Whether the documentation supports the code; which of two defensible codes better describes what happened; whether a query is needed; whether the guidelines' conventions were correctly applied (it may catch a hard conflict, not a judgment error); and whether the code you entered is the code you meant. **18.** **Search by code, not by concept** — prevents returning the right kind of document about the wrong subject. **Go to the companion article, not just the policy** — prevents missing the diagnosis list, which is the thing you usually needed. **Check the effective date against the date of service** — prevents arguing a denial against the wrong version of a policy, which loses. **19.** Because it is built once and codes are added, deleted, and revised on the annual and quarterly cycles while the form is not. It produces deleted codes still on the form, new and more specific codes absent from it, and codes whose descriptors changed while the number stayed the same — the last of which produces no rejection at all. **20.** Because an automatic rule that corrects claims without review is exactly the absence of review that constitutes **reckless disregard** under the False Claims Act's definition of "knowingly" (Chapter 5 §5.3). The inventory converts an unexamined default into a reviewed process, which is the difference between the two. It is half a day of work against an exposure measured in claims volume. **21.** A coder who slows down to look something up is momentarily less productive; a coder who never slows down is faster and wrong more often. **The rule: any metric that can be improved by looking less carefully needs a quality metric of equal weight beside it** — and a productivity standard that cannot be met accurately is a compliance problem rather than a performance one. **22.** Because a code is a description of what the provider **wrote**, and no reference book, database, encoder, or manual contains that. Every other row on the routing table presupposes an answer to row 2 — the codes, the edits, the coverage policy, and the payment all describe *something*, and the note is the only source for what that something is. **The implication is that the order is not arbitrary: rows 3 through 13 are all downstream of a document no tool can substitute for**, and a workflow that begins anywhere else has inverted the dependency.