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Coding Study Guide
|Coding Study Guide
|The transformation of verbal descriptions of a diagnosis into numbers or a combination of alphanumeric characters is called CODING. Page 246, #3
|The determination of the nature of a cause of disease or the art of distinguishing one disease from another.
|Tabular list arranged numerically.
|Alphabetical listing of diagnosis is contained in VOLUME II. Page 246, #5
|Codes used to classify environment events, circumstances, or conditions that caused the injury, condition, poisoning, or adverse effect are referred as E CODES. Page 247, #11
|Codes used when circumstances other than a disease or injury are recorded as a diagnosis or problem.
|Essential modifiers are indented under the main term. They modify the main term describing different sites, etiology (the cause or origin of a disease or condition), and clinical types. Must be a part of the documented diagnosis.
|Is a daily publication that provides a uniform system for publishing federal regulations, legal notices, presidential proclamations, and executive orders.
|Diseases, procedures, or syndromes named for individuals who discovered or first used them. Page 247, #8
|If no diagnosis
|Code signs and symptoms.
|The manual containing codes used in reporting medical services and procedures performed and supplies used by healthcare providers in the care and treatment of patient is the CPT-4. Page 272 #1
|To help determine the appropriateness and medical necessity of a service or procedure, a SPECIAL REPORT should accompany the claim. Page 273 #11
|Chief Complaint (CC)
|The reason the patient is seeing the physician, usually in the patient's own words.
|Involves a series of questions the provider asks the patient to identify what body parts or body systems are involved.
|This includes time the physician spends on bedside care of the patient and reviewing the health record and writing orders.
|Observation is a classification for a patient who is not sick enough to qualify for the acute inpatient status, but requires hospitalization for a brief time.
|Hospital Discharge Services
|Use these codes for reporting services provided on the final day of a multiple-day stay.
|Critical Care Services
|Critical care services can be provided in any setting. Physican must provide constant attendance or constant attention. Time is the controling factor for assigning the appropriate care code. Not to be used for less than 30 mins duration. CPT guideline
|Requires coding be standardized.
|The reason for admission to the acute care facility.
|Benefits are paid regardless of who is to blame for the accident or injury.
|TRICARE's two main objectives are:
|Accessibility and affordability
|Similar to Medicaid and Medicare, TRICARE-eligible individuals are referred to as:
|CHAMPA is managed by the:
|VA's Health Administration Center (HAC)
|The deadline for filing military claims is:
|Military retirees and their family members are not eligible for TRICARE.
|TRICARE pays for only their allowed services, supplies, and procedures.
|There is no "cost sharing" under TRICARE regulations.
|Eligibility for patients claiming TRICARE and CHAMPVA coverage should be verified immediately.
|TRICARE PAR providers must accept the TRICARE allowable charge as payment in full for the healthcre services provided cannot balance bill.
|Patient's using TRICARE Standard are usually responsible for submitting their own claims.