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Business Practices Chp 17

when completing health insurance electronically, list the three types of codes required on the claim ICD, CPT, HCPCS
what does the symbol + mean add-on code
what does the symbol . (dot) mean new code
what does the symbol (triangle) mean revised code/changed
what is a bundled code contains a group of one or more services that are related to a procedure
to code from the E&M (evaluation and management) section of CPT what 3 things must be deteremined POS (place of service), TOS (type of service), patient status (new/est)
repairs of lacerations are coded according to what three things length in cm, location, type of repair (simple, intermediate, severe)
when coding fractures, name 2 things that need to be determined if it's open or closed, if it can be manipulated
surgical package rules are established by AMA
global package rules are established by centers for Medicaid and Medicare services
the documentation required in a pt's medical record when an injection is given includes name of medication, amount of injection (in cc or grams), route of administration
ICD-10 replaced ICD-9 on what date 10/1/13
qualified diagnosis a condition coded as if it existed but has not been proven - qualified by "suspected, suspicion of, questionable, likely, probably or possible, rule out" - do not get coded
rule out (R/O) coding rule cannot code something that says R/O - code instead actual diagnosis or sign and symptoms
to code diagnoses start in volume 2 (index)
to verify the code refer to volume 1 (description)
NEC not elsewhere classifiable - used when medical record indicates more info avail but more specific code cannot be found
NOS not otherwise specified - unspecified by physician - when more specific code cannot be identified
when coding burns name 3 elements in which burns are classified degree of burn, extent - how much service in %, agent - what caused? oil, fire, etc.
when coding neoplasms name the 5 titles that codes are listed under primary malignancy - original site of tumor, secondary malignancy -additional tumor (metastasis), carcinoma in situ - site of origin, neoplasm of uncertain behavior -not recognizable as benign or malignant, unspecified neoplasm - status not documented
major uses of procedures codes justifies medical services, collects statistics about outcome & effectiveness of treatment, set fees depending on procedure, complexity, skill & length
Medicare modernization act of 2004 states any new, revised and deleted codes must be implemented every January 1st
CPT manual provides a five digit code and description for each procedure
how many sections of the CPT manual six
what section of CPT is 99's E&M evaluation and management - pt status, location, complexity of visit
what section of CPT is 00's anesthesia - smallest section of the book
what section of CPT is 10-69 Sx surgery - largest section & only section broken down into body system &/or organs
what section of CPT is 70 radiology
what section of CPT is 80 pathology & laboratory - all blood work, cultures, microbiology, etc
what section of CPT is 90 medicine - includes ECG, physical therapy
how many digits are modifiers two
how many digits are ICD codes 3-7 digits
reasons for development of diagnosis codes track disease, classify causes, collect data for research, evaluation of hospital service utilization
nonessential modifiers ICD - in parentheses - words that may occur in the diagnosis but are not required
ICD breakdown first three digits (alpha-numerical) = category, all digits thereafter = subcategory. After category - etiology, severity, anatomical location, duration (ESAD)
when coding from the surgery section of CPT the first thing you should do is go to the index
NLP is used in CAC
does not use consultation codes Medicare
according to CPT a surgical package includes the operation, certain types of anesthesia & postoperative visits within designated follow-up days
the sum of multiple laceration repairs can be added together if they are in the same body area and are the same type of wound
code linkage checking a diagnostic code against a procedure code
coding rule for etiology and manifestations is to code the etiology in the first position and the manifestation in the second position
in diagnostic coding which symbol is used as a placeholder an X
the two tables listed in ICD-10 are neoplasm and table of drugs and chemicals
what is the ICD-10 code for hypothyroidism E03.9
what is the ICD-10 code for DMII E11.9
what is the ICD-10 code for HTN I10
what is the ICD-10 code for hypercholestermia E78.0
what is the ICD-10 code for hyperlipidemia E78.5
HCPCS I & HCPCS II additional coding books for CPT - both have temporary and permanent codes
RBRVS Medicare are only ones to use this system
morbidity presence of one disease
co-morbidity presence of two or more diseases
mortality cause of death
benign neoplasms that are noninvasive and do not metastasize - noncancerous
malignant harmful neoplasm that has the capability of spread and invading other tissues = cancer
acute a disease that has a rapid onset and a short, severe course
chronic a disease that progresses slowly and has a long duration
subacute a disease that develops more slowly than acute but more rapidly than chronic
categories listed in V-Z are external morbidities
referral the transfer of pt care from one physician to another
Created by: gcjlentz
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