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Coding
Business Practices Chp 17
| Term | Definition |
|---|---|
| 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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