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coding and DX class

a codified listing of medical, surgical, and diagnostic procedures current procedural terminology - CPT
a CPT code system for patient visits to a physician. includes taking Hx, conducting a physical exam, and developing impressions and plan of care. evaluation and management - E/M
a list of which pairs of CPT codes cannot be used with each other national correct coding initiative - NCCI or CCI
a codified listing of diagnoses, symptoms and other conditions that may affect a patient international classification of diseases - ICD
an insurance company's listing of which ICD codes are acceptable as reasons for conducting a CPT procedure, therefore determining which procedures are medically necessary. linkage tables
a list of the relative value of each CPT procedure medicare fee schedule - MFS
a list of relative values for hospital charges for outpatient services, meant to reduce costs. outpatient prospective payment system - OPPS
a list of payments to hospitals for a hospitalization. pays hospitals for medicare inpatient care. its goal is cost saving. diagnosis related groups - DRGs
a unique 5 digit code and descriptor for each procedure or service describes what typical CPT code category? category 1
in this CPT category physicians use these 4 digit codes + the letter F, to indicate that certain recognized quality services have been performed. these codes identify performance measures for data collection and quality control. category 2
this category of CPT codes is a 4 digit code + the letter T and is used for emerging technologies. category 3
if a category 3, CPT code is used often enough it can be changed to a category 1. true
these codes are used in the category 1 procedure codes to indicate that the service provided differed from the base procedure itself in some way modifier code
this modifier is used when the physician uses another lab or hospital for the technical component and he only does the diagnoses. -26 or 09926 (professional component)
this moifier is used to indicate that the billing if for technical component -TC
an EEG procedure coded without a -26 or a -TC modifier is called____ and actually includes both the professional and technical components. global service.
this modifier is used to indicate the same procedure is performed by the same provider on the same day. this documents there was not an error in billing the same procedure twice. -51 or 09551
this modifier is used to indicate that a test or procedure was only partially completed in some way or stopped due to technical reasons. -52 or 09952
this modifier is used when a procedure is stopped on ends early due to patient medical issues. -53 or 09953
this modifier is used to indicate that a procedure or service was distinct or independent from other services. -59 or 09959
what are the 3 family's E/M codes come in? 1. new patient office visits 2. consultants 3. hospital subsequent day
in the E/M code family of new patient office visits, this would include what set of patients? self referred patients or patients referred for ongoing care
in the E/M code family of consultants, this would include patients? who are referred by a physician requesting an opinion.
in the E/M code family of hospital subsequent day, this would include patients? who are using both primary physician and consultants.
the hospital subsequent day family of codes has how many levels of service? 3
this level of the hospital subsequent day family of codes uses the code ____ and is for stable patients with no continuing problems. one,
this level of the hospital subsequent day family of codes us the the code ____ and is for a patient with one continuing problem that is uncontrolled and requires new physician order for tests or treatments to evaluate or manage the problem that day. two
this level of the hospital subsequent day family of codes us the the code ____ and is for patients with a new problem or multiple uncontrolled continueing problmes which require new physician orders for tests and / or Tx's that day. three
term used for coding for both a broader inclusive procedure and its separate component parts is called unbundling
NCCI _____ coding simultaneously for both the broader procedure and the included piece by piece procedures within that broader procedure. prohibits
oversees a modified version of ICD , tailored to the needs of the U.S. medical system? centers for medicare and medicaid system - CMS
the united states currently uses which code modification? ICD-10-CM
individual CPT codes are ranked according to their relative work and expense, as compared to each other. these are referred to as ? relative value units - RVU's
what are the 3 types of RVU's? 1. physician work 2. practice expense 3. malpractice
who ranks the work RVU procedures? relative value update committee - RUC
has are RVU ranks determined? time, difficulty, stressfulness
the payment to the physician is clculated by multiplying the procedure RVU's by ? the geographic factor an the national conversion factor.
Created by: LTM