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CRIP Definition Set
| Question | Answer |
|---|---|
| 081X | The UV- 04 revenue code for an organ acquisition charge |
| 15 minute rule | A time-based rule for injections and infusions that states that an IV infusion that lasts for 15 minutes or less should be billed as an ivp injection and not as an IV infusion |
| 60 minute | A time-based rule for injections and infusions that state that the initial hour report is for infusions includes infusions lasting longer than 16 minutes, but not exceeding 90 minutes |
| ABN | Advanced beneficiary notice |
| ACEP | American college of emergency physicians |
| Active wound care management | A type of wound care that is used to remove necrotic or revitalized tissue in to promote healing of the wound |
| Allogenic | Type of stem cell transplant that uses stem cells from healthy donor |
| APC | Ambulatory payment classification |
| Autologous | Type of stem cell transplant that uses the patient's own cells which were previously stored |
| Bite block | Used in Radiation oncology; A restraining device usually used in the oral cavity and often attached to an outside source for patient stability |
| Block | Used in radiation oncology; a device fabricated of an energy absorbing material that is used to shape or delineates the treatment protocol to match the configuration of the desired area; also used to shield or protect normal structures |
| Bolus | Used in radiation. Oncology; a tissue equivalent material used to change the surface deposition of a radiation beam |
| CAD | Computer aided detection |
| CAH | Critical access hospital |
| Casting | Use of hand materials such as fiberglass or plaster to wrap the limb or joint entirely to provide total immobilization or restriction of movement, ,2- 165 |
| Cath lab | Cardiac catheterization lab |
| CHD | Congenital heart disease |
| Clinical laboratory | A lab that offers services to review microbiology, chemistry, serology, immunoassay, cytology, pathology services, etc ; must be certified to meet requirements of CLIA unless the lab is exempt |
| CMS | Centers for Medicare and Medicaid services |
| Collimator | Used in radiation. Oncology; a beam shaping device attached to the head of the treatment machine to define the initial configuration of the treatment portal |
| Compensator | Used in radiation. Oncology; and irregular shaped beam modifying device that is utilized to reconfigure the beam intensity to match any regular tissue contours |
| Concurrent Administration | When multiple medications, not hydration, fluids, are infused simultaneously through separate bags but the same IV line, in other words, piggyback; charges should not be billed for multiple drugs within the same bag and they can only be billed once per encounter |
| CPT | Current procedural terminology |
| Definitive | A type of coverage determination that discusses and lists specific diagnosis codes, ICD procedure codes, and the possible signs and symptoms to support the need for the item or service being given |
| Diagnostic mammogram | Radiological mammograms that are considered a cover diagnostic test based on established criteria |
| Digital breast tomosynthesis | A new screening and diagnostic breast imaging tool that is used to improve the early detection of breast cancer |
| DMEPOS | Durable medical equipment, prosthetics, orthotics, and supplies |
| Dosimetry | Used in radiation oncology; the calculation of the radiation dose that it is distributed within a treatment beam |
| Draw station | A facility that collects specimens and sends them to a central lab but does not perform test of any kind |
| DSMT | Diabetes self-management training |
| E&M | Evaluation in management |
| Epogen | A pharmaceutical that is used to treat a lower than normal number of red blood cells caused by chronic kidney disease in patients who are on dialysis to lessen the need for red blood cell transfusions |
| ESRD | End-Stage renal disease |
| Established patient | An individual who has received professional services from the physician or another physician of the same specialty who belongs to the same group practice within the previous 3 years |
| FDA | Us food and drug Administration |
| HBO | Hyperbaric oxygen |
| HBO therapy | A type of wound care that is used when the entire body is exposed to oxygen under atmospheric pressure, thereby providing additional oxygen into the bloodstream and body. Fluids; allows the oxygen to reach tissue or bone that is not accessible to red blood. Cells; promotes the formation of capillary vessels; can enhance white blood cell functions |
| HCPCS | Healthcare common procedure coding system |
| HINN | Hospital issued notice of non-coverage |
| Hospital issued notice of non-coverage | A notice given to inform beneficiaries that all are part of their part. A inpatient hospital care may not be covered by Medicare |
| Independent laboratory | A lab that is independent of a hospital that meets the requirements to qualify as an emergency hospital or is independent of an attending or consulting physician |
| Initial service | The service that best describes the reason for the encounter involving injections or infusion; only one initial service code can be reported for a single dos unless an additional initial service is medically necessary because the combo of the substance or drugs being administered requires the use of a separate vascular device where the patient returned for a separate and medically necessary encounter on the same day |
| Initiation | One of three triggering events for an ABN; occurs at the beginning of the treatment for a new encounter or new plan of care |
| IPO | Inpatient only |
| Isodose | Used in radiation oncology; the plotting of lines or a series of lines following paths of the same dose distribution within a treatment beam |
| IV | Intravenous infusion |
| IVP | Intravenous push |
| IVUS | Intravascular ultrasound |
| KVO | Keep vein open |
| LCD | Local coverage determination |
| LH | Left heart |
| Limiting charge | Limits on the amount non-participating physicians can charge beneficiaries part of the rbrvs |
| MAAC | Maximum allowable actual charge; replaced by the limiting charge |
| MAC | Medicare administrative contractor |
| MAR | Medication administration record |
| MCE | Medicare code editor |
| MNT | Medical nutrition therapy |
| MOON | Medicare outpatient observation notice |
| MRI | Magnetic resonance imaging |
| MS-DRG | Medicare severity diagnosis related group |
| MUE | Medically unlikely events |
| Multi-Layer compression or unna boots | A type of wound care that is compression dressing that promotes wound healing by providing sustained compression on the wound |
| MVPS | Medicare volume performance standard; part of the rbrvs |
| NCCI | National correct codeine initiative |
| NCD | National coverage determination |
| NDC | National drug code |
| New patient | An individual who has not received any professional service from the physician or another physician of the same specialty who belongs to the same group practice within the previous 3 years. A new patient usually requires that all the levels above are meant. |
| Non-CHD | Non-Congenital heart disease |
| Non-Definitive | A type of coverage determination that provides potential coverage circumstances, but most likely does not provide specific diagnosis, signs, symptoms, or ICD-10 CM codes that will be covered or non-covered |
| Non-Selective debridement | A type of wound care that is used to remove tissue that is revitalized and to promote the healing of the wound; used when both healthy tissue and narcotic tissue are removed; includes what to moist dressings, wet to dry dressings, abrasions, occlusive dressings, and enzymatic chemicals |
| OPO | Oregon procurement organization |
| Optional reflex test | A type of reflex test that occurs when the initial test results may have a clinical value without the additional reflex testing |
| PACU | Post anesthesia care unit |
| Part B | Medicare part B; medical insurance that covers practitioner fees. Doctors, CRNA, psychologist, etc. Outpatient hospital charges; lab and radiology charges; ambulatory surgical Center charges, durable medical equipment, and some home health |
| PET | Positron Emissions Tomography |
| Physician office laboratory | A lab area and a physician's office that is maintained by the physician or group practice and is utilized to perform diagnostic tests |
| Port or portal | Used in radiation oncology; synonymous words referring to the site on the skin where the radiation beam enters the body |
| Portal verification | Used in radiation oncology; the means of verifying the placement and configuration of the treatment portal |
| PSA | Prostate specific antigen |
| Qualified hospital laboratory | A lab that provides clinical laboratory tests 24 hours a day, 7 days a week to serve a hospital's emergency room that is also available 24 hours a day and 7 days a week. Must have physicians physically present or available within 30 minutes. They also must have lab techs on duty or one call at all times to provide testing for the emergency room |
| RBRVS | Resource-Based relative value scale |
| Reduction | One of three triggering events for an ABN; occurs when the frequency or duration of care is decreased |
| Reference laboratory | A lab that receives a specimen from a referring lavatory for testing and actually performs the test |
| Referring laboratory | A lab that receives a specimen to be tested and then refers the specimen to another laboratory for performance of the actual laboratory test; must be Medicare approved |
| Required reflex test | A type of reflex test, which, if positive, requires additional follow-up testing in order to have clinical value |
| RH | Right heart |
| RVU | Relative value unit; the heart of the fee schedule, comprised of work, required, practice expenses, and malpractice insurance expense |
| Screening mammograms | Radiology procedures that are used for the early detection of breast cancer; they include a physician's interpretation of the mammogram resultsRadiology procedures that are used for the early detection of breast cancer; they include a physician's interpretation of the mammogram results |
| Selective debrisment | A type of wound care that describes the type of treatment, such as high pressure water jet which can be used with or without suction and debrisment with the use of scissors, forceps, or a scalpel. Type of an open wound, wound assessment, Whirlpool, and instructions for continued Care per session; also describes the total wound surface area for the first 20 cm or less |
| Self-Aministered drug | P drugs provided on an outpatient basis that are not covered by Medicare; examples include creams and ointments, tablets/capsules given orally, suppositories, etc |
| Sequito Administration | When multiple drugs are infused back to back or one right after another; must be different drug through the same IV access and there must be a clinical reason for doing a sequential versus a concurrent Administration |
| Splinting | P use of a device which has a hard surface( such as plaster, fiberglass, hexalite, aluminum rod, or plastic( on one side of the limb in soft material( such as cotton or elastic knit( around the entire limb or joint to support a weak or ineffective joint or muscle, 2-165 |
| Stereotactic | Used and radiation oncology; a three-dimensional technique that has intersecting multiple portals which create a complex interaction of the treatment, beams and isodose plans |
| Strapping | Application of overlapping strips of adhesive, plaster, tape, or multi-layer compression dressing to exert pressure, immobilize, support, and protect |
| Subsequent Administration | Administration of a substance or drug during a distinct or separate encounter on the same dos as a previous administration |
| Surgical debridement | A type of wound care that includes photographs of the work, assessment and cleaning of the wound, anesthesia, collection of specimens, measurement of the wound, topical ointments, dressings, topic, hemostatic agents, and discharge instructions |
| Termination | One of three triggering events for an ABN; occurs when there is a discontinuation in the services being provided |
| TOB | Type of Bill |
| Transcutaneous oxygen tension measurements | A type of wound care that is the measurement of oxygen that is used to identify if wounds need extra oxygen in order to heal; this measurement can be used to help determine if hyperbaric Oxygen or HBO therapy May benefit the patient |
| Treatment plan | A written plan, also known as the plan of care, required for all outpatient rehabilitation therapy services |
| Type A | Hospital-Based emergency department which must be open 24 hours a day, 7 days a week and must meet other established criteria |
| Type B | Hospital-Based emergency department which is not open 24 hours a day, 7 days a week and meets other established criteria |
| Ultrasound( low frequency, no contact, and non-thermal) | A type of wound care that is used to promote wound healing by using acoustic sound energy at the wound bed and the tissue surrounding the site |
| Wedge | Do you stand radiation oncology; a treatment beam- modifying device that acts to change the intensity of the treatment being? |
| Wound vacuum therapy | A type of wound care that includes topical applications applied to the wound, wound assessment, and instructions related to the patient's ongoing care; used when the physician prescribes a negative pressure wound therapy with vacuum assisted drainage in order to promote healing a non-healing chronic wound such as a decubitus ulcer |
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larae711
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