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Medical Insurance
| CPT five digit codes, indicated by a plus symbol (+), that have been designed to be used with primary procedure codes; descriptions usually start with "each additional", "list separately", or "second lesion". | add on codes |
| code that contains a grouping of one or more services that are related to a procedure; coding and billing for these individual services should not be done | bundled code |
| broken bone that has not penetrated the skin | closed fracture |
| program designed to ensure that national coding guidelines and standards are adhered to | coding compliance program |
| Software program that uses natural language processing software that automatically assigns codes to clinical procedures and services | computer-assisted coding (CAC) |
| The provision of similar services (e.g., hospital visits) to the same patient by more than one physician on the same day | concurrent care |
| Second opinion rendered by a physician in a home, office, hospital, or extended care facility regarding a condition or need for surgery and may initiate diagnostic or therapeutic services; the services must be requested, recorded, and reported | consultations |
| discussion with the patient or family member regarding diagnostic results, impressions, and recommended diagnostic studies; prognosis; risks and benefits of treatment options; instructions for treatment and/or followup | counseling |
| care of an unstable, acutely ill or injured patient requiring constant bedside attention by a physician requiring high complexity decision making; most commonly rendered in a critical care area | critical care |
| submitted procedure code changed to a lower level by a computer system | downcoding |
| Computerized or Web-based software program used to search for, locate, and verify code selections | encoder |
| A second -level coding system used to code those services, products, supplies, drugs, and procedures that are generally not fully listed in the CPT codebook | HCPCS Level II Codes |
| Joint mobilization technique; realigning a fractured long bone using manual pressure, traction, or angulation; also called reduction | manipulated |
| Coding edits developed by federal legislation that relate to CPT and HCPCS codes for outpatient & physician services; used by Medicare carriers to process claims & detect incorrect reporting of codes, eliminate unbundling, prevent payments from being made | National Correct Coding Initiative (NCCI) |
| Software program used for transcribing medical records that has artificial intelligence technology built in; it scans a document the physician has input using free-text and singles out key terms, converting them into procedure codes | Natural Language Processing (NLP) |
| Broken bone in which the bone has penetrated the skin; also referred to as a compound fracture | open fracture |
| Determination of whether somebody is a new or established patient | patient status (new/test) |
| Location where a medical service is taking place | place of service (POS) |
| Laboratory test that measures how much of an agent is within the body | quantitive analysis |
| CPT five digit procedure cod that, if not performed separately, is an integral part of another procedure; often bundled into other procedures | separate procedure |
| Entry point into interior parts of the body that is used by physicians performing surgical procedures, for example, open incision, scope, approaching through a body oriface (ear, nose, vagina) | surgical approach |
| kind of service or procedure provided by a medical doctor (e.g, office visit, laboratory test, surgery) | type of service (TOS) |
| Breaking down a procedure into separate billable codes with charges to increase reimbursement; also known as fragmentation, exploding, or a la carte medicine | unbundling |
| Practice of coding and billing a health plan for a procedure that reimburses the physician at a higher rate than the procedure actually done; also know as code creep, overcoming, and overbilling | upcoding |
| Is a computerized or Web-based software program that is used instead ode to coding books to search for, locate, and verify code selections (E.g., optum endocderpro, trucode, epicoder, flash code) | An encoder |
| When a service is rendered and a code number cannot be found for the procedure, check the? | category III codes found at the end of the other sections |
| The most common reference used to code procedures is the ? | Current Procedural Terminology (CPT) published by the American Medical Association |
| Uses five-digit code numbers with two-digit modifiers. | CPT Coding |
| A coding compliance program might include which of the following? | Educating both staff and physicians in coding and compliance |
| What is the purpose of the standard code set? | to share health care information in an electronic format |
| When searching | |
| Determination of whether somebody is a new or established patient | patient status (new/test) |
| Location where a medical service is taking place | place of service (POS) |
| Laboratory test that measures how much of an agent is within the body | quantitive analysis |
| CPT five digit procedure cod that, if not performed separately, is an integral part of another procedure; often bundled into other procedures | separate procedure |
| Entry point into interior parts of the body that is used by physicians performing surgical procedures, for example, open incision, scope, approaching through a body oriface (ear, nose, vagina) | surgical approach |
| kind of service or procedure provided by a medical doctor (e.g, office visit, laboratory test, surgery) | type of service (TOS) |
| Breaking down a procedure into separate billable codes with charges to increase reimbursement; also known as fragmentation, exploding, or a la carte medicine | unbundling |
| Practice of coding and billing a health plan for a procedure that reimburses the physician at a higher rate than the procedure actually done; also know as code creep, overcoming, and overbilling | upcoding |
| Is a computerized or Web-based software program that is used instead ode to coding books to search for, locate, and verify code selections (E.g., optum endocderpro, trucode, epicoder, flash code) | An encoder |
| When a service is rendered and a code number cannot be found for the procedure, check the? | category III codes found at the end of the other sections |
| The most common reference used to code procedures is the ? | Current Procedural Terminology (CPT) published by the American Medical Association |
| Uses five-digit code numbers with two-digit modifiers. | CPT Coding |
| A coding compliance program might include which of the following? | Educating both staff and physicians in coding and compliance |
| What is the purpose of the standard code set? | to share health care information in an electronic format |
| When searching |
Created by:
nwatson0423