Question 1

admitting diagnosis (ADX)

Accepted Answer

The patient’s condition determined by a physician at admission to an inpatient facility.

Question 2

ambulatory care

Accepted Answer

Outpatient care.

Question 3

ambulatory patient classification (APC)

Accepted Answer

A Medicare payment classification for outpatient services.

Question 4

ambulatory surgical center (ASC)

Accepted Answer

A clinic that provides outpatient surgery.

Question 5

ambulatory surgical unit (ASU)

Accepted Answer

A hospital department that provides outpatient surgery.

Question 6

at-home recovery care

Accepted Answer

Assistance with the activities of daily living provided for a patient in the home.

Question 7

attending physician

Accepted Answer

The clinician primarily responsible for the care of the patient from the beginning of a hospitalization.

Question 8

case mix index

Accepted Answer

A measure of the clinical severity or resource requirements of the patients in a particular hospital or treated by a particular clinician during a specific time period.

Question 9

charge master

Accepted Answer

A hospital’s list of the codes and charges for its services.

Question 10

comorbidity

Accepted Answer

Admitted patient’s coexisting condition that affects the length of the hospital stay or the course of treatment.

Question 11

complication

Accepted Answer

Condition an admitted patient develops after surgery or treatment that affects the length of hospital stay or the course of further treatment.

Question 12

diagnosis-related group (DRGs)

Accepted Answer

A system of analyzing conditions and treatments for similar groups of patients used to establish Medicare fees for hospital inpatient services.

Question 13

emergency

Accepted Answer

A situation in which a delay in the treatment of the patient would lead to a significant increase in the threat to life or a body part.

Question 14

grouper

Accepted Answer

Software used to calculate the DRG to be paid based on the codes assigned for the patient’s stay.

Question 15

health information management (HIM)

Accepted Answer

Hospital department that organizes and maintains patient medical records; also profession devoted to managing, analyzing, and utilizing data vital for patient care, making the data accessible to healthcare providers.

Question 16

HIPAA X12 837 Health Care Claim: Institutional (837I)

Accepted Answer

The format for claims for institutional services.

Question 17

home health agency (HHA)

Accepted Answer

Organization that provides home care services to patients.

Question 18

home healthcare

Accepted Answer

Care given to patients in their homes, such as skilled nursing care.

Question 19

hospice care

Accepted Answer

Care for terminally ill people provided by a public or private organization.

Question 20

hospital-acquired condition (HAC)

Accepted Answer

A condition that a hospital causes or allows to develop during an inpatient stay.

Question 21

hospital-issued notice of noncoverage (HINN)

Accepted Answer

A form used to describe benefit guidelines for inpatient hospital services.

Question 22

ICD-10-PCS

Accepted Answer

Mandated code set for inpatient procedural reporting for hospitals and payers as of October 1, 2015.

Question 23

inpatient

Accepted Answer

A person admitted to a medical facility for services that require a stay over two midnights.

Question 24

inpatient-only list

Accepted Answer

Describes procedures that can be billed only from the facility inpatient setting.

Question 25

Inpatient Prospective Payment System (IPPS)

Accepted Answer

Medicare payment system for hospital services; based on diagnosis-related groups (DRGs).

Question 26

major diagnostic categories (MDCs)

Accepted Answer

Twenty-five categories in which MS-DRGs are grouped; each MDC is subdivided into medical and surgical MS-DRGs.

Question 27

master patient index (MPI)

Accepted Answer

Hospital’s main patient database.

Question 28

Medicare-Severity DRGs (MS-DRGs)

Accepted Answer

Medicare Inpatient Prospective Payment System revision that takes into account whether certain conditions were present on admission.

Question 29

never event

Accepted Answer

Preventable medical error resulting in serious consequences for the patient; Medicare policy is never to pay the healthcare provider for these conditions.

Question 30

observation services

Accepted Answer

Medical service furnished in a hospital to evaluate an outpatient’s condition or determine the need for admission as an inpatient; billed as outpatient services.

Question 31

Outpatient Prospective Payment System (OPPS)

Accepted Answer

The payment system for Medicare Part B services that facilities provide on an outpatient basis.

Question 32

present on admission (POA)

Accepted Answer

Indicator required by Medicare that identifies whether a coded condition was present at the time of hospital admission.

Question 33

principal diagnosis (PDX)

Accepted Answer

In inpatient coding, the condition that after study is established as chiefly responsible for a patient’s admission to a hospital.

Question 34

principal procedure

Accepted Answer

The main service performed for the condition listed as the principal diagnosis for a hospital inpatient.

Question 35

registration

Accepted Answer

Process of gathering personal and insurance information about a patient during admission to a hospital.

Question 36

sequencing

Accepted Answer

Listing the correct order of a principal diagnosis according to guidelines.

Question 37

skilled nursing facility (SNF)

Accepted Answer

Healthcare facility in which licensed nurses provide nursing and/or rehabilitation services under a physician’s direction.

Question 38

three-day payment window

Accepted Answer

Rules requiring Medicare to bundle all outpatient services provided by a hospital to a patient within three days before admission into the DRG payment for that patient.

Question 39

UB-04

Accepted Answer

Currently mandated paper claim for hospital billing.

Question 40

UB-92

Accepted Answer

Former paper hospital claim; also known as the CMS-1450.

MED112 CODE/BILL

MED112 KEY TERMS CH 17

Term	Definition
MED112 CH 17 KEY TERMS
admitting diagnosis (ADX)	The patient’s condition determined by a physician at admission to an inpatient facility.
ambulatory care	Outpatient care.
ambulatory patient classification (APC)	A Medicare payment classification for outpatient services.
ambulatory surgical center (ASC)	A clinic that provides outpatient surgery.
ambulatory surgical unit (ASU)	A hospital department that provides outpatient surgery.
at-home recovery care	Assistance with the activities of daily living provided for a patient in the home.
attending physician	The clinician primarily responsible for the care of the patient from the beginning of a hospitalization.
case mix index	A measure of the clinical severity or resource requirements of the patients in a particular hospital or treated by a particular clinician during a specific time period.
charge master	A hospital’s list of the codes and charges for its services.
comorbidity	Admitted patient’s coexisting condition that affects the length of the hospital stay or the course of treatment.
complication	Condition an admitted patient develops after surgery or treatment that affects the length of hospital stay or the course of further treatment.
diagnosis-related group (DRGs)	A system of analyzing conditions and treatments for similar groups of patients used to establish Medicare fees for hospital inpatient services.
emergency	A situation in which a delay in the treatment of the patient would lead to a significant increase in the threat to life or a body part.
grouper	Software used to calculate the DRG to be paid based on the codes assigned for the patient’s stay.
health information management (HIM)	Hospital department that organizes and maintains patient medical records; also profession devoted to managing, analyzing, and utilizing data vital for patient care, making the data accessible to healthcare providers.
HIPAA X12 837 Health Care Claim: Institutional (837I)	The format for claims for institutional services.
home health agency (HHA)	Organization that provides home care services to patients.
home healthcare	Care given to patients in their homes, such as skilled nursing care.
hospice care	Care for terminally ill people provided by a public or private organization.
hospital-acquired condition (HAC)	A condition that a hospital causes or allows to develop during an inpatient stay.
hospital-issued notice of noncoverage (HINN)	A form used to describe benefit guidelines for inpatient hospital services.
ICD-10-PCS	Mandated code set for inpatient procedural reporting for hospitals and payers as of October 1, 2015.
inpatient	A person admitted to a medical facility for services that require a stay over two midnights.
inpatient-only list	Describes procedures that can be billed only from the facility inpatient setting.
Inpatient Prospective Payment System (IPPS)	Medicare payment system for hospital services; based on diagnosis-related groups (DRGs).
major diagnostic categories (MDCs)	Twenty-five categories in which MS-DRGs are grouped; each MDC is subdivided into medical and surgical MS-DRGs.
master patient index (MPI)	Hospital’s main patient database.
Medicare-Severity DRGs (MS-DRGs)	Medicare Inpatient Prospective Payment System revision that takes into account whether certain conditions were present on admission.
never event	Preventable medical error resulting in serious consequences for the patient; Medicare policy is never to pay the healthcare provider for these conditions.
observation services	Medical service furnished in a hospital to evaluate an outpatient’s condition or determine the need for admission as an inpatient; billed as outpatient services.
Outpatient Prospective Payment System (OPPS)	The payment system for Medicare Part B services that facilities provide on an outpatient basis.
present on admission (POA)	Indicator required by Medicare that identifies whether a coded condition was present at the time of hospital admission.
principal diagnosis (PDX)	In inpatient coding, the condition that after study is established as chiefly responsible for a patient’s admission to a hospital.
principal procedure	The main service performed for the condition listed as the principal diagnosis for a hospital inpatient.
registration	Process of gathering personal and insurance information about a patient during admission to a hospital.
sequencing	Listing the correct order of a principal diagnosis according to guidelines.
skilled nursing facility (SNF)	Healthcare facility in which licensed nurses provide nursing and/or rehabilitation services under a physician’s direction.
three-day payment window	Rules requiring Medicare to bundle all outpatient services provided by a hospital to a patient within three days before admission into the DRG payment for that patient.
UB-04	Currently mandated paper claim for hospital billing.
UB-92	Former paper hospital claim; also known as the CMS-1450.
Uniform Hospital Discharge Data Set (UHDDS)

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