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CBCS: Module 3 Vocab

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Term
Definition
Abstracting   Reviewing medical record documentation to discover clinical concepts that assigning codes to the highest level of specificity  
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Clinical Documentation   Information recorded in the medical record pertaining to the health status of a patient as determined by a health care provider  
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CPT   Current Procedural Technology. Codes for services and procedures  
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Electronic Health Record (EHR)   A digital version of a patient's chart that includes information documented by multiple providers at different facilities regarding one patient  
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HCPCS   Healthcare Common Procedure Coding System  
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ICD-10-CM   International Classification of Diseases 10th Revision Clinical Modification. This codes for diseases/injuries/statuses  
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Medical Coding   Process of abstracting diagnoses, procedures, and services from the medical record and converting them to alphanumeric codes for claims submission's  
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Medical Necessity   Process of providing diagnosis codes that support the services rendered to the patient; coding for medical necessity involves associating applicable diagnosis codes to service/procedure codes within the billing software a.k.a. linking/linkage  
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Medical Record   Documents health care services provided to a patient  
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Query   Contacting the responsible provider to request clarification about documented diagnoses or procedures  
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Claim Denial   Unpaid medical claim returned to payer due to coding errors, missing information, preauthorization requirements, or health plan coverage issues  
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Downcoding   Unpaid medical claim returned by payer due to coding errors, missing information. preauthorization requirements, or health plan coverage issues  
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Encounter Form   Financial record source document used by providers to record treated diagnoses and services provided to a patient for a single encounter  
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Modifier   Provides additional information about a procedure or service without altering the definition of the code description  
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Preauthorization   Prior approval for services granted by payer after health pan review  
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(HPI) History of Present Illness   Brief description pf the patient's present illness or other reason for an encounter, including details about location, duration, severity, and associated signs and symptoms  
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Unbundling   Submitting multiple CPT codes when a single code is available to report services in full  
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Upcoding   Assignment of ICD-10-CM code that is more severe then diagnosis supported by the documentation in the medical record  
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