Ch. 10-Revenue Cycle Middle Processes--Resource Tracking Flashcards
AHA Coding Clinic for HCPCS
Newsletter that provides official coding guidance for users of HCPCS Level II procedure, service, and supply codes
AHA Coding Clinic for ICD-10-CM and ICD-10-PCS
A publication issued quarterly by the American Hospital Association and approved by the CMS to give coding advice and direction for ICD-10-CM and ICD-10-PCS
Category I CPT Code
CPT code that represents a procedure or service that is consistent with contemporary medical practice and that is performed by many physicians in clinical practice in multiple locations
Category II CPT Code
CPT code that represents services or test results contributing to positive health outcomes and high-quality patient care
Category III CPT Code
CPT code that represents emerging technologies for which a Category I code has yet to be established
Charge
Price assigned to a unit of medical or health services, such as a visit to a physician or a day in a hospital
Charge capture
The accounting for all reportable services and supplies rendered to a patient
Charge code
Hospital-specific internally assigned code used to identify an item or service within the charge description master
AKA service code, charge description number, item code, or charge identifier
Charge description
Hospital-specific explanatory phrase that is assigned to describe a procedure, service, or supply in the charge description master
Charge description master (CDM)
Data table used by healthcare facilities to manage required billing elements for all services provided to patients
Charge status indicator
Identifier used to indicate whether a charge description master line item charge is currently active or inactive
Classification system
A system for grouping similar diseases and procedures and organizing related information for easy retrieval
A system for assigning numeric or alphanumeric code numbers to represent specific diseases and procedures
CPT Assistant
Official monthly newsletter for CPT coding issues and guidance
Current Procedural Terminology (CPT)
Coding System created and maintained by the American Medical Association that is used to report diagnostic and surgical services and procedures
Department code
Hospital-specific number that is assigned to each clinical or ancillary department that provides services to patients and has at least one charge item in the charge description master.
AKA general ledger number
Hard coding
Use of the charge description master to code repetitive or non complex services
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
Significant piece of legislation aimed at improving healthcare data transmission among providers and insurers; designated code sets to be used for electronic transmission of claims
Healthcare Common Procedure Coding System (HCPCS)
Coding system created and maintained by the Centers for Medicare and Medicaid Services (CMS) that provides codes for procedures, services, and supplies not represented by a CPT code
Healthcare Common Procedure Coding System (HCPCS) codes
A code that is part of the Healthcare Component Procedure Coding System
ICD-10-CM/PCS Coordination and Maintenance Committee
Committee composed of representatives from the National Center for Health Statistics (NCHS) and the Centers for Medicare and Medicaid Services (CMS) that is responsible for maintaining the US clinical modification version of ICD-10-CM and ICD-10-PCS code sets
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
Coding and classification system used to report diagnoses in all healthcare settings
International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS)
Coding and classification system used to report inpatient procedures and services
Line item
Individual line of a charge description master that includes all the required data elements, such as charge code, description, revenue code, and charge
Medicare Claims Processing Manual
Online publication that provides guidance for producing claims for all healthcare settings. Includes billing regulations, as well as service area-specific requirements
Modifier
Two-digit alpha, alphanumeric, or numeric code that provides the means by which a physician or facility can indicate that a service provided to the patient has been altered by some special circumstances but for which the basic code description itself has not changed
National Center for Health Statistics (NCHS)
Organization that developed the clinical modification to the Internation Classification of Diseases, Tenth Revision (ICD-10); responsible for maintaining and updating the diagnosis portion of the Internation Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
Payer identifier
Code that is used in the charge description master to differentiate among payers that have specific or special billing protocol in place
Revenue Code
Four-digit billing code that categorizes charges based on type of service, supply, procedure, or location of service
Single path coding
Process where one coding professional assigns the codes required for both facility and professional claims during the same coding session
Soft coding
Process in which all diagnoses and procedures are identified, coded, and then abstracted into the HIM coding system
World Health Organization
Organization that created and maintains the Internation Classification of Diseases (ICD) used throughout the world to collect morbidity and mortality information
