Ch. 10-Revenue Cycle Middle Processes--Resource Tracking

Question 1

AHA Coding Clinic for HCPCS

Answer 1

Newsletter that provides official coding guidance for users of HCPCS Level II procedure, service, and supply codes

Question 2

AHA Coding Clinic for ICD-10-CM and ICD-10-PCS

Answer 2

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

Question 3

Category I CPT Code

Answer 3

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

Question 4

Category II CPT Code

Answer 4

CPT code that represents services or test results contributing to positive health outcomes and high-quality patient care

Question 5

Category III CPT Code

Answer 5

CPT code that represents emerging technologies for which a Category I code has yet to be established

Question 6

Charge

Answer 6

Price assigned to a unit of medical or health services, such as a visit to a physician or a day in a hospital

Question 7

Charge capture

Answer 7

The accounting for all reportable services and supplies rendered to a patient

Question 8

Charge code

Answer 8

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

Question 9

Charge description

Answer 9

Hospital-specific explanatory phrase that is assigned to describe a procedure, service, or supply in the charge description master

Question 10

Charge description master (CDM)

Answer 10

Data table used by healthcare facilities to manage required billing elements for all services provided to patients

Question 11

Charge status indicator

Answer 11

Identifier used to indicate whether a charge description master line item charge is currently active or inactive

Question 12

Classification system

Answer 12

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

Question 13

CPT Assistant

Answer 13

Official monthly newsletter for CPT coding issues and guidance

Question 14

Current Procedural Terminology (CPT)

Answer 14

Coding System created and maintained by the American Medical Association that is used to report diagnostic and surgical services and procedures

Question 15

Department code

Answer 15

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

Question 16

Hard coding

Answer 16

Use of the charge description master to code repetitive or non complex services

Question 17

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Answer 17

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

Question 18

Healthcare Common Procedure Coding System (HCPCS)

Answer 18

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

Question 19

Healthcare Common Procedure Coding System (HCPCS) codes

Answer 19

A code that is part of the Healthcare Component Procedure Coding System

Question 20

ICD-10-CM/PCS Coordination and Maintenance Committee

Answer 20

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

Question 21

International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)

Answer 21

Coding and classification system used to report diagnoses in all healthcare settings

Question 22

International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS)

Answer 22

Coding and classification system used to report inpatient procedures and services

Question 23

Line item

Answer 23

Individual line of a charge description master that includes all the required data elements, such as charge code, description, revenue code, and charge

Question 24

Medicare Claims Processing Manual

Answer 24

Online publication that provides guidance for producing claims for all healthcare settings. Includes billing regulations, as well as service area-specific requirements

Question 25

Modifier

Answer 25

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

Question 26

National Center for Health Statistics (NCHS)

Answer 26

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)

Question 27

Payer identifier

Answer 27

Code that is used in the charge description master to differentiate among payers that have specific or special billing protocol in place

Question 28

Revenue Code

Answer 28

Four-digit billing code that categorizes charges based on type of service, supply, procedure, or location of service

Question 29

Single path coding

Answer 29

Process where one coding professional assigns the codes required for both facility and professional claims during the same coding session

Question 30

Soft coding

Answer 30

Process in which all diagnoses and procedures are identified, coded, and then abstracted into the HIM coding system

Question 31

World Health Organization

Answer 31

Organization that created and maintains the Internation Classification of Diseases (ICD) used throughout the world to collect morbidity and mortality information