Ch 12: Basics Of Diagnostic Coding Flashcards
A summary of the diagnostic statement and or procedures and services performed
Abstract
The initial assessment and treatment of the disease, condition or injury
Acute
A disease that manifests over a long period because medical treatment has not resolved it
Chronic
An industry journal that provides insight into the coding of complex medical cases.
The journal Is sponsored by the American Hospital Association who also supports a website that can except questions from coders on specific cases.
Coding clinic
Information about a patient’s diagnosis or diagnoses that has been extracted from the medical documentation
Diagnostic statement
Every meeting between a patient and a healthcare provider. The patient’s history and she complains, in addition to the medical services provided, or documented in the patient’s health record
Encounter
The cause of a disorder; a claim may be classified according to it
Etiology
The microscopic composition of tissue
Histologic
A term used in the Diagnosis of a condition that can be immediately threatening.
Impending
An indication of the existence, reality, or presence of something, especially an illness; a secondary process.
Manifestation
A growth of uncontrolled abnormal tissue; a tumor.
Neoplasm
Instructions or guides for assigning classifications, defining category content, or using subdivision codes. They are found in both the alphabetic index and the tabular list
Notations
The process by which the medical office submit a claim to the insurance company which then pays the provider for services rendered. All insurance claims must submit diagnoses and procedure codes, not as descriptions.
Reimbursements
