Chapters 1 & 2 Flashcards
Classification Systems
The term used in health care to Identify ICD- 10- CM, CPT, ICD-10-PCS, and HCPC level code sets
What are the 4 Aspects of the Health Care system that Classification Systems Communicate?
Medical Necessity
Statistical Analyses
Reimbursement
Resource Allocation
Diagnosis-Diagnostic Statement
Explains WHY the patient requires the attention of a healthcare Provider
Medical Necessity
The assessment that the provider was acting according to standard practices in providing a procedure or service for an individual with a specific diagnosis.
Procedure
Explains WHAT the physician or health care provider did for that patient.
Actions, or a series of actions, taken to accomplish an objective (result) ex: surgically removing a mole or sectioning the small intestine
Statistical Analyses
Research organizations and govn’t agencies statistically analyze the data provided by codes to develop programs, identify research areas, allocate funds, and write public health policies that will best address areas of concern for the health of our nation
Reimbursement
The process of paying for health care services after they have been provided
What might the Physicians notes Explain
The reasons why the encountered occurred- such as specific condition or illness, the signs or symptoms of a yet- unnamed problem, or another reason for the encounter such as preventive service
What Three Parties are involved in reimbursement?
The health care provider – 1ST Party
The patient – 2nd party
The insurance company or other organization financially responsible – 3rd Party Payer
What is an Alphabetic Index A.K.A
Index to Diseases and Injuries
Resource Allocations
Deciding how to efficiently and effectively distribute funds, equipment, and staff members to the patients and locations who need them most
Condition
State of abnormality or dysfunction
Ex- infection, fracture and wound
Eponym
A disease or condition named for a person
Ex- Epstien-Barr Syndrom and Cushings Disease
Includes Note Directly below the Term you are coding means?
What are they know as in the ICD-10 CM book?
Provides you with the alternative words or phrases that the physician might use that mean the same condition. In English they are known as Synonyms.
In the ICD-10-CM book they are known as Non Essential Modifiers
What are Diagnostic descriptions listed by?
three things
Condition
Eponym
Other descriptors (ex- personal history, family history)
Nonessential Modifiers
Descriptors whose inclusion in the physician’s notes are not absolutely necessary and that are provided simply to further clarify a code description; optional terms
Simply put – a descriptor used to clarify a code description but isn’t necessary
How Does the Tabular List organize all ICD-10-CM codes (2 Ways)
First in Alphabetic Order, Then in numeric order
A00 through Z99.89
Purpose of a Neoplasm Table
Itemizes all the anatomical sites in the human body that may develop a tumor
Table of Drugs and Chemicals
Lists pharmaceuticals and chemicals that may cause poisoning of adverse effects in the human body
What is the format of ICD-10- CM Codes?
(how are they listed?)
When an additional character is needed to complete the code- How might that look?
3- character code category
A letter of the alphabet followed by
A minimum of 2 characters (either letters or numbers
An extra symbol is added such as a bullet or a box with a check mark
External Causes
An event, outside the body, that causes injury, poisoning, or an adverse reaction
Services
Spending time with a patient and or family about health care situations
Actions that will most often involve counseling, educating, and advising the patient, such as discussing test results or sharing recommendations for risk reduction
Index to External Causes Lists what?
Causes of injury and poisoning to explain HOW a patient got injured and WHERE
Treatments
The provision of medical care for a disorder or disease
Are typically an application of a health care service, such as radiation treatments for tumor reduction or acupuncture
Diagnostic Test
Procedures are performed to provide the with additional information required to determine a confirmed diagnosis
What three code sets are available for you to use to translate health care procedures, services, and treatments into codes.
CPT- Current Procedural Terminology
ICD-10-CM PCS- International Classification of Diseases-10th Revision-Procedure Coding Systems
HCPCS Level II - Healthcare Common Procedure Coding Systems
Preventive
Procedures and services are provided to keep a healthy patient healthy—to avoid illness or injury, including early detection testing known as screenings
CPT used to describe what?
For what kind of Patient?
Procedures performed by a physician in any location
Services range from speaking with a patient about test results to performing surgery or determining a treatment plan.
CPT codes are used to report the contribution made by OUTPATIENT Facilities. Ex- physician’s office, a clinic, an ambulatory surgical center, or the emergency department of a hospital such as a sterile procedure room, trained nursing and support staff
Therapeutic
Procedures, treatments, and services are performed with the intention of removing, correcting, or repairing an abnormality or condition
How many parts and Sections does the CPT Code Book have?
List them.
How are they organized?
Are there exceptions?
2 parts and 6 Sections
Evaluation and Management Anesthesia Surgery Radiology Pathology and Laboratory Medicine
Generally presented in numeric order by code number
Some Exceptions so read carefully
ICD- 10-CM PCS Codes Describe What?
The contribution made by the hospital to a procedure provided to an INPATIENT
List the CPT sections and their structures
CPT Codes (Category I) 5 didget codes. They all have no letters, no punctuation.) Ex: 51100 Aspiration of the bladder, by needle.
Category II codes- 5 character codes, with four numbers followed by the letter F. Ex: 20001F Weight recorded. (used for supplemental tracking of performance measurements. Not reimbursable but support research on specific physician actions taken on behalf of the patient’s health)
Category III codes- are 5 character codes. These codes also have 4 numbers; however these codes are follwed by the letter T. Ex: 0208T ure ton Audiometry (threshold), automated: air only temporary codes used to report emerging technological procedures. These codes enable tracking physician adoption and the frequency of the use to identify what should stay and what will be deleted
Modifiers are listed in appendix A and are 2 character: two numbers: 2 letters, or one letter and one number. Used under special circumstances such as the use of unusual anesthesia, 2 surgeons working on the same patient at the same time.
Inpatient
An individual admitted for an overnight or longer stay in a hospital in an acute care facility.
How are CPT codes organized?
What four Types of Entries are there? Explain.
Alphabetical order by code description, presented in four types of entries
Procedures or Services such as bypass,decompression,insertion
Anatomical site or organ, such as brain stem, spinal cord, lymph nodes
Condition, such as pregnancy, fracture, abscess
Eponyms, synonyms, or abriev. Such as potts- smith procedure or EEG
