Chapters 1-4 Review Flashcards
Accounts receivable (A/ R)
- revenue that is due to the practice or provider for services or procedures rendered to the patient: may be due from health insurance coverage, workers’ compensation, liability coverage, or the patient.
American Academy of Professional Coders(A A P C)
- a credentialing organization for Certified Professional Coders.
Billing language
includes terms such as accounts receivable (A/ R), clean claims, denials, modifiers, and advanced beneficiary notices (A B N s).
Certified Professional Coder (C P C)
- credential confirms to employers and others the coder’s knowledge, experience, and abilities as a medical coder.
Certified Professional Coder (C P C) exam
- 150 question, five hour and 40 minute exam that tests the coder’s ability
Clean Claim
- contains complete and accurate demographic information as well as diagnosis and procedure codes. If it is not, the contractual turnaround, or adjudication, time frame does not have to be met.
Compliance Language
brings terms such as unbundling, fraud, false claim, and abuse into the translation.
Medical Coding
the process of translating provider documentation and medical terminology into codes that illustrate the procedures and services performed by medical professionals.
Medical necessity
appropriate ICD-10 code for the diagnosis or condition must be linked to the service or procedure and support medical necessity.
Medically managed
a diagnosis that might not receive direct treatment during an encounter but that the provider has to consider when determining treatment for other conditions.
Provider language
is built on medical terminology, anatomy, and pathophysiology and describes services, procedures, and the medical necessity of those services.
Payer Language
comprises terms such as noncovered services, medical necessity, compliance language, and unbundling.
Revenue Cycle
the flow of a practice’s revenue, which begins when charges for services, procedures, or supplies are incurred and continues until those charges are paid in full or adjusted off the account.
What is the CMS-1500 claim form?`
It is a source of Medical Data
is the standard billing form used to submit healthcare data
Acute
condition with a sudden onset, usually without warning, and of brief duration.
And
In ICD, notation meaning “and/or.”
Chronic
Condition with a slow onset and of long duration
Default code
In ICD-10-CM, codes that are unspecified or are most often used with a condition
located directly behind the boldface main term
used only when the provider’s documentation has no additional detail on the patient’s condition or disease.
Excludes 1
In ICD-10-CM, a note indicating that the condition, disease, or injury being coded is located elsewhere in the manual and should never be coded with the code under which it is located.
Conditions identified by this note cannot be present together and therefore are never coded during the same encounter.
Excludes 2
In ICD-10-CM, a note indicating that the condition excluded is distinct from the code condition and is coded elsewhere in the manual.
The condition excluded may occur with the condition represented by the code, and these two codes may be coded together during the same encounter.
Extenders
In ICD, alphabetic seventh characters used to complete the description of many codes by conveying additional information
episode of care
type of fracture
late effects
trimester of pregnancy
Impending condition
In ICD, specific diagnostic conditions whose codes are used only when the condition was averted due to medical intervention. Also called threatened conditions
includes
ICD-10-CM instructional note that clarifies the code or category being considered by providing definitions or examples of conditions included in the code.
main term
Main term identifies, without further descriptive clarifications, the patient’s condition, injury, or disease.
Determining the main term is the first step in locating a code.
Main terms are bolded in the Alphabetic Index and each is further defined by indented subterms.
manifestation
The way a condition due to an underlying disease or condition presents itself.
NEC
Notation meaning “not elsewhere classified”; indicates that a more specific code is not provided in the ICD manual.
Used when a more specific code is not provided.
Provider documentation is more specific than I C D- 10- C M allows for in the code description.
NOC
Notation meaning “not otherwise specified”; the equivalent of unspecified.
The equivalent of “unspecified.”
Used only when documentation does not provide enough information to assign a more specific code.
Parentheses
are found in both the Tabular List and Alphabetic Index and are Punctuation marks used in the ICD manuals to enclose supplemental terms, or nonessential modifiers.
May or may not be included in the provider’s documentation, but noninclusion does not affect code choice
Placeholder characters
In ICD-10-CM, an “×” placed in the fourth-, fifth-, or sixth-character position when needed to enable the seventh-character extender to remain in the seventh-character position.
Sequela
The condition produced after the initial injury or condition has healed.
in most cases two codes are needed
Sign
An objective condition that can be measured and recorded.
square brackets
Square brackets, [ ], are used in the Tabular List to enclose explanatory phrases or other terms or names of conditions in the nomenclature of the code or inclusion list.
used in the Alphabetic Index to identify mandatory sequencing of etiology/manifestation coding.
symptom
A subjective condition that is relayed to the provider by the patient.
threatened (impending) condition
Codes are only used when a condition was averted due to medical intervention, such as a myocardial infarction prevented by intervention in the cardiac cath lab.
