Chp 11 Flashcards
Diagnostic Coding
document that informs covered patients that Medicare may not cover a certain service and the patient will be responsible for the bill.
Advance Beneficiary Notice
(ABN)
a review of an account; inspection of records to determine compliance and to detect fraud.
Audit
general notes, symbols, typeface, format, and puctuation that direct and guide the coder to the most complete and accurate ICD-9 code.
Conventions
notation in a file telling that a record is stored elsewhere and giving the reference; verification to another source, checking the tabular list against the alphabetic list in ICD-9 coding.
Cross-reference
indicating the external cause or reason for an injury or illness.
E codes
word derived from a personal name, e.g. Alzheimer disease
Eponym
cause of disease.
Etiology
a medical setting in which patients are admitted for diagnostic, radiographic, or treatment purposes.
Inpatient
a system for transforming verbal descriptions of disease, injuries, conditions, and proceudres to numeric code.
Internal Classification of Diseases, Ninth or Tenth Revision, Clinical Modification
(ICD-9-CM or ICD-10-CM)
conditions that result from another condition. (e.g. left-sided paralysis may be a late effect of a stroke).
Late effects
words in a multiple-word diagnosis that a coder should locate in the alphabetic listing. They represent the condition (not the location to be coded).
Main terms
a determination made by a third party that a certain service or procedure was necessary based on sound medical practice.
Medical necessity
a medical setting in which patients receive care but are not admitted.
Outpatient
the condition or chief complaint that brings a person to a medical facility for treatment.
Primary diagnosis
?
Service
