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Medical Terminology > coding > Flashcards

coding Flashcards

1
Q

ICD codes

A

diagnostic codes

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2
Q

CPT codes

A

procedural codes

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3
Q

What are some examples of 3rd party payers?

A

HMO, PPO, POS, Gov. plans (Tricare, medicare, medicaid), HDHP, HSA

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4
Q

Statutory law

A

legislation passed by either state legislature or the congress of the US

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5
Q

Who has control over statutory law?

A

citizens who vote have some control over it

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6
Q

CoPs

A

Conditions of participation

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7
Q

CfCs

A

Conditions for coverage

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8
Q

What were Health and Safety standards, CoPs, and CfCs primarily made for?

A

Patient safety

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9
Q

Examples of CoPs

A

-Transplant centers
-Psychiatric Hospitals
-Intermediate Care
-Hospitals
-Hospice
-Home Health

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10
Q

Examples of CfCs

A

-ASCs
-ESRD facilites
-Long term care facilities
-OT practices
-Organ procurement organizations
-Portable x-ray providers

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11
Q

What was mandated by federal or state law?

A

Retention of Records

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12
Q

Why was HIPAA passed?

A

Concerns about fraud

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13
Q

COBRA

A

Consolidated Omnibus Budget Reconciliation Act

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14
Q

How many years was Dr. Barry Schultz sentenced to?

A

157 years

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15
Q

For one of Dr.Schultz patients, how many oxycodone pills did he prescribe in 7 months?

A

nearly 17,000; another received 23,000 over an 8 month period

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16
Q

How much was Dr.Schultz a day for prescribing and selling opioids?

A

$6,000 a day

17
Q

How bad was the Opioid Crisis in Broward County?

A

One street had 31 different pain clinics

18
Q

How much did Dr. Moss bill the US government for and how?

A

$2.5 million dollars by falsifying Medicare and Medicaid claims either by billing for services he actually did not perform or by utilizing his PA (Mr.Tywon)

19
Q

NPI#

A

National Provider Identifier

20
Q

Who uses CPT codes?

A

All healthcare providers, payers, and facilities use CPT codes

21
Q

What do CPT codes help determine?

A

used by insurers to help determine the amount of
reimbursement

22
Q

How often are CPT codes updated?

23
Q

What are the essential elements in reporting CPT codes?

A

-Medical Terminology
-Anatomy
-Insurance payer rules
-Procedural bundling rules
-Proper modifier usage

24
Q

CPT Modifiers

A

Clarify services and procedures performed by providers

25
Q

What is the criteria for medical necessity?

A

-purpose
-scope
-evidence
-value

26
Q

Who determines medical necessity?

A

By third-party payers

Medical Terminology (26 decks)

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