Coding Flashcards
Which of the following manuals is used for diagnostic coding?
ICD-10-CM
Which of the following represents the reason for a patient visit?
A code that represents the reason for a pt. visit.
Which of the following best describes a procedural code?
A code that represents the service performed by the physician.
Which of the following organizations publishes the CPT manual?
The American Medical Association (AMA)
1830
International List of Causes of Death reported data on causes of death and documented diseases classified by anatomical location around the world
1893
Bertillon Classification of Causes of Death later became known as International Classification of Causes of Death used as the standard in North merica until the mid-twentieth century.
1948
World Health Organization (WHO) published reports on disease and causes of death in the International Classification of Disease. This document was used to index hospital records, categorizing them for medical research.
1977
The US began using the International Classification of Disease to code medical records acording to diagnoses. This allowed diseases to be classified and studied.
1979
Classification was modified for medical billing and insurance claims, and is used in the medical office today. The International Classification of Disease, 10th Edition, Clinical Modification, or ICD-10-CM
2015
ICD code set is updated periodically to reflect changes in medicine and clinical practice. On October 1, 2015, the code was updated to the ICD-10 code set.
In what year did CPT codes become a part of the HCPCS coding system?
1983
ICD
International Classification of Diseases are published by the United States Department of Health and Human Services, and is supervised on an international level by the United Nations World Health Organization
A12.3456
ICD code set
- used in the medical office to provide diagnostic codes
- The ICD-10-CM code set is 3-7 charcters long and each code starts with a letter, and then a three character code before a decimal point
- represented by the first three characters
CPT Codes
Current Procedural Terminology, provides diagnostic, therapeutic, and surgical codes for all services that medical staff may perform. The CPT codes were added as a part of HCPCS code set, and sometimes referred to as a Level 1 HCPCS code.
-used to report procedure performed and used for reimbursement
-five numbers long and doctors can add a modifier
12345-12
HCPCS
maintaned by the Centers for Medicare and Medicaid Services (CMS). Requires use of HCPCS codes and its claims, and only accepts CPT codes when there is no HCPCS code that is available. HCPCS codes known as Level II odes represent a variety of medical services, supplies, drugs, and durable medical equipment not found in CPT codes.
-Required for reporting of all Medicare Part B claims
In which coding system would a MA find codes for durable medical equipment?
HCPCS
Which set of codes was adopted as a part of the HCPCS coding system?
CPT
What two reasons do medical offices use ICD, CPT, and HCPCS for coding?
- to keep statistical data within an office
- to communicate with insurance carriers
Why is coding used in the medical office?
- to keep statistical data
- to communicate with insurance carriers
What is the purpose of modifiers?
To further specify the codes
Diagnostic codes
codes that refer to the physician’s diagnosis, the codes are used to record and track statistical healthcare data. Diagnostic code aid in the insurance claim process, the actual amount of payment recieved from the insurance company is based on the procedure.
Accurate diagnostic coding is important to both financial and legal status of the medical practice because improper coding can….
- result in a reduced reimbursement from insurance carriers
- If improper codes are in result fraud or abuse, civil or criminal penalties can be assigned.
Which of these best defines a primary diagnosis?
The most significant condition for which service was provided.
In what order should secondary diagnoses be documented?
According to the coding guidelines
Which typer of ICD-CM-10 is not generally used for coding in the medical office?
ICD-10-PCS
What are the four sections of the ICD?
- The Index to Diseases
- Neoplasm Table
- Table of Drugs and Chemicals
- Index to the External Cause of Injury and Poisoning
If a patient is diagnosed with a fractured ankle, which of the following terms should be used as a main term?
Fracture
What kind of central modifiers in diagnostic coding be used for?
Specify the location of an injury, specify the type of illness, specify the cause of an illness or injury, all of the above.
When coding a diagnosis, in which volume of the ICD-10-CM should the assistant look to first?
Volume 2
An essential modifier, if available, must be included into the code.
True
A manifestation should be documented as a primary diagnosis.
False
From which volume of the ICD-10-Cm should the final code for the insurance claim come?
Volume 1
Codes selected should be the LEAST specific available, because this gives more chances for reimbursement.
False
What does it mean when a code in Volume 1 of the ICD-10-CM is highlighted in yellow?
Unspecified
Procedure for Performing Diagnostic Coding
- Prepare for Procedure
- Determine the Diagnosis
- Use the ICD-10-CM
- Assign the Code
After detemining the appropriate cide, in which the following places should you document the code?
- On the patient’s medical record
- On the superbill
- On the claim form
In which volume would you locate the main term?
Volume 2
The main term will be an automatic site.
False
After you locate the main term in Volume 2, where do you cross-reference the code?
On Volume 1
Which of the following best describes a procedure?
The action a physician takes in response to a diagnosis.
Which level of HCPCS is actually the American Medical Association’s CPT-4
Level 1
How many digits does a procedural code have?
Five, with two-digit, optional modifiers
HCPCS Level III codes are no longer used for Medicare reporting
True
Main terms in procedural coding systems, such as the CPT-4, can be anatomical sites.
True
What should the assistant read before performing procedural coding?
The CPT-4 manual guidelines
In the CPT-4 Index, what will you find indented underneat main terms?
Subterms
What should the assistant do when a code range is given in the CPT-4 Index?
Read through the entire code range
If procedure is performed by more than one physician a modifier should be used.
True
If assistant cannot find an appropriate procedural code in the CPT-4, where should the assistant look next?
HCPCS Level II
In the CPT-4, after you locate the code for the main term in the alphabetic index, where should you reference it?
In the main section of the manual
What documents would you use to determine the procedure?
The physicians clinical notes and the superbill
