ICD-10-CM, CPT, and HCPCS Flashcards
Sections of the ICD-10-CM
1) Alphabetic Index
2) Tabular List
ICD-10 Main Term
the diagnosis found in the Alphabetic Index; bolded word that identifies a disease or condition, such as diabetes (Alphabetic Index)
ICD-10 Default code
code listed next to the main term that is most often associated with a particular disease or condition (Alphabetic Index)
ICD-10 Subterm
descriptive terms found indented under the main term (Alphabetic Index)
ICD-10 Turnover Lines
used if the main term or subterm is too long to fit on one line; always indented further to the right than subterms (Alphabetic Index)
Etiology
The cause or origin of a disease
ICD-10 Nonsensical Modifiers
Supplementary terms that are not essential to the selection of the correct code, and which are shown in parentheses on the same line as a main term or subterm (Alphabetic Index)
Manifestation
signs, symptoms, or secondary processes of a patient’s disease or condition that may be coded
ICD-10 Table of Neoplasms
a table of neoplasms (an abnormal mass that can be benign or cancerous) found in the alphabetical index that lists codes by anatomical site (Alphabetic Index)
ICD-10 Index to External Causes
index of all the external causes of disease and injuries that are listed in the related chapter (Alphabetic Index)
ICD-10 Table of Drugs and Chemicals
a table used if a patient’s diagnosis results from exposure to a drug or chemical; lists classifications of drugs and other chemical substances in alphabetical order (Alphabetic Index)
ICD-10 Alphabetic Index
A list of diseases and injuries in alphabetical order followed by a corresponding code
ICD-10 Tabular List
A list of alphanumeric diagnosis codes arranged in the Alphabetical Index; used to verify the corresponding code indented in the Alphabetical Index
ICD-10 Code Blocks
a range of codes and conditions made into chapters by body systems or conditions (Tabular List)
ICD-10 V-codes
represent external causes of morbidity (the situation that caused the condition or injury); may or may not be required by the payer to be reported as a secondary code in addition to the condition or injury (Tabular List)
ICD-10 Z-codes
used for factors influencing healthcare status and contact with healthcare services (Tabular List)
ICD-10 Category
a three-character code in the Tabular List
ICD-10 Subcategory
four- or five-character code in the Tabular List; indented under the category code
ICD-10 7th Character
for some conditions; a key used in the Tabular List
A - patient encounters that involve treatment of a disease or condition in its acute stage
D - patient is seen in follow-up when the condition or disease is under control but still chronic
S - patient is being seen for another disease or condition that was the result of the initial disease or condition
X - used as a placeholder if required
Sequela
the residual effect that was produced by the original disease or condition, often referred to as the late effect
Eponym
a name or phrase that is formed from or based on a person’s name
ICD-10 If “see” appears after the main term
the coder must look up the term that follows in the index as it means that the main term where the coder first looked is not correct; another category must be used
ICD-10 If “see also” appears after the main term
points the coder to additional, related index entries that the coder should review
ICD-10 Cross References
“see”; “see also”
ICD-10 NEC
Not Elsewhere Classified - indicates the code to use when a disease or condition cannot be placed in any other category
ICD-10 NOS
Not Otherwise Specified - indicates that the location of a condition is not completely described in the medical record
ICD-10 First Listed Code
code for diagnosis that is the patient’s main condition; in cases involving an underlying condition and a manifestation, this is the underlying condition
ICD-10 Connecting Words
may indicate the need for two codes or for a single code that covers both conditions; “due to”, “during”, “following”, “with”
ICD-10 Combination Codes
can describe both the etiology and the manifestation instead of using two codes
ICD-10-CM
International Classification of Diseases, 10th revision, Clinical Modification; a system copyrighted by the WHO of the UN
ICD-10 code followed by a hyphen (-)
the coder will need to drill down to select the right code
ICD-10 DX Statement
Diagnostic Statement; a physician’s description of the patient’s encounter
Acute
symptoms are sudden, severe, and short in duration; can result from a chronic disease that suddenly causes severe symptoms
Coexisting condition
additional illness that either has an effect on the patient’s primary illness or is also treated during the encounter
ICD-10 External Cause code
another diagnosis code assigned for the situation that caused the injury; supports the diagnosis
General Equivalence Mappings (GEMS)
used during the transition from ICD-9 to ICD-10 to translate codes from one set to another
ICD-10 Coding Sequelae
two codes are usually required; first reported is the code for the specific effect, followed by the code for the cause; the code for the acute illness that led to the sequela is never used with a code for the late effect itself
After Study
At the patient’s discharge
ICD-10 Suspected Conditions
Possible but not confirmed diagnoses, such as those preceded by “rule out”, “suspected”, “probable”, or “likely”
-not coated in the outpatient setting
-in inpatient coding, If a definitive condition has not been established, then at discharge, the inpatient coder codes the condition that matches the planned course of treatment most closely as if it were established
ICD-10 Coding the Reason for Surgery
coded according to the diagnosis that is listed as the reason for the procedure; in some cases, the post-operative diagnosis is available and is different from the physician’s primary diagnosis before the surgery
The postoperative diagnosis is coded because it is the highest level of certainty available
CPT
Current Procedural Terminology
CPT Sections
1) Procedure Codes
2) Anesthesia Codes
3) Surgery Codes
4) Radiology Codes
5) Pathology and Lab Codes
6) Medicine Codes
CPT Sec 1 - Procedure Codes
5-digit codes found in the CPT manual with three categories
Cat 1 - most commonly used; found in the main body
Cat 2 - optional, not paid by insurance, performance-based (reducing alcohol use)
Cat 3 - temporary until a permanent code is established; alphabetic 5th digit
CPT Sec 2 - Anesthesia Codes
the anesthesiologist will also submit a claim with a code representing the anesthesia based on the payer’s rules; 15 minutes = 1 unit
CPT Sec 3 - Surgery Codes
The largest section because it further divides into 19 subsections representing codes for surgeries for each body system
CPT Sec 4 - Radiology Codes
Categorized by anatomical regions
CPT Sec 5 - Pathology and Lab Codes
18 sections to define parts of the body and the disease process
CPT Sec 6 - Medicine Codes
Psychiatry, vaccines and admin, biofeedback, dialysis, and others
E/M Codes
Evaluation and Management Codes - most commonly reported codes; office visits, consultations, inpatient care, emergency services, some nursing care, telemedicine, and other services
Key Components of E/M Codes
1) chief complaint
2) level of history (HPI, PMH, FH, SH)
3) levels of examination
4) medical decision-making
Annual updates for CPT Category 1 Codes
announced by the AMA on October 1 and are in effect for procedures and services provided after January 1 of the following year
Unlisted Procedure Codes
-If there is a temporary code in Category 3 of the CPT manual that represents the service, it is used instead of the unlisted procedure code
-If using an unlisted procedure code, a special report or letter attachment is included to further explain the details of the service
Renumbered CPT Codes Crosswalk
indicates changes and updates by the number symbol; found in Appendix M of the CPT manual; will provide the coder a link between deleted and corrected codes
HCPCS
Healthcare Common Procedure Coding System; codes for items that are used in medical procedures but are not listed in CPT, such as supplies and equipment
CPT Code Ranges
shown when more than one code applies to an entry
-two codes are separated by a comma
-more than two sequential codes are separated by a hyphen
CPT Symbold for changed codes
-bullet Indicates a new procedure code
-triangle indicates that the code’s descriptor has changed
-facing triangles indicate new or revised text other than the code descriptor
CPT Symbol for add-on codes
Plus sign indicates an add-on code; describes secondary procedures that are commonly carried out in addition to a primary procedure; “each additional” or “list separately in addition to the primary procedure”
CPT Symbol for telemedicine
Star indicates telemedicine codes; the provider must exchange sufficient information with the patient to meet the key components and/or requirements of the service as if it had been rendered face-to-face
CPT Symbol for FDA Approval Pending
Lightning bolt is used with vaccine codes that have been submitted to the FDA and are expected to be approved for use soon; the code cannot be used until approved at which point the symbol is removed
CPT Resequencing codes
the practice of displaying the codes outside of numerical order in favor of grouping them according to the relationships among code descriptors (not enough numbers are left in a particular numerical sequence of codes to handle all new items that need to be included))
When to use CPT Modifiers
-a procedure has two parts, a technical component and a professional component
-a service or procedure has been performed more than once, by more than one physician and/or in more than one location
-a service or procedure has been increased or reduced
-only part of the procedure has been done
-a bilateral or multiple procedure has been performed
-unusual difficulties occurred during the procedure
HCPCS Levels
Level I - CPT codes are known as level 1 codes
Level II - five-character alphanumeric code
-Each category represents a type of services or equipment (A-V)
HCPCS Temporary codes
used for new emerging procedures, supplies, and equipment
HCPCS Misc Codes (NEC)
-similar to CPT unlisted codes
-used infrequently and only when no permanent code exists for service
-report attachment included to explain medical necessity
DMEPOS
Durable Medical Equipment, Prosthetics, Orthotics, and Supplies
DME examples
Wheelchair
Hospital bed
Cane
POS examples
Cervical collar
Prosthetic extremity
