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Insurance Billing and Coding Essentials > ICD-10-CM, CPT, and HCPCS > Flashcards

ICD-10-CM, CPT, and HCPCS Flashcards

1
Q

Sections of the ICD-10-CM

A

1) Alphabetic Index
2) Tabular List

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2
Q

ICD-10 Main Term

A

the diagnosis found in the Alphabetic Index; bolded word that identifies a disease or condition, such as diabetes (Alphabetic Index)

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3
Q

ICD-10 Default code

A

code listed next to the main term that is most often associated with a particular disease or condition (Alphabetic Index)

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4
Q

ICD-10 Subterm

A

descriptive terms found indented under the main term (Alphabetic Index)

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5
Q

ICD-10 Turnover Lines

A

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)

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6
Q

Etiology

A

The cause or origin of a disease

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7
Q

ICD-10 Nonsensical Modifiers

A

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)

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8
Q

Manifestation

A

signs, symptoms, or secondary processes of a patient’s disease or condition that may be coded

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9
Q

ICD-10 Table of Neoplasms

A

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)

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10
Q

ICD-10 Index to External Causes

A

index of all the external causes of disease and injuries that are listed in the related chapter (Alphabetic Index)

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11
Q

ICD-10 Table of Drugs and Chemicals

A

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)

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12
Q

ICD-10 Alphabetic Index

A

A list of diseases and injuries in alphabetical order followed by a corresponding code

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13
Q

ICD-10 Tabular List

A

A list of alphanumeric diagnosis codes arranged in the Alphabetical Index; used to verify the corresponding code indented in the Alphabetical Index

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14
Q

ICD-10 Code Blocks

A

a range of codes and conditions made into chapters by body systems or conditions (Tabular List)

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15
Q

ICD-10 V-codes

A

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)

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16
Q

ICD-10 Z-codes

A

used for factors influencing healthcare status and contact with healthcare services (Tabular List)

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17
Q

ICD-10 Category

A

a three-character code in the Tabular List

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18
Q

ICD-10 Subcategory

A

four- or five-character code in the Tabular List; indented under the category code

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19
Q

ICD-10 7th Character

A

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

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20
Q

Sequela

A

the residual effect that was produced by the original disease or condition, often referred to as the late effect

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21
Q

Eponym

A

a name or phrase that is formed from or based on a person’s name

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22
Q

ICD-10 If “see” appears after the main term

A

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

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23
Q

ICD-10 If “see also” appears after the main term

A

points the coder to additional, related index entries that the coder should review

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24
Q

ICD-10 Cross References

A

“see”; “see also”

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25
Q

ICD-10 NEC

A

Not Elsewhere Classified - indicates the code to use when a disease or condition cannot be placed in any other category

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26
Q

ICD-10 NOS

A

Not Otherwise Specified - indicates that the location of a condition is not completely described in the medical record

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27
Q

ICD-10 First Listed Code

A

code for diagnosis that is the patient’s main condition; in cases involving an underlying condition and a manifestation, this is the underlying condition

28
Q

ICD-10 Connecting Words

A

may indicate the need for two codes or for a single code that covers both conditions; “due to”, “during”, “following”, “with”

29
Q

ICD-10 Combination Codes

A

can describe both the etiology and the manifestation instead of using two codes

30
Q

ICD-10-CM

A

International Classification of Diseases, 10th revision, Clinical Modification; a system copyrighted by the WHO of the UN

31
Q

ICD-10 code followed by a hyphen (-)

A

the coder will need to drill down to select the right code

32
Q

ICD-10 DX Statement

A

Diagnostic Statement; a physician’s description of the patient’s encounter

33
Q

Acute

A

symptoms are sudden, severe, and short in duration; can result from a chronic disease that suddenly causes severe symptoms

34
Q

Coexisting condition

A

additional illness that either has an effect on the patient’s primary illness or is also treated during the encounter

35
Q

ICD-10 External Cause code

A

another diagnosis code assigned for the situation that caused the injury; supports the diagnosis

36
Q

General Equivalence Mappings (GEMS)

A

used during the transition from ICD-9 to ICD-10 to translate codes from one set to another

37
Q

ICD-10 Coding Sequelae

A

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

38
Q

After Study

A

At the patient’s discharge

39
Q

ICD-10 Suspected Conditions

A

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

40
Q

ICD-10 Coding the Reason for Surgery

A

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

41
Q

CPT

A

Current Procedural Terminology

42
Q

CPT Sections

A

1) Procedure Codes
2) Anesthesia Codes
3) Surgery Codes
4) Radiology Codes
5) Pathology and Lab Codes
6) Medicine Codes

43
Q

CPT Sec 1 - Procedure Codes

A

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

44
Q

CPT Sec 2 - Anesthesia Codes

A

the anesthesiologist will also submit a claim with a code representing the anesthesia based on the payer’s rules; 15 minutes = 1 unit

45
Q

CPT Sec 3 - Surgery Codes

A

The largest section because it further divides into 19 subsections representing codes for surgeries for each body system

46
Q

CPT Sec 4 - Radiology Codes

A

Categorized by anatomical regions

47
Q

CPT Sec 5 - Pathology and Lab Codes

A

18 sections to define parts of the body and the disease process

48
Q

CPT Sec 6 - Medicine Codes

A

Psychiatry, vaccines and admin, biofeedback, dialysis, and others

49
Q

E/M Codes

A

Evaluation and Management Codes - most commonly reported codes; office visits, consultations, inpatient care, emergency services, some nursing care, telemedicine, and other services

50
Q

Key Components of E/M Codes

A

1) chief complaint
2) level of history (HPI, PMH, FH, SH)
3) levels of examination
4) medical decision-making

51
Q

Annual updates for CPT Category 1 Codes

A

announced by the AMA on October 1 and are in effect for procedures and services provided after January 1 of the following year

52
Q

Unlisted Procedure Codes

A

-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

53
Q

Renumbered CPT Codes Crosswalk

A

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

54
Q

HCPCS

A

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

55
Q

CPT Code Ranges

A

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

56
Q

CPT Symbold for changed codes

A

-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

57
Q

CPT Symbol for add-on codes

A

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”

58
Q

CPT Symbol for telemedicine

A

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

59
Q

CPT Symbol for FDA Approval Pending

A

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

60
Q

CPT Resequencing codes

A

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))

61
Q

When to use CPT Modifiers

A

-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

62
Q

HCPCS Levels

A

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)

63
Q

HCPCS Temporary codes

A

used for new emerging procedures, supplies, and equipment

64
Q

HCPCS Misc Codes (NEC)

A

-similar to CPT unlisted codes
-used infrequently and only when no permanent code exists for service
-report attachment included to explain medical necessity

65
Q

DMEPOS

A

Durable Medical Equipment, Prosthetics, Orthotics, and Supplies

DME examples
Wheelchair
Hospital bed
Cane

POS examples
Cervical collar
Prosthetic extremity

Insurance Billing and Coding Essentials (2 decks)

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