Introduction to Medical Coding & Billing

Question 1

HIPAA: A Cornerstone of Patient Privacy

Answer 1

The Health Insurance Portability and Accountability Act (HIPAA), a critical element in healthcare, establishes standards to protect sensitive patient health information. It prohibits the disclosure of health information without patient consent or knowledge, thereby ensuring confidentiality and privacy in healthcare settings. HIPAA’s pivotal role in healthcare transcends just privacy; it also encompasses the way healthcare providers handle electronic records and transactions.

Question 2

Medical Coding: The Language of Healthcare Services

Answer 2

Medical coding, primarily purposed for facilitating billing and reimbursement processes, acts as a universal language that translates healthcare services, diagnoses, and procedures into standardized codes. These codes are essential for billing, ensuring that healthcare providers are reimbursed by insurance payers accurately for the services rendered. Coding removes ambiguities, allowing for efficient and clear communication among providers, billers, and insurers.

Question 3

Explanation of Benefits(EOB)

Answer 3

A statement sent by insurance companies to patients. It details the services received, the amounts billed, the covered amounts, and what the patient may owe as a co-pay or deductible. EOBs are crucial in providing transparency and understanding to patients regarding their healthcare costs and insurance coverage.

Question 4

ICD-10-CM

Answer 4

he International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is the system used predominantly for diagnostic coding. It is a detailed classification system that allows for precise coding of diseases, symptoms, and medical conditions.

Question 5

AAPC

Answer 5

The American Academy of Professional Coders (AAPC) is a respected organization providing certification to medical coders and billers.

Question 6

Modifiers in CPT Coding

Answer 6

Are essential in providing additional information or context to a procedure code. They indicate if a procedure has been altered in some way without changing its definition. Modifiers can impact reimbursement and convey necessary details about the service performed, such as it being bilateral or involving multiple procedures.

Question 7

Co-Pay

Answer 7

The co-pay is a fixed amount paid by the patient for a covered healthcare service, typically at the time of service.

Question 8

PHI

Answer 8

Protected Health Information (PHI) under HIPAA includes any information in a medical record that can be used to identify an individual and that was created, used, or disclosed in the course of providing a healthcare service.
Ex: Patient name

Question 9

Global Period in Billing

Answer 9

The global period in medical billing refers to a time frame around a surgical procedure, typically including the day of surgery and a postoperative period. During this time, any services related to the procedure are considered part of the global surgical package and are not billed separately.

Question 10

NPI

Answer 10

The National Provider Identifier (NPI) is a unique identification number for healthcare providers, used in administrative and financial transactions. It is a standard under HIPAA and is essential for billing and electronic transactions in healthcare.

Question 11

Deductibles

Answer 11

A deductible is the amount a patient pays for healthcare services before their insurance plan starts to pay. It is a yearly amount, and once it is met, the insurance coverage begins to share the costs of services.

Question 12

NPP

Answer 12

The Notice of Privacy Practices (NPP) is a document required by HIPAA that healthcare providers must provide to their patients. It explains how a patient’s health information will be used and protected, and it ensures that patients are aware of their privacy rights.

Question 13

Billing Denials

Answer 13

Billing denials in medical billing can occur due to various reasons such as inaccurate patient information, upcoding, and downcoding. These denials can be costly and time-consuming to resolve, hence emphasizing the need for accuracy and compliance in the billing process.

Question 14

Upcoding

Answer 14

Upcoding in medical billing refers to coding for a more complex or expensive service than what was actually provided. It is considered fraudulent and unethical, leading to higher costs for insurers and patients and potentially resulting in legal consequences.

Question 15

Human Anatomy

Answer 15

Is the scientific study of the body’s structures. Some of these structures are very small and can only be observed and analyzed with the assistance of a microscope.

Question 16

Gross Anatomy

Answer 16

Is the study of the larger structures of the body, those visible without the aid of magnification

Question 17

Microscopic Anatomy

Answer 17

Is the study of structures that can be observed only with the use of a microscope or other magnification devices

Question 18

Regional Anatomy

Answer 18

Is the study of the interrelationships of all of the structures in a specific body region, such as the abdomen.

Question 19

Cardio

Answer 19

Pertaining to the heart.

Question 20

Myo

Answer 20

Pertaining to muscle

Question 21

Pathy

Answer 21

Indicating a disorder or disease

Question 22

Hypo

Answer 22

Below normal or deficient

Question 23

Itis

Answer 23

Signifies inflammation

Question 24

Arthritis

Answer 24

Inflammation of the joints

Question 25

Hepat

Answer 25

Liver

Question 26

Hyper

Answer 26

Signifies an excess or increased level

Question 27

Ectomy

Answer 27

Denotes the surgical removal of a body part.
Ex: appendectomy

Question 28

Tonsillitis

Answer 28

Inflammation of the tonsils

Question 29

Inflammation

Answer 29

Is a prevalent disease process characterized by redness, swelling, heat, and pain.

Question 30

Infection

Answer 30

Occurs when microorganisms invade the body, leading to illness.

Question 31

Degenerative Diseases

Answer 31

Involve the progressive deterioration of body tissues or organs over time.
Ex: osteoarthritis, Alzheimer’s disease, and age-related macular degeneration.

Question 32

Benign

Answer 32

Non-Cancerous

Question 33

Malignant

Answer 33

Cancerous

Question 34

Neoplasms

Answer 34

or Tumors, are abnormal growths of cells that may be benign (non-cancerous) or malignant (cancerous).

Question 35

Endocrine Disorders

Answer 35

Involve dysfunctions of the endocrine system and its glands, such as diabetes, thyroid disorders, and adrenal insufficiency.

Question 36

Respiratory Diseases

Answer 36

Affect the lungs and airways, including conditions like asthma, chronic obstructive pulmonary disease (COPD), and pneumonia.

Question 37

Gastrointestinal Disorders

Answer 37

Encompass a range of conditions affecting the digestive system, including gastritis, gastroesophageal reflux disease (GERD), and inflammatory bowel disease (IBD).

Question 38

Renal Diseases

Answer 38

Involve the dysfunction of the kidneys, such as chronic kidney disease, kidney stones, and urinary tract infections.

Question 39

Mental Health Conditions

Answer 39

Including anxiety disorders, depression, and schizophrenia, impact a person’s emotional and psychological well-being.