Main terms Flashcards
emergency department services, physician direction of advanced life support
emergency - cpt code 99288
intertochanteric femoral fracture (closed treatment)
fracture, femur, intertrochanteric, closed treatment - cpt code 27238
removal of gallbladder calculi by means of an open procedure
removal, caliculi (stone) - cpt code 47480
lung, bullae resection
resection, lung, bullae - cpt code 32141
providers are reimbursed for the procedures and services rendered based on what code
cpt/hcpcs
what organization first published the cpt coding system
AMA
a common, concise coding system is required by what law
HIPAA
name the box location on the CMS-1500 form for cpt/hcpcs codes
24D
what symbol indicates that the description for a code has changed
triangle
what appendix are modifiers located in
six
how many sections are in the cpt manual
six
guidelines that are applicable to all codes are found at the beginning of what
each section
before assigning an indented code, refer to the preceding
stand-alone
what appendix are clinical examples located in
appendix C
a procedure or service not found in the cpt manual may be coded as what
unlisted procedure
reporting a category III code requires a
special report
what type of cpt codes have 4 numbers followed by a letter
category III codes
single codes displayed in the cpt index should be verified in the _______portion of the cpt manual to ensure accuracy
tabular
coding system devloped by the american medical association
CPT
special guides that help the coder compare codes and descriptors with the previous edition of cpt
symbols
provides specific instruction about coding for each section of the cpt manual
guidelines
supplemental codes used for performance measurements
category II
temporary cpt codes
category III
existing from birth
congenital
period of time a surgical procedure is being performed
intraoperative
after childbirth
postpartum
pertaining to the cervix of the uterus
cervical
expansion of the cervix
dilation
the perinatal period starts before birth through how many days after birth
28 days
exclude and include notes are only referenced where
tabular
pressure ulcers are graded and reported based on the stage of the ulcer and
depth
when a disease is documented as a portion of the bone at the joint, which site designation should be reported
bone
fx due to a bone disease
pathological fx
concentration of mineral salts also known as a stone
calculus
what main term in the index should you lacate first to find teh causative organism
infection
when a pt presents for management of anemia associated with a malignancy and the encounter is for the anemia only, what is sequenced as the primary dx for this encounter
malignancy
name 2 types of anemia due to blood loss located as subterms in the index
chronic and acute
whay type of code is applied for dementia with parkinsonism
combination code
new tumor growth that can be benign or malignant
neoplasm
study of the structures, composition, and function of the tissues
histology
infalmmatory condition in response to microorganisms in the tissue, blood, lungs, skin, or urinary system
sepsis
medical condition that is present in conjunction with another medical condition, potentially hidden at first
underlying condition
what condition is reported as the first listed diagnosis when otitis media is the result of an underlying disease
underlying desease
2 codes are required for reporting secondary HTN, sequencing of these codes is based on what?
reason for the encounter
causative organism is also known as etiology, what is the disease process also described as
manifestation
a dash (-) at the end of an alphabetic index entry indicates what requirement
additional characters
instructional notes are included in what list
tabular
section IV of the ICD-10 official guidelines for coding and reporting is for what type of coding
outpatient
dehydration with pneumonia is not considered an ______ part of a disease process
integral
when a code first note is indicated and the patient has an underlying condition documented, which is listed as teh principle or first list diagnosis
underlying condition
when a condition is described as both acute and chronic with separate subentries in the alphabetic index at the same indention level, which is coded first
acute
when one code can identify 2 diagnoses or a diagnosis with an associated complication it is considered what type of code
combination
what type of diagnosis codes do you report when the acute phase of an illness or injury has passed but residual remains
late effects
laterality refers to what type of organs
paired
use of more than one ICD 10 code to fully describe a condition
multiple coding
single ICD 10 code used to classify 2 diagnoses
combination code
sudden onset and short duration
acute
a condition that follows an illness
sequela
occuring on 2 sides
bilateral
in the outpatient setting, the term first listed diagnosis is used in lieu of what diagnosis
principle
what diagnosis is used when the documented condition is not confirmed in the oupatient setting
signs and symptoms
what is the first listed diagnosis when a patient presents for outpatient surgery
reason for surgery
is is important to code all the conditions or problems that are being managed during an encounter to support what
data integrity
z codes are used more frequently in what setting
outpatient
what 2 code categories are used to report the 1st listed diagnosis for medical observation for suspected conditions and conditions ruled out
Z03 and Z04
additional diagnosis codes are used to report what conditions
coexisting
in what setting are uncertain diagnoses reported
inpatient
what type of condition may be reported as many times as the patient receives care or treatment for
chronic
what code is assigned for encounters for routine lab/radiology testing in the absence of any signs, symptoms, or associated diagnosis
Z01.89 - encounter for other specified special examinations
when the primary reason for therapeutic services is chemotherapy or radiation therapy, what code category is assigned as the first listed diagnosis
Z codes
what code is assigned as an additional diagnosis for patients receiving preoperative evaluations
condition that describes the reason for the surgery
for routine outpatient prenatal visits when no complications are present, what code category is assigned
Z34
when the postoperative diagnosis is different than the preoperative diagnosis at the time the diagnosis is confirmed, which diagnosis is reported
postoperative diagnosis
type of codes used to classify persons who are not currently sick
Z codes
section of the official guidelines for coding and reporting that includes selection of principal diagnosis for non outpatient settings
section II
assigned to indicate a patient has the sequelae or residual of a past disease or condition
status code
classification of health condition due to external cause, never reported as a first listed diagnosis
external cause code
a diagnosis that is documented at the time of discharge as probable, suspected, possible or rule out are what
uncertain diagnosis
how many alphanumeric positions do level II codes hold
5
what code grouping reports temporary codes assigned by CMS
Q codes
what code group is use by state medicaid agencies
T codes
where are level II modifers found in the HCPCS manual
after the table of drugs section or preceding the A codes
what name are J codes referred to in the table of drugs
generic
which A code would you report for a surgical tray
A4550
collection of codes that represents procedures, supplies, products, and services
HCPCS healthcare common procedure coding system
codes no longer available since the implementation of HIPAA
level III or local codes
reported when no existing level II code adequately describes the service or item being billed
miscelaneous codes
introduction of fluid into a tissue, vessel, or cavity
injection
equipment used by a patient with a chronic disabling condition
DME
what part of the cpt manual lists a full description for all modifiers
appendix A
when a cpt code does not fully explain an unusual procedure, what should be added to the code
modifier
what a modifier is applied to a surgical procedure to indicate increased physician work was performed
-22
what modifier is applied to indicate a service for which general anesthesia was used when normally normally local anesthesia would be iundicated
-23
what modifier is applied to indicate and E&M encounter was performed and not related to a current global period
-24
when a pt comes into the office twice in one day for different medical reasons, the -25 modifier should be applied to which visit
second E&M
what modifier indictes the professional component of a diagnostic test
-26
third-party payers require this modifier for a mandated service
-32
modifier -33 indicates a covered preventive service, what organization grades preventive services
US preventative services task force (USPSTF)
modifier -47 anesthesia by the surgeon, is never added to what cpt code
anesthesia codes
how many units of service may be billed when reporting the -50 modifier to medicare
one unit
when reporting -51 modifier to indicate multiple procedures performed, which procedure should be reported first on the claim
primary procedure
some payers may decrease thepayment on a procedure when this modifier is applied
-52
modifier -53, discontinued procedure, is never reported with E&M codes or codes based on what
time
when the surgeon transfers postoperative care to another physician, report with what modifier
-54
modifier -55 is used for services provided to the pt after what disposition
discharge from the hospital
medicare considers what service to be part of the surgery and bundled payment not allowing the -56 modifier
preoperative
E/M services provided the day before or the day of a major surgery are included in what package
global days
a planned procedure intended to include the original procedure plus one or more subsequent procedures is indicated by what modifier
-58
modifier -59 is applicable to all cpt codes except what type of codes
E/M codes and weekly radiation management
period of time a surgical procedure is being performed
intraoperative
inform third party payers of circumstances that may affect the way payment is made
modifiers
describing a physicians services in radiology or pathology
professional component
describing the services provided by the facility
technical component
bundling together of time, effort, and services for a specific procedure into one code instead of reporting each component separately
surgical package
