MEDICAL CODING Flashcards
CPT SYSTEM IS MAINTAINED BY WHAT ASSOCIATION?
AMA- AMERICAN MEDICAL ASSOCIATION
WHAT IS THE AMA?
AMERICAN MEDICAL ASSOCIATION
WHAT CODES ARE ESSENTIAL FOR GETTING PAYMENT FROM INSURANCE?
CPT- CURRENT PROCEDURAL TERMINOLOGY CODES
WHAT IS CPT?
CURRENT PROCEDURAL TERMINOLOGY CODES
WHAT ARE CPT CODES USED FOR?
CPT CODES ARE USED FOR REPORTING MINOR PROCEDURES, SURGERIES ETC.
WHAT 2 DIVISIONS IS ICD COMPROMISED OF? WHAT ARE THEY?
CM- CLINICALLY MODIFIED AND PCS- PROCEDURE CODING SYSTEM
EXPLAIN CM- CLINICAL MODIFICATION
USED PRIMARILY FOR DIAGNOSES CODING IN ALL HEALTHCARE SYSTEMS- 68K CODES
EXPLAIN PCS AND WHAT IT IS USED FOR
PROCEDURE CODING SYSTEM- USED ONLY FOR HOSPITAL INPATIENT PROCEDURES
WHAT DOES CM STAND FOR?
CLINICAL MODIFICATION
WHAT IS ICD-10?
INTERNATIONAL CLASSIFICATION OF DISEASES
WHAT ICD 10-CM?
INTERNATIONAL CLASSIFICATION OF DISEASE- CLINICALLY MODIFIED
WHAT ARE THE 4 CATEGORIES OF MEDICAL CODES?
ICD-
ICD-10-CM
1CD-10-PCS
HCPCS- HICKPICKS
WHAT ARE THE 3 CATEGORIES OF CPT CODES?
CPT
CPT ||
CATEGORY |||
WHAT ARE CPT CODES USED FOR? GIVE AN EXAMPLE
USED FOR REPORTING CLAIMS AND GETTING PAID. THIS MAY BE AN OFFICE VISIT OR EMERGENCY DEPT VISIT- IMPORTANT FACTOR CODE IS WHETER PATIENT IS NEW OR ESTABLISHED
WHAT IS CPT ||- GIVE EXAMPLE
SUPPLEMENTAL/ ADDITIONAL TRACKING CODES THAT CAN BE USED FOR PERFORMANCE MEASUREMENT
EXAMPLE-EMERGENCY DEPT. VISIT PATIENT HAD BLOOD PRESSURE EVALUATED-
(THESE CODES OFTEN ARE NOT RECORDED BECAUSE THEY DON’T GENERATE REVENUE)
WHAT ARE CPT CATEGORY ||| CODES? GIVE AN EXAMPLE
- NOT CONTROLLED BY FEDERAL GOVT
- RELATIVELY NEW
- ASSIST HEALTHCARE AND GOVT AGENCIES IN ASSESSING THE EFFECTIVENESS OF NEW HEALTH CARE PROCEDURES
- CRITICAL TO USE/ THEY KEEP THE MEDICAL COMMUNITY INFORMED
WHAT IS HCPCS? EXPLAIN
HEALTHCARE COMMON PROCEDURAL CODING SYSTEM
Supplies, equipment, and devices delivered to patients, as well as treatments not covered by the CPT code system, are reported using HCPCS codes. It is an additional or extra resource to CPT codes. Level II CPT codes are the same as HCPCS codes. The HCPCS is an alphanumeric code that the Centers for Medicare and Medicaid Services uses (CMS)
WHAT DOES CMS STAND FOR?
CENTERS FOR MEDICAID / MEDICARE
WHAT CODES DOES CMS USE?
HCPCS
WHAT ARE THE 2 LEVELS CMS USE IN HCPCS?
HCPCS LEVEL |- SAME AS CPT
HCPCS LEVEL ||- REFERRED TO AS HCPCS CODES
EXPAIN LEVEL 1 HCPCS CODES
Current Procedural Terminology (CPT), a numeric coding system set by the American Medical Association, is Level I of the HCPCS (AMA). The CPT is a standardized coding system that uses descriptive phrases and identifying codes to identify medical services and procedures performed by physicians and other healthcare professionals in an outpatient setting. The CPT is used by these health care providers to determine which treatments and procedures they can bill to public or private health insurance programs. The CPT codes, which make up Level I of the HCPCS, do not include codes required to individually record medical products or services that are routinely billed by suppliers.
WHAT IS INPATIENT?
REQUIRES HOSPITAL STAY
WHAT IS OUTPATIENT?
DOESN’T REQUIRE HOSPITAL STAY
PRIVATE VS. PUBLIC HEALTH INSURANCE
Health insurance that is supported or paid for totally using public (government) funding is known as public health insurance. Individuals insured(COVERED) by private health insurance pay a portion or all of the premiums.
EXAMPLE OF PUBLIC HEALTH INSURANCE
Medicare and Medicaid are the two primary kinds of public health insurance. Medicare is a government health-care program for those 65 and older, as well as persons with certain impairments. Medicaid is a government-run health-care program for low-income people and families with disabilities.
TWO PRIMARY KINDS OF PUBLIC HEALTHCARE
MEDICAID AND MEDICARE
EXAMPLES OF PRIVATE HEALTH INSURANCE
Private health insurance is primarily funded through benefits plans provided by employers. Examples include: Blue Cross and Blue Shield health insurance companies, KAISER ETC.
EXAMPLES OF PRIVATE HEALTH INSURANCE
Private health insurance is primarily funded through benefits plans provided by employers. Examples include: Blue Cross and Blue Shield health insurance companies, KAISER ETC.
LEVEL || HCPCS
- USED TO IDENTIFY ITEMS AND SUPPLIES NOT COVERED BY CPT ( AMBULANCE, PROSTHETICS, MEDICAL EQUP, USED OUTSIDE MEDICAL OFFICES)
- HCPCS codes were created to submit claims for these products.”
WHAT ARE NON-PHYSICIAN SERVICES?
AMBULANCE, WHEEL CHAIRS, WALKERS, MEDICAL EQUIP, NOT LISTED IN CPT ( INCLUDE MEDICINAL PRODUCTS AND DME- DURABLE MEDICAL EQUIP.
WHAT ARE MEDICINAL PRODUCTS?
A medicinal product is defined as any chemical or combination of substances that is advertised as having the ability to prevent or treat illness in humans.
WHAT ARE DME? EXAMPLES
DURABLE MEDICAL EQP FOR DAILY OR LONG TERM USE
-DME coverage may include oxygen equipment, wheelchairs, crutches, or diabetes blood testing strips.
RULE OF THUMB FOR CODING
When in doubt about whether to use CPT or HCPCS codes (these two sets are quite similar), use the guideline below.
When a CPT and an HCPCS Level II code for the same treatment or service have exactly the same content, use the CPT code. Use the HCPCS Level II code if the description is not same and somewhat different.
When a CPT code description includes an instruction to include extra information, such as describing a specific drug, look for an HCPCS national code. You can use HCPCS codes when the drug dose is crucial in the description since they provide additional detail in terms of pharmaceutical dosages.
WHAT ARE THE TWO MAIN JOBS OF CODERS?
TO PROTECT YOUR PROVIDERS
TO INCREASE REVENUE, MAXIMUM REIMBURSEMENT
TRUE OR FALSE
YOU CAN CODE WHAT IS NOT DOCUMENTED
FALSE
MISTAKES AND FALSE CODING CAN BE FINED AND AUDITED
DIFFERENCES BETWEEN CODER AND BILLER?
CODERS EXTRACT INFORMATION AND TURN THEM INTO CODES, HANDS CODES TO BILLERS
BILLERS- ENTER CODES INTO SYSTEM TO PROPER INSURANCE COMPANY
6 STEPS TO MEDICAL CODING
1.GATHER INFORMATION
2.ASK QUESTIONS IF NECESSARY
3. DIAGNOSIS OR DIAGNOSAS
4.PROCEDURE OR PROCEDURES
5.MEDICAL EQUIPMENT USED, MEDICAL NECESSITY
6.DOUBLE CHECK YOUR CODES
GADPED
