MEDICAL CODING Flashcards
(37 cards)
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.