Module 1 Flashcards
What’s Medical Coding?
Medical coding involves assigning specific codes to various medical services and procedures.
What’s the order of Medical coding and billing?
1- scheduling and registration
2-Insurance Verification
3- Coding and Charge Capture
4- Medical Records
5- Claim Submission and billing
6-Patients pay collection and payment review
Accurate coding and billing contribute to patient safety and care ___.?
continuity
The acronym HIPAA stands for which of the following?
Health Insurance Portability and Accountability Act
Medical terminology?
Medical terminology forms the foundation of medical coding and billing processes.
Billing terminology
Billing terminology encompasses the specific language and concepts used in the billing and reimbursement processes. It involves understanding terms related to insurance coverage, claims submission, payment systems, and financial transactions within the healthcare industry.
Compliance terminology
Compliance terminology refers to the vocabulary and concepts related and adherence to legal and regulatory requirements in the healthcare industry.
CPT codes (Current Procedural Terminology)
American Medical Association created specify the services a doctor or clinic provides. There are four categories. Category 1 codes represent procedures or services. Category 2 is used solely for performance evaluation and is appended to a Category 1 code. Category 3 codes represent brand-new technologies or emerging services. PLA codes are codes for proprietary laboratory analyses.
Healthcare Common Procedural Coding System (HCPS)
The Medicaid and Medicare Services developed this system. They are used to determine medications, supplies, or hospital services.
International Classification of Diseases (ICD)
WHO (World Health Organization) developed this service as an international language for health statistics. All potential illnesses, injuries, and causes of mortality are coded on a map of the human condition from conception to death.
Medical Coding Process
- Assessing patient chart, pre-coding
- Pre-coding
- CPT and ICD -19 coding
- Quality audit
- Submission of coded charts
Category 1
represents procedures or services: it includes codes from 00100-99499
Category 2/SupplementL Codes
used solely for performance evaluation and are appended to a Category 1, due to their nature affixing these tags to category 1 codes are simpler
Category 3
Brand new technologies or emerging services. There mostly used for data gathering, evaluation, and processes that still need to satisfy the requirements for a Category 1 code
PLA Codes
they’re for proprietary laboratory analysis. There codes that just received COT codes. They resemble Category 3 in some ways how ever there only used for services and technology that may be provided by a single healthcare facility, physician, or laboratory or that may be offered to a number of laboratories that have received FDA approval
HCPCS
Healthcare Common Procedural Coding System
HCPCS what is it used for
- This system is used to determine medications, supplies , or hospital services
Is it important?
Yes, - CMS and some third-party payers mandate physician to submit claims with HCPCS codes, although private payers typically use CPT codes. Organizations are required to use HCPCS codes under the HIPAA
What are they used for
- HCPCS codes are used to describe non-physician services, such as the usage of prescription drugs, durable medical equipment, and ambulance services.
What do CPT NOT DO
- CPT codes do not list the supplies a provider utilizes; they solely describe the operation
ICD Stands for?
International Classification of Diseases
Who created ICD
Who (World Health Organization)
What is ICD
- WHO(World Health Organization) developed ICD ( International Classification of Diseases) service as an international language for health statistics
Is it used frequently
Almost all healthcare decisions made today are based on six health statistics
What are six health statistics it’s based on
- Knowing what causes illness and deaths(morbidity, and morality).
- Tracking epidemics and trends and illnesses.
- Choosing a health service programming strategy.
- Allocating funds for healthcare.
- Research and development investments.
- Preparing and planning for new medical facilities.
