Types of Patients to Coding (Day 3)

Question 1

Types of Patients

Answer 1

1) New Patient
2) Established Patient
3) Inpatient
4) Outpatient

Question 2

Define

New Patient

Answer 2

A Patient who visits the Provider’s Office for the first time or after 36 months is called New Patient.

Question 3

Define

Established Patient

Answer 3

A Patient who often or regularly visits at Provider’s Office.

Question 4

Define

Inpatient

Answer 4

A Patient who takes more than 24 hours of service is called Inpatient.

Question 5

Define

Outpatient

Answer 5

A Patient who takes less than 24 hours of service is called Outpatient.

Question 6

Types of Hospital

Answer 6

1) SNF (Skilled Nursing Facility)
2) Hospice
3) Home Health Services
4) Ambulatory Surgical Center

Question 7

Define

SNF

Answer 7

SNF stands for Skilled Nursing Facility. It is a place where skilled and trained Nurses provide services to Patient.
(Pre-Operative services and Post-Operative services)

Question 8

Define

Hospice

Answer 8

A Patient who is terminally ill will be admitted into Hospice.

Question 9

Define

Home Health Services

Answer 9

A Patient who takes services at his home itself is called Home Health Services.

Question 10

Define

Ambulatory Surgical Center

Answer 10

It is a platform where only surgeries will be performed.

Question 11

Types of Physician

Answer 11

1) PCP (Primary Care Physician)/ Gatekeeper/ Reffering Provider
2) Specialist/ Rendering Provider
3) Ordering Physician (Duty Doctor): A person who performs services at pathology

Question 12

Define

Ordering Physician

Answer 12

Also known as Duty Doctor, who is a person who performs services at pathology/ laboratory centers.

Question 13

Full Explanation of:

Types of Forms

Answer 13

There are 2 types of forms that are: CMS-1500 and UB-04

• CMS-1500 stands for Center for Medicare & Medicaid Services. It is named as Professional claims/ Physician claims. It has total of 33 boxes in it. It is used for Outpatient services.
• UB-04 stands for Uniform Billing/ Universal Billing. It is named as Hospital claims/ Facility claims. It has total 81 boxes in it. It is used for Inpatient services.

Question 14

Define

CMS-1500

Answer 14

It stands for Center for Medicare & Medicaid Services. It is named as Professional claims/ Physician claims. It has total of 33 boxes in it. It is used for Outpatient services.

Question 15

Define

UB-04

Answer 15

It stands for Uniform Billing/ Universal Billing. It is named as Hospital claims/ Facility claims. It has total 81 boxes in it. It is used for Inpatient services.

Question 16

Coding

Answer 16

Coding has 4 parts in it: Anatomy, Diagnosis Code/DX Code, Procedure Code/Treatment Code/PX and Modifier.

Question 17

Full Explanation of:

Diagnosis Code

Answer 17

• It is a disease code also known as DX code. It has one platform called ICD (International Classification of Disease) regulated by WHO (World Health Organisation).
• Before 2014 we were using old format i.e. ICD-9 which has 3 to 5 volume, after 2015 we are using new format i.e. ICD-10CM (Clinical Modification) which has 5 to 7 volume and infinite.
• We will get Diagnosis code in box number 21 of claim form. 12 diagnosis code can be built in one claim form.
• ICD Index helps us to know which format of ICD we are using. 9 stands for old format i.e. ICD-9 (3-5 volume) and 0 stands for new format i.e. ICD-10CM (5-7 & infinite volume).

Question 18

Procedure Code

Answer 18

It is a code also known as Treatment Code/PX.
It has 3 parts in it:
1) CPT (Current Procedural Terminology)
2) HCPCS (Healthcare Common Procedural Coding System)
3) Local HCPCS Code
We can get Procedure code in box number 24 (D) of claim form. 6 procedure codes can be built in one claim form.

Question 19

What is CPT?

Answer 19

CPT stands for Current Procedural Terminology. It ranges into 6 parts:
i) Anesthesia (00100 - 01999)
ii) Surgery (10021 - 69990)
iii) Radiology (70041 - 79999)
iv) Pathology (80041 - 89298)
v) Evaluation & Management (99202 - 99499)
vi) Medicines & Drugs

Question 20

HCPCS

Answer 20

HCPCS stands for Health Care Common Procedural Coding System. It is a 5 digit code with 1 alphabet and 4 numerics. All the new treatments will come under HCPCS.

Question 21

Local HCPCS Code

Answer 21

It is a 5 digit code with 1 alphabet and 4 numerics. This code is used for DME (Durable Medical Equipments) like wheel chair, support stick, etc.

Question 22

Modifier

Answer 22

Modifier is used for additional information or pricing information. It is a two digit code which might be alpha, numeric or alpha-numeric.
We can get modifiers in box number 24(D) of claim form. 4 modifiers can be added infront of one Procedure code.