Week 2 - Ch. 4 & 5 Flashcards

1
Q

value of estimates in patient treatment

A

helps the patient plan; helps the practice by collecting those fees as soon as possible; helps with confusion and expense with collections

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2
Q

professional fees

A

amount the provider charges

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3
Q

HIPAA mandated diagnosis code set

A

ICD-10-CM

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4
Q

3-7 character alphanumeric representation of a disease or condition

A

code

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5
Q

part of ICD-10-CM listing diseases and injuries alphabetically with corresponding diagnosis codes

A

alphabetic index

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6
Q

part of ICD-10-CM listing diagnosis codes in chapters alphanumerically

A

tabular list

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7
Q

summary table of code numbers for neoplasms by anatomical site and divided by the description of the neoplasm

A

neoplasm table

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8
Q

index in table format of drugs and chemicals that are listed in the tabular list

A

table of drugs and chemicals

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9
Q

index of all external causes of diseases and injuries classified in the tabular list

A

index to external causes

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10
Q

physician’s description of the main reason for a patient’s encounger

A

diagnostic statement

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11
Q

typographic technique that provides visual guidance for understanding information

A

convention

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12
Q

word that identifies a disease or condition in the alphabetic index

A

main term

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13
Q

ICD-10-CM code listed next to the main term in the alphabetic index that is most often associated with a particular disease or condition

A

default code

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14
Q

word or phrase that describes a main term in the alphabetic index

A

subterm

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15
Q

cause or origin of a disease or condition

A

etiology

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16
Q

supplementary word or phrase that helps define a code in ICD-10-CM

A

nonessential modifier

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17
Q

name or phrase formed from or based on a person’s name

A

eponym

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18
Q

abbreviation indicating the code to use when a disease or condition cannot be placed in any other category

A

NEC (not elsewhere classifiable)

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19
Q

term that indicated the code to use when no information is available for assigning the disesase or condition a more specific code

A

NOS (not otherwise specified)

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20
Q

characteristic sign or symptom of a disease

A

manifestation

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21
Q

code for diagnosis that is the patient’s main condition; in cases involving an underlying condition and a manifestatoin; the underlying condition is the

A

first listed code

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22
Q

single code describing both the etiology and the manifestation(s) ofa a particular condition

A

combination code

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23
Q

character “x” inserted in a code to fill a blank space

A

placeholder character (X)

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24
Q

necessary assignment of a seventh character to a code; often for the sequence of an encounter

A

seventh character extension

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25
three character code for classifying a disease or condition
category
26
four or five character code number
subcategory
27
tabular list entries addressing the applicability of certain codes to specified conditions
inclusion notes
28
tabular list entries limiting applicability of particular codes to specified conditions
exclusion notes
29
exclusion note used when two conditions could not exist together; such as an acquired and a congenital condition; means "not coded here"
excludes 1
30
exclusion note meaning that a particular condition is not included here; but a patient cound have both conditions at the same time
excludes 2
31
use of ICD-10-CM classification system to capture the side of the body that is documented; the fourth; fifth; or sixth characters of a code specify the affected side
laterality
32
general rules; inpatient (hospital) coding guidelines; and outpatient (physician/office/clinic) coding guidance from the four cooperating parties (CMS advisers and participants from the AHA; AHIMA; and NCHS)
ICD-10-CM Official Guidelines for Coding and Reporting
33
first listed diagnosis
primary diagnosis
34
additional illness that either has an effect on the patient's primary illness or is also treated during the encounter
coexisting condition
35
illness or condition with severe symptoms and a short duration
acute
36
illness or condition with a long duration
chronic
37
condition that remain after an acute illness or injury has been treated and resolved
sequelae
38
in inpatient coding; the condition established after study to be chiefly responsible for the admission of the patient
principal diagnosis
39
ICD-10-CM code for an external cause of a disesase or injury
external cause code
40
abbreviation for codes from 21st chapter of the ICD-10-CM that indentify factors that infuence health status and encoutners that are not due to illness or injury
Z code
41
patient's description of the symptoms or other reasons for seeking medical care
chief complaint (CC)
42
previous HIPAA mandated diagnosis code set
ICD-9-CM
43
acronym for general equivalence mappings; reference tables of related ICD-10-CM and ICD-9-CM codes
GEMs
44
contains the standardized classification system for reporting medical procedures and services
Current Procedural Terminology (CPT)
45
procedure codes found in the main body of CPT
Category I Codes
46
optional CPT codes that track performance measures
Category II Codes
47
temporary codes for emerging technology; services; and procedures
Category III Codes
48
usages notes at the beginning of CPT sections
section guidelines
49
service not listed in CPT
unlisted procedure
50
note explaining the reasons for a new; variable; or unlisted procedure or service
special report
51
procedure performed and reported in addition to the primary procedure
add-on code
52
most resource intensive CPT procedure during an encounter
primary procedure
53
CPT procedure codes that have been reassigned to another sequence
resequenced
54
number appended to a code to report particular facts
modifier
55
reflects the technician's work and the equipment and supplies used in performing it
technical component (TC)
56
represents a physician's skill; time; and expertise used in performing it
professional component (PC)
57
codes that cover physicians' services performed to determine the optimum course for patient care
E/M Codes (Evaluation and mangement codes)
58
service in which a physician advises a requesting physician about a patient's condition and care
consultation
59
factor documented for various levels of evaluation and management services
key component
60
patient who receives healthcare in a hospital setting without admission
outpatient
61
code used with anesthesia codes to indicated a patient's health status
physical status modifier
62
combination of services included in a single procedure code
surgical package
63
combination of services included in a single procedure code
global surgery rule
64
days surrounding a surgical procedure when all services relating to the procedure are considered part of the surgical package
global period
65
descriptor used for a procedure that is usually part of a surgical package by may also be performed separately
separate procedure
66
using a single payment for two or more related procedure codes
bundling
67
incorrect billing practice of breaking a panel or package of services/procedures into component parts
unbundling
68
incorrect billing practice in which procedures are unbundled and separatedly reported
fragmented billing
69
single code grouping laboratory tests frequently done together
panel
70
procedure codes from Medicare claims
Healthcare Common procedure coding system (HCPCS)
71
HCPCS national codes
Level II
72
reusable physical supplies ordered by the provider for home use
Durable medical equipment (DME)
73
situation in which a policy never pays a provider
never event