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Medical Billing Specialist > Week 2 - Ch. 4 & 5 > Flashcards

Week 2 - Ch. 4 & 5 Flashcards

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USMLE® Step 1 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
Q

three character code for classifying a disease or condition

A

category

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26
Q

four or five character code number

A

subcategory

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27
Q

tabular list entries addressing the applicability of certain codes to specified conditions

A

inclusion notes

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28
Q

tabular list entries limiting applicability of particular codes to specified conditions

A

exclusion notes

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29
Q

exclusion note used when two conditions could not exist together; such as an acquired and a congenital condition; means “not coded here”

A

excludes 1

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30
Q

exclusion note meaning that a particular condition is not included here; but a patient cound have both conditions at the same time

A

excludes 2

31
Q

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

A

laterality

32
Q

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)

A

ICD-10-CM Official Guidelines for Coding and Reporting

33
Q

first listed diagnosis

A

primary diagnosis

34
Q

additional illness that either has an effect on the patient’s primary illness or is also treated during the encounter

A

coexisting condition

35
Q

illness or condition with severe symptoms and a short duration

A

acute

36
Q

illness or condition with a long duration

A

chronic

37
Q

condition that remain after an acute illness or injury has been treated and resolved

A

sequelae

38
Q

in inpatient coding; the condition established after study to be chiefly responsible for the admission of the patient

A

principal diagnosis

39
Q

ICD-10-CM code for an external cause of a disesase or injury

A

external cause code

40
Q

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

A

Z code

41
Q

patient’s description of the symptoms or other reasons for seeking medical care

A

chief complaint (CC)

42
Q

previous HIPAA mandated diagnosis code set

A

ICD-9-CM

43
Q

acronym for general equivalence mappings; reference tables of related ICD-10-CM and ICD-9-CM codes

A

GEMs

44
Q

contains the standardized classification system for reporting medical procedures and services

A

Current Procedural Terminology (CPT)

45
Q

procedure codes found in the main body of CPT

A

Category I Codes

46
Q

optional CPT codes that track performance measures

A

Category II Codes

47
Q

temporary codes for emerging technology; services; and procedures

A

Category III Codes

48
Q

usages notes at the beginning of CPT sections

A

section guidelines

49
Q

service not listed in CPT

A

unlisted procedure

50
Q

note explaining the reasons for a new; variable; or unlisted procedure or service

A

special report

51
Q

procedure performed and reported in addition to the primary procedure

A

add-on code

52
Q

most resource intensive CPT procedure during an encounter

A

primary procedure

53
Q

CPT procedure codes that have been reassigned to another sequence

A

resequenced

54
Q

number appended to a code to report particular facts

A

modifier

55
Q

reflects the technician’s work and the equipment and supplies used in performing it

A

technical component (TC)

56
Q

represents a physician’s skill; time; and expertise used in performing it

A

professional component (PC)

57
Q

codes that cover physicians’ services performed to determine the optimum course for patient care

A

E/M Codes (Evaluation and mangement codes)

58
Q

service in which a physician advises a requesting physician about a patient’s condition and care

A

consultation

59
Q

factor documented for various levels of evaluation and management services

A

key component

60
Q

patient who receives healthcare in a hospital setting without admission

A

outpatient

61
Q

code used with anesthesia codes to indicated a patient’s health status

A

physical status modifier

62
Q

combination of services included in a single procedure code

A

surgical package

63
Q

combination of services included in a single procedure code

A

global surgery rule

64
Q

days surrounding a surgical procedure when all services relating to the procedure are considered part of the surgical package

A

global period

65
Q

descriptor used for a procedure that is usually part of a surgical package by may also be performed separately

A

separate procedure

66
Q

using a single payment for two or more related procedure codes

A

bundling

67
Q

incorrect billing practice of breaking a panel or package of services/procedures into component parts

A

unbundling

68
Q

incorrect billing practice in which procedures are unbundled and separatedly reported

A

fragmented billing

69
Q

single code grouping laboratory tests frequently done together

A

panel

70
Q

procedure codes from Medicare claims

A

Healthcare Common procedure coding system (HCPCS)

71
Q

HCPCS national codes

A

Level II

72
Q

reusable physical supplies ordered by the provider for home use

A

Durable medical equipment (DME)

73
Q

situation in which a policy never pays a provider

A

never event

Medical Billing Specialist (7 decks)

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