Week 2 - Ch. 4 & 5 Flashcards
value of estimates in patient treatment
helps the patient plan; helps the practice by collecting those fees as soon as possible; helps with confusion and expense with collections
professional fees
amount the provider charges
HIPAA mandated diagnosis code set
ICD-10-CM
3-7 character alphanumeric representation of a disease or condition
code
part of ICD-10-CM listing diseases and injuries alphabetically with corresponding diagnosis codes
alphabetic index
part of ICD-10-CM listing diagnosis codes in chapters alphanumerically
tabular list
summary table of code numbers for neoplasms by anatomical site and divided by the description of the neoplasm
neoplasm table
index in table format of drugs and chemicals that are listed in the tabular list
table of drugs and chemicals
index of all external causes of diseases and injuries classified in the tabular list
index to external causes
physician’s description of the main reason for a patient’s encounger
diagnostic statement
typographic technique that provides visual guidance for understanding information
convention
word that identifies a disease or condition in the alphabetic index
main term
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
default code
word or phrase that describes a main term in the alphabetic index
subterm
cause or origin of a disease or condition
etiology
supplementary word or phrase that helps define a code in ICD-10-CM
nonessential modifier
name or phrase formed from or based on a person’s name
eponym
abbreviation indicating the code to use when a disease or condition cannot be placed in any other category
NEC (not elsewhere classifiable)
term that indicated the code to use when no information is available for assigning the disesase or condition a more specific code
NOS (not otherwise specified)
characteristic sign or symptom of a disease
manifestation
code for diagnosis that is the patient’s main condition; in cases involving an underlying condition and a manifestatoin; the underlying condition is the
first listed code
single code describing both the etiology and the manifestation(s) ofa a particular condition
combination code
character “x” inserted in a code to fill a blank space
placeholder character (X)
necessary assignment of a seventh character to a code; often for the sequence of an encounter
seventh character extension
three character code for classifying a disease or condition
category
four or five character code number
subcategory
tabular list entries addressing the applicability of certain codes to specified conditions
inclusion notes
tabular list entries limiting applicability of particular codes to specified conditions
exclusion notes
exclusion note used when two conditions could not exist together; such as an acquired and a congenital condition; means “not coded here”
excludes 1
exclusion note meaning that a particular condition is not included here; but a patient cound have both conditions at the same time
excludes 2
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
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
first listed diagnosis
primary diagnosis
additional illness that either has an effect on the patient’s primary illness or is also treated during the encounter
coexisting condition
illness or condition with severe symptoms and a short duration
acute
illness or condition with a long duration
chronic
condition that remain after an acute illness or injury has been treated and resolved
sequelae
in inpatient coding; the condition established after study to be chiefly responsible for the admission of the patient
principal diagnosis
ICD-10-CM code for an external cause of a disesase or injury
external cause code
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
patient’s description of the symptoms or other reasons for seeking medical care
chief complaint (CC)
previous HIPAA mandated diagnosis code set
ICD-9-CM
acronym for general equivalence mappings; reference tables of related ICD-10-CM and ICD-9-CM codes
GEMs
contains the standardized classification system for reporting medical procedures and services
Current Procedural Terminology (CPT)
procedure codes found in the main body of CPT
Category I Codes
optional CPT codes that track performance measures
Category II Codes
temporary codes for emerging technology; services; and procedures
Category III Codes
usages notes at the beginning of CPT sections
section guidelines
service not listed in CPT
unlisted procedure
note explaining the reasons for a new; variable; or unlisted procedure or service
special report
procedure performed and reported in addition to the primary procedure
add-on code
most resource intensive CPT procedure during an encounter
primary procedure
CPT procedure codes that have been reassigned to another sequence
resequenced
number appended to a code to report particular facts
modifier
reflects the technician’s work and the equipment and supplies used in performing it
technical component (TC)
represents a physician’s skill; time; and expertise used in performing it
professional component (PC)
codes that cover physicians’ services performed to determine the optimum course for patient care
E/M Codes (Evaluation and mangement codes)
service in which a physician advises a requesting physician about a patient’s condition and care
consultation
factor documented for various levels of evaluation and management services
key component
patient who receives healthcare in a hospital setting without admission
outpatient
code used with anesthesia codes to indicated a patient’s health status
physical status modifier
combination of services included in a single procedure code
surgical package
combination of services included in a single procedure code
global surgery rule
days surrounding a surgical procedure when all services relating to the procedure are considered part of the surgical package
global period
descriptor used for a procedure that is usually part of a surgical package by may also be performed separately
separate procedure
using a single payment for two or more related procedure codes
bundling
incorrect billing practice of breaking a panel or package of services/procedures into component parts
unbundling
incorrect billing practice in which procedures are unbundled and separatedly reported
fragmented billing
single code grouping laboratory tests frequently done together
panel
procedure codes from Medicare claims
Healthcare Common procedure coding system (HCPCS)
HCPCS national codes
Level II
reusable physical supplies ordered by the provider for home use
Durable medical equipment (DME)
situation in which a policy never pays a provider
never event
