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LTC Chapter 1 Introduction to ICD-9-Cm Coding Set 1
Learning to Code 2010 Thomas J. Falen, Introduction to ICD-9-CM coding
30
Medical
Professional
06/16/2010

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Term
d
Definition

ICD-9-CM and CPT/HCPCS are used to:

a) provide data in order to understand, standardize, and improve health care

b) improve medical outcomes

c) improve patient services at a reduced cost to the consumer

d) all of the above

e) all but c

Term
International Cassification of Diseases, 9th Revision, Clinical Modification
Definition
What does ICD-9-CM mean?
Term
It emphasizes chronic diseases rather than acute infectious diseases that are more prevalent in developing countries
Definition
Why was ICD-9-CM developed specifically for use in the United States?
Term
Diagnosis related groups for inpatient hospital services
Definition
What was the first prospective payment system developed under the Medicare program?
Term
h
Definition

What influences the amount paid under the MS-DRG system?

a) principal diagnosis

b) complications

c) comorbidities

d) necessity of operating room procedures

e) age of patient

f) sex of patient

g) discharge status

h) all of the above

i) all but e and f

j) all but f

Term
MS-DRG relative weight X hospital base rate = amount reimbursed
Definition
What is the established formula for calculating a MS-DRG?
Term

$3492.68

 

0.7095 X 4,922.73 = 3492.68 (rounded figure)

Definition
How much is the reimbursement for the MS-DRG treatment of simple pneumonia (195) with a national relative weight of 0.7095 and the hospital base rate of $4,922.73?
Term
b, d, e
Definition

Huffman's basic rules of an effective coding classifications system are:

a) hospitals get the most money possible for a treatment

b) single classification principle

c) multiple classification principle

d) categories are exhaustive

e) categories are mutually exclusive

 

Term

False

 

A coder should always check the tabular section and verify it is the correct code

Definition
T or F: A coder should always code from the index
Term
1. b   2. a  3. c   4. d
Definition

Label (a) nonessential modifier  (b) main term  (c) subterm

  (d) connecting words

 

[1] Anxiety  [2] (neurosis) (reaction) (state)  300.00

[3]--  alcohol-induced  291.89

                !    depression    300.4                  

--  hysteria  300.20      

[4] in                

                              acute stress reaction 308.0

                     panic type  300.01

      

         

 

 

Term
nonessential modifier
Definition
adds information that will clarify code selection but does not change the code assignment
Term
Tabular List of Diseases
Definition
a list that contains 17 chapters relating to various body systems
Term
V code
Definition
code that when used as a principal diagnosis describes reason for contact with health services, and when used as a secondary diagnosis describes other factors influencing health care--describes not disease states but how their presence affects patient care
Term
E code
Definition
secondary diagnosis code that explains the external cause of injury, the external cause of a poisoning, and/or the adverse effect of a medication taken as prescribed
Term
Hypertension table, Neoplasm table, Table of Drugs and Chemicals
Definition

What three tables are available in the Alphabetic Index to Diseases that provide coders with easy access to related conditions associated with three main diseases?

 

Term
ICD-10
Definition
What classification system did the World Health Organization originally publish in 1992?
Term
UB-04, CMS 1450
Definition
standard billing forms used by hospitals
Term
CMS 1500
Definition
standard billing form used by physicians
Term
ICD-9-CM
Definition
What code set is used for reporting hospital inpatient services?
Term
ICD-9-CM, CPT/HCPCS
Definition
What code sets are used for reporting hospital outpatient services?
Term
ICD-9-CM, CPT/HCPCS
Definition
What code sets are used by physicians to report their services?
Term
to code causes of death on death certificates
Definition
ICD-10 is used in the United States at the moment for what purpose?
Term
October 1, 2013
Definition
When is the official implementation date for ICD-10CM and ICD-10-PCS in the United States?
Term
CMS
Definition
What is the abbreviation for United States Centers for Medicare and Medicaid Services?
Term
Prospective Payment Systems
Definition
What does PPS stand for?
Term
PPS
Definition
reimbursement formulas determined in advance of the health-care services rendered that are not based on the health-care provider's costs to treat the patient
Term
Tax Equity and Fiscal Responsibility Act
Definition
What does TEFRA stand for?
Term
types, number, medical records
Definition
Data on the ____ and ____ of diseases in the United States provide important information to help us understand the overall condition of our nation's health.  Information contained in patients' __________ holds great value in letting us know what is happening in our healthcare.
Term
ICD-9-CM
Definition
widely used classification system for coding, classifying, and identifying patient diseases and procedures in the United States
Term
numbers
Definition
Medical coding systems transform verbal medical descriptions of patient diseases and procedures into ______.
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