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Definition
| a number of things bound together |
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| one who carries, transports; with insurance, it;s the company who provides the policy |
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| giving a share; helping toward a result |
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| current procedural terminology |
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| (CPT)- a numerical listing of procedures performed in medical practice; a standardized identification of procedure. Published by the American Medical Association |
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| to meet unexpectedly, or by chance |
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| listing of allowable charge |
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| international classification of diseases |
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| (ICD)- a comprehensive listing of diseases and disorders of the human body |
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| changes; limits the meaning |
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| a system of technical or scientific names |
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| denoting a number or system of numbers |
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| occurring first in time, development, or sequence; earliest |
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| refers to the purpose or reason for doing a test or procedure, an insurance company criteria for reimbursement |
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| to pay back or compensate for money spent, or for losses or damages incurred |
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| one step removed from the first; not primary |
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| named particularly; mentioned in detailed |
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| third-party reimbursement |
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Definition
| indicates payment made for services rendered by someone else than the patient |
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| to cut the top or end off; to lop; with insurance |
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Term
| Today, the most common third-party reimbursers are ____ |
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Definition
| federal and state agencies, insurance companies, and worker's compensation |
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Before, third-party reimbersement was easy and simple
T/F
Why? |
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Definition
T
because the contract for services was primarily between the physician and the patient and controls were minimal |
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Term
| As early as 1890's, a physician developed a _______ and it should be revised every ____ yrs |
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Definition
| classification of causes of death. 10 |
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| As early as 1890's, a physician developed a classification of causes of death which should be revised every ______ yrs. And in 1938, the _________ |
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Definition
| 10. fifth revision had evolved into ICD |
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By 1978, the _____ version of the
ICD-9-CM was issued |
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| Internatinal Classification of Diseases-9th edition-Clinical Modification |
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| What will be the full title of the ICD book |
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Definition
| International Statistical Classification of Diseases and Related Health Problems |
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| the particular listing of alpha-numeric codes as ICD-9 |
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| an instructinal manual that provides rules and guidelines of coding |
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| an alphabetic index of the codes in the tabular list |
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Definition
| the transferal of verbal or written descriptions of disease or injury into numeric designations to achieve uniform data that can be easily entered into electronic processing and storage systems |
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| When did ICD coding wasn't no longer an option, but a requirement |
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| the physician's reimbursement is based upon |
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Definition
| disease or condition presented by the patient |
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Definition
| Current Procedural Terminology |
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Definition
| procedures and services the physician provides for the patient |
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Term
Coding mistakes not only cost the physician, but patients are also affected!
How |
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Definition
| because if a mistake is made, the insurance won't pay, which means services are not covered and patients will have to pay out of pocket |
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Term
| one of the most important factors to remember is that the codes have to be |
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Definition
sequenced in relation to the intensity and level of serviced provided.
List primary reason of office visit first, then other reason in order of importance |
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Term
| to become an accurate and efficient coder, three things are necessary: |
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Definition
a working knowledge of Medical terminology
an understanding of anatomy and physiology
comprehension of ICD characteristics and terminology |
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Definition
| factors influencing health status and contact with health serice |
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Definition
| external causes of injury and poisoning |
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Definition
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| why were claims forms developed? |
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Definition
| for the purpose of receiving payment for medical services |
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Definition
1. Code Dx/procedures that affects the care, influences the health status, or is the reason for treatment on that visit
2. Code the minimum # of diagnoses that fully describe the patient's care received on that visit. It must reflect the patient's need for treatment, x-rays, diagnostic procedures, or medications
3. Code ea. problem to the highest level of specificity (3rd, 4th, or 5th digit) available in the classification
4. Sequence codes correctly so that it is possible to understand the chronology of events |
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Term
| what is the main coding rule to remember |
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Definition
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Term
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Definition
| the reason for the patient's visit should be coded first, and the other issues coded next in order of importance |
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| List the six sections of CPT book |
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Definition
1. evaluation & management (E/M)
2. anesthesiology
3. surgery
4. radiology (including nuclear med. & Dx Ultrasound)
5. pathology and lab
6. Medicine (except anesthesiology) |
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Term
| List the six sections of CPT book |
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Definition
1. evaluation & management (E/M)
2. anesthesiology
3. surgery
4. radiology (including nuclear med. & Dx Ultrasound)
5. pathology and lab
6. Medicine (except anesthesiology) |
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Term
| common errors made when filing claims forms |
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Definition
1. incorrect ICD codes
2. incorrect CPT codes
3. COB section is not completed
4. Superbills attached to a claim form are sometimes illegible
5. incorrect patient birthdate
6. member doesnt respond to request for clarification of insurances covering injuries when another party might have responsibility
7. incorrect spelling of patient name
8. lack of operative report if procedure is unusual/complicated/fee is unusual
9. incorrect provider ID#
10. incosistent use of patient's middle name
11. patient ssn used as the cert. #
12. use of incorrect place of service code |
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Term
| reasons why coding is beneficial |
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Definition
1. provides method of clinical communication and care planning among healthcare practicioners, employers, and patients.
2. serves to justify the reason for the med. care provided
3. provide governmental agencies, and any other entity assessing the patient's medical records accurate and complete info |
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Term
| What change occurred with the catastrophic coverage act of 1988? |
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Definition
| the way physicians manage their practice |
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Term
| Medicare reimburses the approved fee at the rate of |
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Definition
| 80% after year's annual deductible amount has been paid by patient and secondary is then sought to cover the 20% no covered |
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Term
Which of the following would be used to identify an incision and drainage procedure?
a. ICD
b. CPT
C. FDA
d. PDA |
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Definition
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| How often are the coding books published? |
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Definition
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Some government payers and commercial insurance carriers require use of the next year's codes as of:
a. 10-01 of the current year
b. 06-01 of the current year
c. 12-01 of the current year
d. 09-01 of the current year |
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Definition
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Which of the codes are related to medical services as opposed to surgical services?
a. CPT
b. ICD
c. E/M
d. M/E |
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Definition
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Term
Which method is best for keeping up to date with medicare changes?
a. Call Medicare
b. Request a booklet
c. Visit its website
d. Attend seminars |
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Definition
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Term
When a physician agrees to accept the approved amount as his or her fee. this is known as
a. a fee schedule
b. Accepting assignment
c. Being a prefferred provider
d. assigning benefits |
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Definition
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Term
| What is the term used to describe payment by someone other than the patient for services rendered |
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Definition
| third party reimbursement |
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| Which rule is designated as the main rule of coding |
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Definition
| identify products and supplies |
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Definition
| Healthcare Common Procedure and Coding system |
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