Medical Coding

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26 Terms

1
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What is the International Classification of Diseases (ICD-10-CM)?

codes for patient diagnoses; maintained by World Health Organization (WHO)

2
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What do ICD-10 codes start with?

letters followed by numbers

3
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How many characters do ICD-10 codes consist of?

three to seven

4
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What is needed for an ICD-10 code?

description of chief complaint, review of systems (ROS), patient exam, and proper documentation by both provider and MA

5
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What serves as the starting point for ICD-10 coding?

alphabetic index

6
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What is the tabular list?

21 chapters of disesase descriptions/codes based on body system or condition

7
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Where should you choose the final ICD-10 code?

tabular list

8
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What are ICD-10 Z codes used for?

indicate the presence of a health-related circumstance or problem, which is not necessarily an injury or illness; what isn't affecting the patient right now but might in the future

9
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What is Current Procedural Terminology (CPT)?

codes used to document/explain procedures and services provided

10
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How many characters are CPT codes?

5 characters; all numerical

11
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How should ICD-10 codes and CPT codes relate?

diagnosis codes MUST match/correlate with procedure codes

12
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What are modifiers?

words that help further describe a procedure code without changing its definition

13
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What are the range of CPT codes for Evaluation and Management (E&M)?

99202-99499

14
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What do E&M codes represent?

Level of complexity of the patient's care provided by provider

15
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Problem-focused exams are focused on

limited examination of the affected body area or organ system

16
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Expanded Problem-Focused Examinations are focused on

Limited examination of the affected body area or organ system and other symptomatic or related organ system(s)

17
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Detailed examinations are focused on

Extended examination of the affected body area(s) and other symptomatic or related organ system(s)

18
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Comprehensive examinations are focused on

general multi-system examination OR complete examination of a single organ system and other symptomatic or related body area(s) or organ system(s)

19
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What are Healthcare Common Procedure Coding (HCPCS) codes for?

represent non-physician services, e.g., ambulance rides, wheelchairs, walkers, etc.

20
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What is a superbill?

Encounter form, source document for billing purposes that contains PT account information and insurance codes for the date of service.

21
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What is downcoding?

applying a code for less than the services that were performed by provider

22
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What is the common cause of downcoding?

lack of documentation

23
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What is upcoding?

submitting a bill for a higher level of reimbursement than actually rendered in order to receive the higher reimbursement

24
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What is important to know about upcoding?

it is fraudulent

25
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What is the National Provider Identifier number?

unique identification number for covered healthcare providers

26
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When it comes to using clearinghouses, what should be used?

the National Provider Identifier number