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What is the International Classification of Diseases (ICD-10-CM)?
codes for patient diagnoses; maintained by World Health Organization (WHO)
What do ICD-10 codes start with?
letters followed by numbers
How many characters do ICD-10 codes consist of?
three to seven
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
What serves as the starting point for ICD-10 coding?
alphabetic index
What is the tabular list?
21 chapters of disesase descriptions/codes based on body system or condition
Where should you choose the final ICD-10 code?
tabular list
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
What is Current Procedural Terminology (CPT)?
codes used to document/explain procedures and services provided
How many characters are CPT codes?
5 characters; all numerical
How should ICD-10 codes and CPT codes relate?
diagnosis codes MUST match/correlate with procedure codes
What are modifiers?
words that help further describe a procedure code without changing its definition
What are the range of CPT codes for Evaluation and Management (E&M)?
99202-99499
What do E&M codes represent?
Level of complexity of the patient's care provided by provider
Problem-focused exams are focused on
limited examination of the affected body area or organ system
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)
Detailed examinations are focused on
Extended examination of the affected body area(s) and other symptomatic or related organ system(s)
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)
What are Healthcare Common Procedure Coding (HCPCS) codes for?
represent non-physician services, e.g., ambulance rides, wheelchairs, walkers, etc.
What is a superbill?
Encounter form, source document for billing purposes that contains PT account information and insurance codes for the date of service.
What is downcoding?
applying a code for less than the services that were performed by provider
What is the common cause of downcoding?
lack of documentation
What is upcoding?
submitting a bill for a higher level of reimbursement than actually rendered in order to receive the higher reimbursement
What is important to know about upcoding?
it is fraudulent
What is the National Provider Identifier number?
unique identification number for covered healthcare providers
When it comes to using clearinghouses, what should be used?
the National Provider Identifier number