human nature

index

you can never code directly from the index

manifestation

A symptom or sign of an ailment

Excludes 1

Not Coded Here: not to e assigned. Excludes 1 is used when two conditions cannot occur together

code first/additional code

Etiology code followed by manifestation code

codes are used to

Facilitate payment of health services Evaluate patients use of health care facilities study health care costs research the quality of health care predict health care trends and plan for future health care needs

combination

Flag 3 contains a 1 when a code from the source system must be linked to more than one conde in the target system to be valid

The WHO

I-10 was orginally issued in 1993 by the World Health Organization

scenario and choice list

Fourth field is the scenario and fifth fields is the choice list choice indicates possible target system codes that when combied are one valid scenario

descriptive alphanumeric

verbal, narraative

etiology

The cause, set of causes

Three levels of indentation in the alphabetic index

Main term

Sub terms

Carryover terms

Alphabetic Index divided into three sections

Index to Diseases and Injuries

Table of Drugs and Chemicals

External Cause and Injuries Index

Main term are in

Bold print

Classification of patient

Morbidity (sickness) Mortality (death)

No Mapping

Means that there is no similar code from one coding systen to the other, When this occurs, there will be 1 as the second character in Flag 2

Code also

instruct that two codes may be required to fully describe a condition but the sequencing of the two codes is discretionary, depending on the severity of the condition and the reason for the encounter

Approximate, Flag 0

Means there is a direct match between the two coding systems

Three types of flag designation

Approximate, No Map Combination

Excludes 2

Not included here. Note indicates that the condition excluded is not part of the condition is is excluded from and a patient may have both conditions at the same time, t is acceptable to use both the code and excudes 2 code together

Alphabetic index consists of three sections

Index to diseases and injuries, Table of Drugs and Chemical External cause of injuries index

Mapping

Crosswalk to find corresponding diagnosis codes between the two code sets. Called GEMs

GEM stand for

General Equivalence Mappings

7th character designates the encounter

A initial encounter, D subsequent encounter, s sequela

Approximate, Flag 1

Assists in the process of conversion by identifying thaose times when more than one code in the I-10 is availabe to replace an I-9 code

CM stand for

Clinical Modification

X placeholder

is used to identify a placeholder that may be expanded in the future

NEC

other specified

NOS

unspecified not otherwise specified

Default code

listed next to a main term in ICD-10-CM Alphabetic index

Number of chapters in the coding book

21

Colon

located in tabular list after the incomplete term that needs one or more of the modifiers that follow in order to make the condition assignable

And

means and/or

With

means two conditions are included in the code

the government through medicare

Who is the largest 3rd party payer in the nation?

Medicare Administrative Contractors

Who handles the day to day operations of the Medicare program for the CMS?

Hospital/facility care

Medicare Part A pays for:

durable medical equipment & supplemental medical insurance

Medicare Part B pays for:

1965--with the passage of the Social Security Act

The Medicare program was established in:

Direct payment, 5% higher fee schedule, faster processing of claims, providers name is in the QIO Directory

The incentive to Medicare participating providers is:

diagnosis codes, CPT codes, HCPCS

Part B services are billed using

80%

Medicare pays for what percentage of covered charges?

Relative Value Units, Geographic Practice Cost Index, Conversion Factor

The physician fee schedule is updated each April 15, and is composed of:

1989-(this act requires participating providers to accept the amount paid, mandatory assignment as payment in full)

A major change took place in Medicare in _____________with the enactment of the Omnibus Budget Reconcilliation Act

November or December edition

What edition of the Federal Register would outpatient facilities be especially interested in?

Global

Medicare sets the payment level for assistant surgeons at a percentage of the fee schedule amount for the ___________surgical service

Medicare Part C

This jprogram is also known as Medicare Advantage

Decrease Medicare expenditures, redistribute physicians payments more equitably, and ensures quality healthcare at a reasonable rate

What are the stated goals of the Physician Payment Reform

Social Security Administration

Medicare funds are collected by:

1st-100%; and 50% on each subsequent

If a surgeon performs more than one procedure on the same patient on the same day, and discounts were made on all subsequent procedures, Medicare would pay what percentages for the first, second, third, fourth, and fifth procedures?

deductible, premium, and coinsurance

What are the three items that the Medicare beneficiaries are responsible for paying before Medicare will begin to pay for services?

`October editions

What edition of the Federal Register would hospital facilities be especially interested in?

Medicare Part D-Prescription Drugs

The Medicare Prescription Drug Improvement, and Modernization Act of 2003 established these new benefits available under the Medicare program

Medicare Administrative Contractors

CMS handles the daily operation of the Medicare program through the use of ____________________________

Resource Based Relative Value Scale

RBRVS

Omnibus Budget Reconcilliation Act

OBRA

Department of Health and Human Services

DHHS

Relative Value Units

RVU

Office of Inspector General

OIG

Maximum Actual Allowable Charge

MAAC

The Federal Register is the offical publication for all_______________________

presidential documents, rules and regulations, proposed rules and notices

______________ is an intential deception or misrepresentation that an individual knows to be false or does not believe to be true, and makes knowing that the deception could result in some unauthorized benefit to himself/herself or some other personF

Fraud

The ________________ responsibility is to ensure that the data are as accurate as possible not only for classification and study purposes but also to obtain appropriate reimbursement

coder's

Nationally, __________________ have been assigned for each service by Medicare (CPT and HCPCS) and determined on the basis of the resources necessary for the physician's performance of the service

unit values

Kickbacks from patients are illegal and not allowed under any circumstances according to ______________

Medicare guidelines

transaction

activities involving the transfer of health care information

transmission

movement of electronic data