Medical Coding & Billing Chapter 6

The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes and classifies ____________ or morbidity data from inpatient and outpatient encounters.

disease

The International Classification of Diseases, 10th Revision, Procedure Classification System (ICD-10-PCS) codes and classifies _______________ data from inpatient hospital admissions only.

procedure

The Centers for Medicare and Medicaid Services (CMS) abbreviates ICD-10-CM and ICD-10-PCS as ____________.

ICD-10-CM/PCS

The intent of ICD-10-CM is to describe the ____________ picture or findings of the patient, which means codes assigned are more precise than those needed for ICD-9-CM's statistical groupings and trend analysis.

clinical

ICD-10-CM codes require up to ______ characters, are entirely alphanumeric, and have unique coding conventions.

7

ICD-10-CM uses an alphabetic index to initially locate codes for conditions and a ___________ list to verify codes.

tabular

The reporting of ICD-10-CM/PCS codes was mandated by ____________ legislation.

HIPAA

Reporting ICD-10-CM codes on submitted claims ensures the medical _____________ of procedures and services provided to patients during an encounter, which is defined as "the determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury."

necessity

The face-to-face contact between a patient and a health care provider who assesses and treats the patient's condition is called a(n) _______________.

encounter

The criteria used to determine medical necessity include purpose, scope, evidence, and _____________________.

value

The ICD-10-CM Tabular List of Diseases and Injuries is a chronological list of codes contained within ______ chapters, which are based on body system or condition.

22

Codes for Special Purposes (U00-U85) is used for the _______________ assignment of codes for new diseases of uncertain etiology or for emergency use.

provisional

All of ICD-10-CM's categories contain a minimum of ______ characters.

3

A three-character ICD-10-CM category that has no further subdivision is a _______________code.

valid

ICD-10-CM codes that contain 4 or 5 characters are considered codes when additional characters are required.

subcategory

Codes that have an applicable seventh character are considered ______________ without the seventh character.

invalid

The seventh character must always be located in the seventh-character data field, and if a code that requires a seventh character is not six characters in length, placeholder letter _____ is entered to fill in the empty character(s).

X

Factors Influencing Health Status and Contact with Health Services are incorporated into ICD-10-CM's Tabular List of Diseases and Injuries as codes that begin with the letter _____.

Z

The official guidelines for coding and reporting using ICD-10-CM and ICD-10-PCS have been approved by the four organizations that comprise the _________________ Parties for the ICD-10-CM/PCS.

cooperating

The abbreviations for the four organizations that develop and approve the coding guidelines are AHA, AHIMA, CMS, and __________.

NCHS

The official coding guidelines refer to physicians and qualified health care practitioners who are legally accountable for establishing the patient's diagnosis as ______________.

providers

Neoplasms: Primary malignant melanoma of skin of scalp. Enter code

C43.4

Neoplasms: Lipoma of face. Enter code

D17.0

Neoplasms: Glioma of the parietal lobe of the brain. Enter code

C71.3

Neoplasms: Primary adenocarcinoma of prostate. Enter code

C61

Neoplasms: Carcinoma in situ of vocal cord. Enter code

D02.0

Neoplasms: Hodgkin's granuloma of intra-abdominal lymph nodes. Enter code

C81.93

Neoplasms: Paget's disease with primary infiltrating duct carcinoma of nipple and areola of right breast (female). Enter code

C50.011

Neoplasms: Secondary liver cancer. Enter codes

C78.7, C80.1

Neoplasms: Metastatic adenocarcinoma from breast to brain (right mastectomy performed five years ago; breast cancer is no longer present). Enter codes

C79.31, Z85.3

Neoplasms: Cancer of the pleura (primary site). Enter code

C38.4

Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism: Sickle cell disease with crisis. Enter code

D57.00

Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism: Iron deficiency anemia secondary to chronic blood loss. Enter code

D50.0

Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism: Von Willebrand disease. Enter code

D68.09

Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism: Chronic congestive splenomegaly. Enter code

D73.2

Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism: Congenital nonspherocytic hemolytic anemia. Enter code

D55.8

Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism: Essential thrombocytopenia. Enter code

D69.3

Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism: Malignant neutropenia. Enter code

D70.9

Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism: Fanconi's anemia. Enter code

D61.09

Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism: Microangiopathic hemolytic anemia. Enter code

D59.4

Diseases of the Blood and Blood-Forming Organs and Certain Disorders Involving the Immune Mechanism: Aplastic anemia secondary to antineoplastic medication (initial encounter) for left lower female breast cancer. Enter codes

D61.1, T45.1X5A, C50.812