Medical Coding

Flashcards on Diagnostic and Procedural Coding

ICD-10-CM

International Classification of Diseases, maintained by the World Health Organization, used to track morbidity and mortality rates.

ICD-10 Codes

Alphanumeric codes providing a standardized way to classify and document medical conditions, symptoms, and diseases for medical records, billing, and research.

ICD-10 Alphabetic Index

The starting point for coding in ICD-10, but not the final code selection.

ICD-10 Tabular List

21 chapters of disease descriptions and codes based on body system or condition used to choose the final code.

ICD-10 Z Codes

Used when a person encounters health services for specified reasons or when circumstances influence their health but are not current injuries or illnesses.

CPT

Current Procedural Terminology; codes used to document procedures and services in outpatient settings, usually 5-digit numerical codes.

Modifiers

Describe a procedure code without changing its definition.

E/M Codes

Evaluation and Management codes (99202 to 99499) represent services provided by a physician or qualified healthcare professional.

Problem Focused Examination

A limited examination of the affected body area or organ system.

Expanded Problem Focused Examination

A limited exam of the affected area and other symptomatic or related body areas.

Detailed Examination

An extended exam of affected and related body areas.

Comprehensive Examination

A general multi-system exam or complete exam of a single organ system.

HCPCS

Healthcare Common Procedure Coding system; Level II codes represent non-physician services such as ambulance rides and medical equipment.

Downcoding

Reimbursement on a lower code level than submitted, often due to lack of documentation.

Upcoding

Reimbursement on a higher code level than submitted, considered fraudulent.

NPI

The National Provider Identifier; a unique identification number for covered health care providers.

A0427 (HCPCS)

ambulance service, ALS, emergency transport, level 1

A0428 (HCPCS)

ambulance service, BLS, non emergency transport

A0429 (HCPCS)

ambulance service, BLS. emergency transport

Evaluation and management

99201 - 33499

Anesthesiology

00100 - 01999; 99100 - 99149

surgery

10021 - 69990

radiology

70010 - 79999

pathology and laboratory

80048 - 89356

medicine

90281 - 99602; 99500 - 99602