Medical Billing and Coding Lecture Review

Flashcards covering key terminology, documentation rules, and procedural categories for medical billing and coding based on class notes.

What is an Encounter Form/superbill?

A document listing procedures and codes.

What is Appendix A?

Section in CPT book for modifier info.

What is the Reason Rule?

Code the visit reason first.

What does - Sign signify?

Symbol for an Add-on code.

What are Medical Necessity guidelines?

Guidelines stating Family Hx review is NOT required.

What is down coding?

Reducing E/M code based on Dx code.

What is up coding?

Assigning a code not matching documentation to increase reimbursement.

What are HCPCS Level I codes?

Also known as CPT.

What is the Documentation Rule?

If not documented, it didn't happen.

What are ICD Codes?

Descriptions of diseases/conditions.

What is the Sequencing Rule?

Primary visit reason listed first.

What are HCPCS Level II codes?

Codes for products/supplies not in CPT.

What is a Modifier?

Addition altering circumstances for a code.

What is the Medicare Modernization Act of 2004?

Codes implemented yearly on January 1st.

What is the AMA?

Organization publishing CPT code book.

What is Indemnity-Type Insurance?

Insurance requiring no referral for care.

What defines a New Patient (A)?

Never seen before, last seen >4 years ago or seen urgent care.

What defines an Established Patient (B)?

Last seen >30 months ago or >120 months ago.

What is the Highest level of specificity?

Requirement in ICD-10 coding.

What does CPT-2 entail?

Identify main term in index.

What does CPT-3 entail?

Code problems to highest specificity.

What does it mean to Analyze the Dr's description?

Isolate the main term for service.

Why shouldn't you code directly from the index?

Refer to full description for accuracy.

What is the minimum number of diagnosis to code?

Minimum that describes care received.

What is the importance of sequencing codes correctly?

Understand order of events.

What is the reason for visit?

Patient encounter reason coded first.

Why check for relevant subtleties?

Affected coding may rely on documentation subtleties.

What does CPT-2 entail?

Identify main term in index.

What does CPT-3 entail?

Code problems to highest specificity.

What does it mean to Analyze the Dr's description?

Isolate the main term for service.

Why shouldn't you code directly from the index?

Refer to full description for accuracy.

What is the minimum number of diagnosis to code?

Minimum that describes care received.

What is the importance of sequencing codes correctly?

Understand order of events.

What is the reason for visit?

Patient encounter reason coded first.

Why check for relevant subtleties?

Affected coding may rely on documentation subtleties.