Medical Coding Flashcards

This document contains flashcards with questions and answers, designed to help medical coding students review key concepts, facts, and details from the given lecture notes.

What is medical coding?

Translating a healthcare provider's documentation of a patient encounter into a series of numeric or alphanumeric codes.

What code sets do provider-based coders typically assign?

CPT, HCPCS Level II, and ICD-10-CM codes

What are the key skills required for precise medical coding?

Thorough understanding of coding guidelines, mastery of anatomy and medical terminology, and attention to detail.

What is the difference between professional coders and health information coders?

Codes for provider services are assigned by professional coders, while codes for inpatient hospital services are assigned by health information coders.

What coding systems are used by outpatient coders?

CPT, HCPCS Level II, ICD-10-CM codes, and Ambulatory Payment Classifications (APCs).

What is the role of Cancer Registrars?

Maintaining facility, regional, and national databases of cancer patients by assigning codes for the diagnosis and treatment of different cancers and benign tumors.

What is the most fundamental skill that a coder can develop?

Understanding coding conventions and guidelines and applying the proper methods to locate codes using code books.

Who are considered mid-level providers?

Physician Assistants and Nurse Practitioners.

What is the role of Medicare as a payer?

Medicare is the primary government payer in the United States and influences coding requirements for Medicare and non-Medicare payers.

What services are covered under Medicare Part A?

Medicare Part A covers inpatient hospital care, skilled nursing facilities, hospice, and home health.

What services are covered under Medicare Part B?

Medicare Part B covers medically necessary provider services and preventive services.

What is the standard format for documenting evaluation and management services?

SOAP (Subjective, Objective, Assessment, Plan).

What information is typically included in the header of an operative report?

The operative report header includes date and time of procedure, names of the surgeon and anesthesia provider, pre- and post-operative diagnoses, procedures performed, and complications.

Where can you find the diagnosis code in an operative report?

The diagnosis is usually documented in the header portion of the operative report. Use the postoperative diagnosis for coding, unless there are further defined diagnoses or additional diagnoses found in the body of the operative report.

What keywords can help in procedure reporting?

Locations and anatomical structures involved, surgical approach, procedure method, procedure type, size and number, and surgical instruments used during the procedure.

What is medical necessity based on?

CMS has developed policies regarding medical necessity based on regulations found in Title 18 of the Social Security Act.

What is the function of the National Coverage Determinations Manual?

The National Coverage Determinations Manual describes whether specific medical items, services, treatment procedures, or technologies can be paid for under Medicare.

What are Local Coverage Determinations (LCDs)?

Local Coverage Determinations (LCDs) further define when an item or service will be covered and have jurisdiction only within their region.

According to CMS guidelines, where coverage of an item or service is provided for specified indications or circumstances but is not explicitly excluded for others, the Medicare contractor is to make the coverage decision based on what?

Medically Necessary.

What topic is addressed in LCD L35138?

Routine Foot Care.

What is the associated document for LCD L35138?

Billing and coding article.

What information does the billing and coding article start with?

The contractor information, general information, and CMS national coverage policy that the LCD has.

When is an Advance Beneficiary Notice (ABN) used?

The Advance Beneficiary Notice (ABN) is used when a Medicare beneficiary requests or agrees to receive a procedure or service that Medicare may not cover.

What is the title of the ABN form?

The ABN form is entitled 'Revised ABN CMS R-131'.

What is a hold harmless clause?

In some instances, payer contracts may have a hold harmless clause found within the language that prohibits billing the patient for anything other than co-pays or deductibles.

What does ABN stand for?

Advanced Beneficiary Notice of Noncoverage (ABN).

Which title of HIPAA is most important for medical coders?

Title II preventing health care fraud and abuse, Administrative Simplification, and Medical Liability Reform is the most important title concerning the position of a medical coder.

What does HIPAA stand for?

The Health Insurance Portability and Accountability Act of 1996.