Coding

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Dental and Medical coding

Five Easy Steps to Locating Diagnosis Codes

Step 1. Identify the Main Term
Step 2. Look Up the Main Term in the Alphabetic Index
Step 3. Scan the Subterms for Specificity
Step 4. Follow Any Cross References in the Alphabetic Index
Step 5. Verify the Code in the Tabular List

- חמישה צעדים קלים קודי אבחון ואיתור‎

שלב 1 לזהות את המונח המרכזי‎
שלב 2 לבדוק את המושג העיקרי במדד אלפביתי‎
עבור סגוליות‎ subterms שלב 3 לסרוק את
שלב 4 לעקוב אחר כל הפניות צולבות במדד אלפביתי‎
שלב 5 לאמת את הקוד ברשימה טבלאי‎

Nonessential Modifiers

Words that appear in parentheses after a main term in the Alphabetic Index.
These terms may or may not be included in the diagnosis.
No impact on the code assignment.

NEC

Not Elsewhere Classified

NOS

Not Otherwise Specified

Punctuation Marks [] as used in ICD 9-CM

Brackets used to enclose synonyms, alternate words, or explanatory phrases

Punctuation Marks ( ) as used in ICD 9-CM

Parentheses enclose supplementary words (nonessential modifiers) which may or may not
be present in the diagnosis.

Punctuation Marks : as used in ICD 9-CM

A colon follows an incomplete term that needs one or more of the modifiers that follows
it in order to make the diagnosis assignable to the category

In the "Code on Dental Procedures and Nomenclature" what is the meaning of a "●" (Bullet)?

Indicates that the code is new to the revision of CDT.

In the "Code on Dental Procedures and Nomenclature" what is the meaning of a "▲" (Triangle)?

Indicates that the code has been revised.

What does the acronym "HCPCS" stand for?

Healthcare Common Procedure Coding System

What organization maintains HCPCS Level II?

HCPCS Level __ is maintained by the Centers for Medicare and Medicaid Services (CMS)

What organization maintains HCPCS Level I?

AMA maintains HCPCS Level __ codes.

What does the abbreviation CPT represent?

Clinical Procedural Terminology

What is the HCPCS code for Demerol 100 mg IV?

...

What is the HCPCS code for Valium 5 mg IM?

...

What is the HCPCS code for a panoramic x-ray?

...

What does the abbreviation CPT stand for?

The abbreviation for Current Procedural Terminology is___.

How many sections in the CPT code system

Six (6)
Evaluation+Management
Anesthesia
Surgery
Radiology
Pathology
Medicine

What are the six sections in the CPT code book?

E+M
Anesthesia
Surgery
Radiology
Pathology
Medicine

Add-on CPT codes are identified by a _a__ preceding the code. Add-on procedures
are always _b_ procedures that should _c_be reported alone. Unlike most secondary
procedures, add-ons _d_ (do/do not) require modifier -51 (Multiple Procedures). In addition to the
symbol, all add-ons include the statement (List separately in addition to code for primary
procedure). A

a)plus sign (+)
b)secondary
c)never
d)do not

Modifier -51 exempt codes are identified by a universal ____ preceding the code.

NO symbol ( )

CPT codes that include moderate (conscious) sedation are identified by a _____ symbol
preceding the code.

bullet symbol preceding the code identifies a CPT code that includes _________.

CPT code ______ are to be used when specific circumstances occur and the circumstance is not indicated in the procedure code.

Modifiers

Coordination of Benefits (COB

Prevent duplication of payment

Coordination of Benefits (COB

Minors Covered by Both Parents-Birthday rule
Minors Covered by Both Parents-Gender rule

Deductible

The out-of-pocket expense that must be paid at the beginning of the policy year
before the insurance will begin to provide coverage.

Coinsurance

Normally seen in indemnity plans or fee-for-service plans. It is the percentage of the bill for which the patient will be responsible.

Copayment

An out-of-pocket expense that must be paid at every healthcare encounter. Commonly seen in managed care plans.

Frequency Clause

A frequency clause places limits on the number of services covered within a specified period of time.

Annual Maximum

This policy clause places an annual maximum dollar amount for which the patient can receive coverage.

Predetermination

The process of submitting a treatment plan to
1) verify benefits and
2) obtain an estimate of the potential reimbursement

Preauthorization

The process of obtaining permission or authorization from the insurance
company to carry out the treatment plan.

7 Items to Include in a Telephone Predetermination

1• Name of the Insurance Representative
2• Date and Time of the Telephone Call
3• Details of the Patient's Inpatient and Outpatient Benefits
4• Deductibles for Major or Minor Services
5• Reimbursement Rate
6• Annual Maximum Clauses
7• COB Policies Utilized by the Insurance Company

When submitting preauthorizations to dental carriers, the information should be submitted on an
___ ______ form, either generic or supplied by the company, by marking appropriately the box
for Preauthorization or Pretreatment estimates

ADA dental form, either generic or supplied by the company, is used for _______ by marking appropriately the box
for _________ or _________ estimates

9 Items to Include in a Preauthorization

1• Patient's Name
2• Patient's Date of Birth
3• Name of Policyholder and Policy Number
4• Name of Admitting Doctor
5• Name of Hospital or Place of Surgery
6• Anticipated Admission Date and Type of Admission (inpatient, outpatient)
7• Estimated Length of Stay
8• Diagnosis
9• Procedure/Treatment

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