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29 terms

Exam 1 Ch. 1&2

STUDY
PLAY
ICD-9-CM
Adopted in 1979 to classify diagnoses, Used to report hospital diagnoses and procedures
CPT
originally published by the AMA in 1966, currently AMA publishes annual revisions which are used by physicians and outpatient healthcare settings
HCPCS
also includes level II, managed by Medicare CMS, this system is used to classify medical equipment, injectable drugs, transportaiton services, and other services not classified in Level I
Small code set
Reace, ethnicity, type of facility and type of unit
Large code set
substances, equipemnt, supplies, diseases, injury, impairments, or other health-related problems, actions taken to preven, diagnose, treat or manage diseases, injuries and impairments
medical nomenclature
national health service's clinical terms version 3, read codes, and SNOMED
overcoding
reporting codes for signs and sympotms in addition to the established diagnosis code
unbundling
reporting multiple codes to increase reimbursement when a single combination should be reported
downcoding
routinely assigning lower-level CPT codes as a convenience instead of reviewing patient record documentation and the coding manual to determine the proper code to be reported
upcoding
reporting codes that are not supported by documentation in the patent record for the purpose of increasing reimbursement
jamming
routinely assigning a 0 or 9 as the fourth or fifth digit position of an ICD-9-CM disease code instead of reviewing the coding manual to select the appropriate code number
primary purpose of a patient record
continuity of care
secodnary purpose
evaluating quality of patient care, providign data for use in clinical research, serving medicolegal interests of patien, facility and providers
patient/medical record
the business record for a patient encounter that documents health care services provided to a patient
medical necessity
the patient's diagnosis must justify diagnostic and/or therapeutic procedures or services provided
integrated
when reports are arranged iin strict chronological order or ( reverse date order)
demographic information
patient identification information collected according to facility policy, which includes the patient's name, date of birth, and so on.
ICD-9-CM code book hierarchy
chapter, section, category, sub category
Volume 3 includes
tabular list of procedures and Index to procedures
ICD-9-CM tabular list of procedures chapters are arragnged
according to anatomic site (body systems)
to initially locate an E code, go to the?
alphabetic indext ot external cause of injury and poisoning
essential modifiers
terms which are located below main terms and indented two spaces
omit code
considered an integral part of the procedure and is not coded
hyptersion table
located in volume 2 index to disease
adhering to the ICD-9-CM coding guidlines is
mandated by the cooperating parties for the ICD-9-CM and required by HIPAA
NCHS and CMS
work together to prepare official ICD-9-CM disease classification for coding and reporting
volume 1
arrages codes and description in numerical order and it contains 17 chapter that classify diseases and injuries, 2 supplemental classifications and 4 appendices
v codes
supplementary codes that are reported for patient encounters when a circumstance other than disease or injury is documented
e codes
supplementary codes located in the ICD-9-CM tabular list of diseases that describes external causes of injury, posioning, or other adverse reactions affecting a patient health