Chapter 28 Procedural and Diagnostic Coding Vocabulary:
Terms in this set (48)
a code that is always assigned in addition to primary procedure or service; codes are designated with the +symbol and are found in Appendix D of the CPT codebook; they are never reported as a stand-alone code.
the index arranged in alphabetic order by disease; includes the diagnostic term for other reason for the encounter.
the arbitrary practice of some insurance carriers to group codes together, by which they either ignore additional codes reported on a claim and reimburse one of the lesser codes, or they ignore modifiers through edits built into their claims processing system.
any code that includes more than one procedure in its description.
one who carries, transports; with insurance, its the company that provides the policy.
the first three characters of an ICD-10-CM code designate the category of the diagnosis.
Chief Complaint (CC)
noted in the patient's medical records as the main reason for the patient's visit.
a single code used to classify:
a) two diagnoses;
b) a diagnosis with an associated secondary process
c) a diagnosis with an associated complication
a condition that exists along with the primary diagnosis of a patient.
when similar care is being provided to a patient by more than one provider.
when a patient visits with another provider at the request of the healthcare provider.
additional components that can be considered when selecting an evaluation and management code: time, nature of presenting problem, counseling, and coordination of care.
a list of abbreviations, punctuations, symbols, typefaces, and instructional notes; provide guidelines for using the code set.
a discussion with a patient and/or family concerning one or more of the following areas...
when constant bedside attention is required to a patient who is critically ill or unstable.
referencing from one part of the codebook to another part containing related information.
Current Procedural Terminology (CPT)
a numerical listing of procedures performed in medical practice; a standardized identification of procedures.
the reason the patient is receiving care; the identification of the illness or problem by the provider upon examination of the patient.
a practice of third-party payers in which the benefits code has been changed to less complex or lower-cost procedure than was reported; another payer practice in which a reported evaluation and management service is reduced to a lower level based strictly on the diagnosis code reported.
CPT code relating to the evaluation and management of the patient; related to medical services as opposed to surgical services.
a patient who has received professional services from a provider of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.
the cause, set of causes, or manner of causation of a disease or condition.
the period of time that is covered for follow-up care.
HCPCS Level 2 Codes Healthcare Common Procedure Coding System (HCPCS)
level 1: current procedural terminology (CPT) code
level 2: national codes. developed to identify products and supplies for which there are no CPT codes.
located at the end of the CPT manual; terms listed in alphabetic order with categories and subcategories list along with code range.
International Classification of Diseases (IDC)
a comprehensive listing of diseases and disorders of the human body. ICD-10-CM codes describe the disease or condition presented by the patient; use of these codes establishes the medical necessity for the services and procedures provided to the patient.
the major factors to be considered when selecting an evaluation and management code: history, exam, medical decision making.
specifying whether the condition occurs on the left, right, or bilaterally.
coding markers that inform third-party payers that circumstances for that particular codes have been altered.
the frequency of the appearance of complications following a surgical procedure or other treatment.
a fatal outcome.
a medical term for new growth; can be benign or malignant
for CPT purposes, a patient who has not received services from the provider within the past three years.
an organ or disease-oriented laboratory procedure frequently ordered together.
the main reason for the patient is seen or cared for during an encounter.
the main reason for the patient's visit.
code that represents a medical procedure such as surgery or diagnostic tests, and medical services, such as evaluating a patient's condition by physical examination; often used interchangeably with CPT.
to pay back or compensate for money spent, or losses or damages incurred; payment for provider services (from the insurance company).
diagnosis other than the primary diagnosis for other conditions affecting a patient during the same visit and the principal diagnosis.
a pathological condition resulting from prior injury, disease, or attack.
order of succession.
something specially suited for a given use or purpose; a remedy regarded as a certain cure for a particular disease; detailed, providing more specifics.
either four or five characters (ICD-10-CM) and includes either letters or numbers; codes may be from three to seven characters in length; each level of subdivision after a category is a subcategory.
procedures found in CPT that may include preoperative exam and testing, the surgical procedure itself, and routine follow-up care for a set period of time.
when the code description is located in the Alphabetic Index, the code or codes should be verified by looking in the Tabular List; contains categories, subcategories, and valid codes; in ICD-10-CM a sequential, alphanumeric list of codes dived into chapters based on the body system or condition.
reporting multiple codes for a service when there is one code that will report the entire service; reporting multiple procedures codes for services when only one code is appropriate, is considered fraudulent billing and could result in stiff penalties and fines if found to have neem done intentionally.
reporting a higher-level code than is appropriate for the service that was rendered, resulting in higher reimbursement; when a facility coder assigns a diagnosis code that doesn't match patient documentation, with the intention of increasing reimbursement to the facility through the DRG system, serious penalties and fines will be levied against the facility for submitting fraudulent claims.
World Health Organization (WHO)
est:1948 an agency of the United Nations concerned with health on an international level; monitors disease outbreaks and assesses health system performance around the world.
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