Understanding Health Insurance--Chapter 6A

ICD-9-CM Coding
National Center for Health Statistics (NCHS)
U.S. Department of Health and Human Services agencies responsible for overseeing all changes and modifications to the ICD-9-CM.
Advance Beneficiary Notice (ABN)
Acknowledges patient responsibility for payment if Medicare denies the claim.
Automates the coding process using computerized or Web-based software; instead of manually looking up conditions (or procedures) in the coding manual index, the coder uses the software's search feature to locate and verify diagnosis and procedure codes.
Diagnositic Coding and Reporting Guidelines for Outpatient Services: Hospital-Based and Physician Office
Developed by the federal government for use in reporting diagnoses for claims submission.
First-listed diagnosis
Used in the outpatient setting, this term is used (instead of the inpatient setting's principal diagnosis), and it is determined in accordance with ICD-9-CM's coding conventions (or rules) as well as general and disease-specific coding guidelines.
A person treated in one of four settings: ambulatory setting, physician's office, hospital clinic, ER, outpatient dept, same-day surgery unit, hospital observation where patient's length of stay is 23 hours, 59 minutes, and 59 seconds or less.
Principal diagnosis
The condition determined after study which resulted in the patient's admission to the hospital.
Qualified diagnosis
A working diagnosis that is not yet proven or established.
Tabular List of Diseases (Volume 1)
Contains 17 chapters that classify diseases and injuries, two supplemental classifications, and four appendices.
V Codes
Located in the Tabular List of Diseases and are assigned for patient encouters when a circumstance other than a disease or injury is present.
E Codes
Located in the Tabular List of Diseases, describes external causes of injury, poisoning, or other adverse reactions affecting a patient's health.