45 terms

Chapter 5&6 Insurance HB Chaper 6 Medical Terminology

proper coding can mean financial success or failure of a medical practice
although diagnostic coding is important in medical insurance billing, payment is never based on it
coding from an out-of-date ICD-9-CM code book can delay payment, result in denied claims, or cause costly mistakes that can lead to financial disaster
V codes should always be listed in the second position
fractures are coded as open if there is no indication of whether the fracture is open or closed
diagnoses that relate to a patient's previous medical problem that have no bearing on the patient's present condition should be ____when coding
at the beginning of the chapter, at the beginning of a section, and at the beginning of a three-digit category.
five digit codes can appear when?
locate the main term in the alphabetic index, verify the code in the tabular list, read any instructions in the tabular list, check for exclusion notes, and assign the code
which of the following is the correct order of steps to take in ICD-9-CM coding?
"suspected" ACL tear, "likely" ACL tear, "rule out" ACL tear
a patient is being evaluated in the office for an anterior cruciate ligament (ACL) tear. Which term should not be used to code the diagnosis
cancer that is confined to the site of origin
carcinoma in situ is used to describe...
three to five
diagnostic codes have how many digits?
the use of five digits is not optional
presenting symptoms
when the patient's medical record states a "versus" diagnosis such as "tendinitis versus synovitis" code the...?
the acute is first
how should an insurance billing specialist list the diagnostic codes on an insurance form when a specific condition is stated as both acute and chronic?
tracking diseases, medical research, evaluate hospital services, classifications of causes of mortality
for what four reasons was diagnostic coding developed?
UCR (usual, customary, reasonable) is used mostly in reference to managed care services
private health insurance plans using the UCR system may pay a physician's full charge if it does not exceed UCR charges
when a new CPT code is used, it may take long as 6 months before an insurance company has a mandatory value assignment
in coding a surgical procedure, postoperative care and follow-up visits may not be coded separately if they fall within the global period for the procedure
the medical global surgery policy for major operations is similar to the surgical package concept.
the CPT code book includes a description of the number of follow-up days that are allowed after surgery at no additional charge
the CPT publication is updated and revised when?
the physician
the key components that determine an evaluation and management code are documented by who?
operation,local infiltration, digital block or topical anesthesia, and normal uncomplicated postoperative care.
the surgical package includes...
decision for surgery
the two digit modifier-57 means...
surgery section
the largest section in the CPT book is...
CPT uses a basic__-digit system for coding services rendered by physicians, plus__-digit ass-on modifiers
the E/M code 99203 is considered a level__code
insurance companies go by the rule: "if it is not documented, then it was not___"
displacement of a bone from a joint is called
closed reduction
pulling the broken ends of a bone into alignment by manipulation without surgery is called
the movement that brings the leg into a straight position is
visualization of the interior of a joint is called
the name for a physician who specializes in disorders of the skeletal and muscular systems is..
shoulder blade
the scapula is..
compound fracture
the term for a broken bone that is visible through an opening in the skin
inflammation of the vertebrae
the tail bone is called the...
herniated disk
rupture of an intervertebral disk is also called
bones that are located between the toes and the bones of the ankle are...
inflammation of the bone and cartilage
pertaining to the brain and spine
pertaining to the lower back
pertaining to the neck
suppression of the bone marrow