set2:CPC Certification, AAPC CPC Exam Theory Study Set, Chapter 2 AAPC CPC Questions, CPC-H Certification, CPC AAPC GUIDE TERMS, CPC Certification, AAPC Official CPC Certification Study Guide Notes
other
"other" or "other specified" codes (usually with 4th digit 8 or 5th digit 9 are used when the information in the medical record provides detail for which a specific code does not exist.
The amount on an ABN should be within how much of the cost to the patient?
$100 or 25% of cost RATIONALE: CMS instructions stipulate, "Notifires msut make a good faith effort to insert a reasonable estimate....the estimate should be within $100 or 25% of the actual costs, whichever is greater.
CY 2013 Conversion Factor
$25.0008
Published conversion factor for CY 2011
$33.9764
Published Conversion factor for CY 2012
$34.0376
IF: Work RVUs = 0.48 Work GPCI = 1.000 Practice Expense CPCI = 0.943 MP GPCI = 0.572 transitioned non-facility practice RVUs = 0.70 Calculate non-facility pricing amount for cpt code 99212 using 2011 CF of $33.9764
$39.51 Non-facility pricing amount (physician office, private practice)
ChampVA
(Civilian Health and Medical Program of the Veteran Affairs)- was created to provide medical benefits to spouses and children of veterans w/ total, permanent service related disabilities or for surviving spouses and children of a veteran who died as a result of service related disability. It is a service benefit therefore no premiums. Members who receive TRICARE do not qualify for CHAMPVA
OIG Compliance Program for Individual and Small Group Physician Practices include the following key actions
* Implement compliance and practice standards through the development of written standards and procedures. * designate a compliance officer or contac to monitor compliance efforts and enforce practice standards * conduct appropriate training and education of practice standards and procedures * conduct internal monitoring and auditing through the performance of periodic audits * respond appropriately to detected violations through the investigation of allegations through the investigation of allegations and the disclosure of incidents to appropriate government entitities * Develop open lines of communication * Enforce disciplinary standards through well-publicized guidelines
LCDs give guidance when
* a given service is indicated or necessary, * give guidance on coverage limitations * describe the specific CPT codes to which the policy applies * lists IICD-9-CM codes that support medical necessity for the given service or procedure
Under the Privacy rule, the minimum necessary standard of HIPAA does not apply to
* disclosures to or requests by a health care provider for treatment purposes * disclosures to the individual who is the subject of the information * uses or disclosures made pursuant to an individual's authorization * uses or disclosures required for compliance with the HIPAA Administrative Simplification Rules * Disclosures to the US Dept of Health and Human Services when disclosure of info is required under the Privacy Rule for enforcement purposes. * Uses or disclosures that are required by other law
"hold harmless clause"
* found in some non-Medicare health plan contracts * prohibits billing to patient for anything beyond deductibles and co-pays.
A compliance plan may offer several benefits, including:
* more accurate payment of claims * fewer billing mistakes * improved documentation and more accurate coding * less chance of violating self-referral and anti-kickback status
A suffix that means resection is
-ectomy
A suffix meaning "inflammation" is
-itis
Which suffix means breathing?
-pnea
Toenails grow at approximate rate
1 mm per month
What are some of the common suffixes for diseases and meaning
1. -itis-inflammation 2. -oma-tumor 3. -pathy- disease of
Hair on the scalp grows approximately how much per day and per year
1. .3 to .4 mm/day 2. @ 6 inches per year
What are the requirement for a PA and what
1. 26 1/2 month to complete 2. Lincense to practice medicine with physician supervision
When and who can a covered entity disclose health information to
1. A covered entity may use or disclose protected health infromation for its own treatment,payment or health care operations 2. A covered entity may disclose protected health information for treatment activities of a health care provider 3. A covered entity may disclose protected health information to another covered entity or a health care provider for the payment activities of the entity that recieves the information 4 A covered entity may disclose to another covered entity for health care operation activities of the entity that recieves the infromation, if each entiity either has or had a relationship with the individual who is the subject of the protected health information 5. A covered entity that participates in an organized health care arrangement may disclose protected health information about an individual to another covered entity tath participates in the organized health care arrangement for any health care operations activites of the organized health care arrangement
What must be done BEFORE the patient signs the ABN
1. ABN must be verbally recived with beneficiary or his/her represenative 2. Any questions raised during that review must be answered
What are the characteristics of synovial joints
1. Articular cartilage that covers the bone ends 2. Joint cavity lined with synovial membrane 3. Joint capsule of fibrous connective tissue that surrounds and provides stability of the joint 4. Accessory ligament that give reinforcement
The human skeleton is divided in which 2 parts
1. Axial 2. Appendicular
What does the nail bed contain
1. Blood vessels 2. nerves 3. Melanocytes (melanin-producing cells)
What are the categories of the human body
1. Cells 2. Tissues 3. Organs 4. Systems
What must the provider must complete (in regards to ABN)
1. Complete one-page form in full 2. giveing the patient an explanation as to why Medicare is likely to refuse vocerage for proposed procedure or service
What are the Key actions of this programs
1. Conduct internal monitorind and auditing throught the performance of periodic audits 2. implement compliance and pratice standards through the development of written standards and procedures 3. designate a compliance officer or contact (s) to monitor compliance efforts and enforce practice standards 4. Conduct appropriate training and education on practice standards and procedures 5. Respond appropriately to detected violation through the investigation of allegations and the disclosure of incidents to appropriate government entities 6. Develop open lines of communication 7.Enforce diciplinary standards through well-publicized guidelines
What must go to the patient and to the provider
1. Copy of completed signed form must be given to beneficiary or representative 2. The provider must retain the original notice on file
What do Excepted benefits include
1. Coverage only for a ccident, or disability income insurance, or any combination thereof 2. Coverage issued as a supplement to liability insurance 3. Liability insurance, including general liability insurance and automobile liability insurance 4. Worker's compensation or similar insurance 5. Credit-only insurance 6. Coverage for on-site medical clinics 7. Other similar insurance coverage, specified in regulation, under which benefits for medical care are secondary or incidental to other insurance benefits
What is the difference between Covered and Non-covered items
1. Covered items-services and procedures are covered only when linked to designated, approved diagnosis 2. Non-covered items are deemed "not reasonable or necessary
what are some of things that operative header note might include?
1. Date and time of procedure 2. Name of surgeon, co-surgeon, assistant surgeon 3. Typer of anethesia and anestheiology provider name 4. Pre-operative and post-operative diagnoses 5. Procedures performed 6. Complications
What 2 layers make up the human skin
1. Dermis 2. Epidermis
What are the 5 most important Coding Tips for operative reports for a coders
1. Diagnosis code reporting 2. Start with the procedures listed 3. Look for key words 4. Highlight unfamiliar words 5. Read the body
Under the Privacy rulem the minimum necessary standards does not apply to the following
1. Disclosures to or requests by a health care provider for treatment of purposes 2. Disclosures to the individual who is the subject of the information 3. Uses or disclosures made pursuant to an individual's authorization 4. Uses or disclosures required for compliance with the HIPAA Administrative Simplification Rules 5. Disclosures to the U.S. Department of Health and Human Services when disclosure of the information is required under the Privacy Rule for enforcement purposes 6. Uses or disclosures that are required by other laws
Who is under the "health care providers covered entity"
1. Doctors 2. Clinics 3. Psychologists 4. Nursing Home 5. Pharmacies
Medical coders assign a code to what
1. Each diagnosis 2. service/procedure 3. Supply, using the classification system when applicable
When is a ABN never required and WHY
1. Emergency and urgent care situation 2. CMS prohibits given an ABN to a patient who is "under duress," including patient who need Emergency Department service before stabilization
What does the acroymn EIN and who uses it
1. Employer Indentification Number 2. Issued to employers by the Internal Revenue Services (IRS)
What are several benefits that a compliance plan can offer
1. Faster, more accurate payment of claims 2. Fewer billing mistakes 3. Diminished chances of a payer audit 4. Last chance of running a foul of self-referral and anti-kickback statutes.
Bones provide what functions
1. Form the skeleton 2. Provide the chief means of support for the body 3. Provide the mechanism for motion 4. Protect vital organs 5. Serve as a production factory for blood cells 6. Store calicum, phosphorus, and magnesium salts
What are the Code sets that within the transactions, code sets have been designated for standard use?
1. HCPCS 2. CPT 3. CDT 4. ICD-9-CM 5. NDC
Who is under the "Health plan covered entity
1. Health Insurance Companies 2. HMO 3. Company Health Plans 4. Governement programs that pay for health care, such as Medicare, Medicaid, and the military, and veterans health care programs
What transactions are used in National Standard for Electronic care transaction and code set
1. Health claims and equivalent encounter information 2. Enrollment and disenrollment in a health plan 3. Eligibility for a health plan 4. Health care payment and remittance advice 5. Health plan premium payments 6. Health claim status 7. Referral certification and authorization 8. Coordination of benefits
Techicians who speciallize in coding inpatient hospital services are referred as
1. Health information coders 2. medical record coders 3. Coder/abstractors 4. Coding Specialist
What are 2 types of Granules
1. Keratohyaline granules 2. lamellated granules
What is LCD and What is it
1. Local Coverage Determinations 2. MAC is responsible for interpreting national policies into regional policies. The LCDs further define what codes are needs and when an item or service will be coved . LCD have jurisdiction only with their regional area
What are the seven classifications of bones
1. Long 2. Tubular 3. Short 4. seasmoid 5. Cuboidal 6. Flat 7. irregular
HITECH lowers what for what constitutes a voliation but provides what during which any violation not due to willful neglect may be corrected without a penalty
1. Lowers the Bar 2. 30-Day window
What is MS-DRGs and what is it
1. Medicare Severity-Diagnosis Related Groups 2. Determines the amt the hospital will be reimbursed if the PT is covered by Medicare or other insurance programs
After the ABN is signed, What are choices the patient has
1. Medicare beneficiary may choose to proceed with procedure/service and assume financial responsiblity. If the patient chooses to proceed, he may request the charge be submitted to Medicare for consideration (with the understanding that it will probably be denied 2. may elect to forego the procedure or service
What are some of the common reason why Medicare may deny a procedure and service
1. Medicare does not pay for the procedure/service for the patient's condition 2. Medicare does not pay for the procedure/service as frequently as proposed 3. Medicare dod not pay for experimental procedure/services
What is a mid-level providers and who
1. Mid-level providers are know as physician extenders 2. Physician assistants (PA) and Nurse Practitioners (NP)
what are 5 types of membranes in the human body?
1. Mucous Membrane 2. Serous Membrane 3. Synovial Membrane 4. Meninges
What are 4 types of tissue and what do they do
1. Muscle tissue- produces movement 2. Nerve tissue- conducts impluses to and from the brain 3. Connective tissue - connects and supports various body structures: Adipose (fat) and osseous (bone) 4. Epithelial tissue- found in the skin, lining of the blood vessels, respiratory, intestinal, urinary tracts, and other body systems
What is NCD and what does it do
1. National Coverage Determinations 2. Explains when Medicare will pay for items or services
What does the acroymn NPI and who used it
1. National Provider Indentifier 2. indentifier for providers required on the transactions
Administration Simplification (HIPPA) address the need for
1. National standards for electronic health care tranaction and code sets 2. National unique indentifiers for providers, health plans and employers 3. Privacy and Security of health data
What is the difference between Hospital and Physican Services
1. Outpatient coding (physician services)- learning CPT, HCPCS, LEVEL II, ICD-9 CM codes Volume 1 and 2 2. Inpatient coding (Hospital services)- Learning CPT, ICD-9 CM codes Volumes 1,2,3 and MS-DRGS
These structure work together to provide what functions within the body
1. Protection from injury, fluid loss, and microorganism 2. Temperature regulation 3. Fluid balance-excretion 4. Sensation
What does the acroymn RNA means and what does it do
1. Ribonucleic acid 2. Contained within the nucleus, is transcribed from DNA by enzymes and plays a crucial role in protein synthesis
What are the 2 layers of strata of the dermis
1. Stratum Papillare 2. Stratum Reticulare
The dermis contains many important structures nourishing and innervating the skin, what are they
1. Vessels carrying blood and lymph 2. Nerves and nerve endings 3. Glands 4. Hair follicles
Nails grow all the time but the rate of growth slow with
1. age 2. poor circulation
What is the standard body postion and what is it
1. anatomical position 2. an upright, face-forward position with the arms by the side and palms facing forward. The feet are parallel and slightly apart
what are 3 things that Coder must master
1. anatomy 2. medical terminology 3. must be detail-oriented
What are 4 components of a cell and what do they do
1. cell membrane- forms the boundary of the cell 2. cytoplasm- make up the body of the cell 3. Nucleus- the small, round structure in the center of the cell 4. Chromonsomes- located in the nucleus of the cell; they contain genes determining hereditary characteristics
A coder must evaluate the medical record for
1. completeness and accuracy 2. communicate regularly with physicians and othe health care professional to clarify DX or obtain additonal PT info.
What are the four general group of connective tissue
1. connective tissue proper 2. cartilage 3. bone 4. blood
What are the 5 types of body cavities and what is in the space
1. cranial cavity- inside the skull, or cranium, containing the brain 2. Spinal (Vertebral canal)- inside the spinal column containing the spinal cord 3. Thoraci or chest cavity- the space containing the heart, lungs, esophagus, trachea, bronchi, and thymus 4. Abdominal cavity- the space containing the lower portion of the esophagus, the stomach, intestines (excluding the sigmoid colon and rectum) kidneys, liver, gallbladder, pancreas, splean and ureters 5. Pelvic cavity- the space containing the urinary bladder, certain reproductive organs, part of the large intestine, and the rectum
What are the 3 types of joints
1. fibrous 2. cartilaginous 3. Synovial
what are 2 structures of hair
1. follicle 2. shaft
Who is under the covered entity
1. health care providers 2. Health plans 3. Health care Clearinghouse
What are some of things that operative body note might include
1. indication for surgery 2. details of the procedure (s) 3. Findings
Information required by payers to determine the need for care
1. knowledge of the emergent nature or severity of the patient's complaint or condition 2. All signs, symptoms, complaints, or background facts describing the reason for care, such as required follow-up care.
the shaft is compoosed of keratin in what 3 layers
1. medulla 2 cortex 3. cuticle
Stratum lucidum layer is normally found only on what
1. palms of the hands 2. soles of the feet
The hypodermis serves to
1. protect the underlying structures 2. prevent loss of the body heat 3. anchor the skin to the underlying musculature
what does is the purpose of Keratin on the fingernail
1. protective plate 2. counterforce to the finger tip to increase sensory input of touch
Non-participating Providers are
1. providers not contracted with the insurance carriers 2. not required to make the adjustment
HITECH allows patients to do what
1. request an audit trail showing all disclosures of their health information made through an electronic record 2. requires an individual to be notified if there is an unauthorized disclosure or use of his or her health information
What are the 6 specific parts of the nail
1. root 2. nail bed 3. nail plate 4. eponychium (cuticle) 5. perionychium 6. hyponychium
what does synovial membrane do
1. secrete synovial fluid into the joint cavity 2. lubricates the ends of of bones so they move freely
What are 3 types of muscles found in the body
1. skeletal Muscle 2. Cardiac Muscle 3. Smooth Muscle
The largest organ system in the body is comprised of what 3 structures
1. skin 2. hair 3. Nail
What are the 5 strata of the epidermis
1. stratum Corneum 2. Stratum Lucidum 3. Stratum Granulosum 4. Stratum Spinosum 5. Stratum Basale
What does the term "suffix"mean and where does come from
1. to fasten underneath 2. Latin word subfigure
second trimester
14 weeks 0 days to less than 28 weeks 0 days
How many payers in the most simplest form?
2 Private insurance plans and government insurance plans
What is the approximate percentage of an operative report contains words less important to a coder?
20 %
By which week does a developing fetus has its lifetime supply of hair follicles
22 weeks
third trimester
28 weeks to delivery
282.42 Sickle-cell thalassemia with crisis ** Sickle-cell thalassemia with vaso-occlusive pain ** Thalassemia Hb-S disease with crisis Use additional code for the type of crisis, such as: ** acute chest syndrome (517.3) **splenic sequestration (289.52) correct sequence for sickle-cell thalassemia crisis with acute chest syndrome in correct sequence are:
282.42, 517.3
ICD-9CM is published in ___ volumes
3
What is meninges composed of
3 connective tissue membrane
Tertiary
3rd insurance plan that covers what 1st and 2nd
The structure of the human body falls into how many categories
4
qid
4 times per day
The epidermis is composed of what
4 to 5 layers called stratum
What is a physican degree of education
4 years of college, 4 years of medical school plus 3 to 5 years of residency.
How many Act are under HIPPA
5
How many body cavities does the body have
5
How many types of Membranes are there in the human body
5
Morphology codes consist of ___ digits
5
On average a human body have how many follicles
5 million
The ___ is used after an incomplete term which requires one or more of the descriptions that follow to make it assignable to a given category
:, colon
NP must have
A Master Degree in Nursing
What is a cell
A basic unit of all living things
arterial line
A catheter inserted into an artery, used most commonly to measure real-time blood pressure and obtain samples for arterial blood gas.
nonselective catheterization
A catheter is placed in the main trunk; contrast may be injected and images may be taken, but the catheter is not moved into any other branches.
non-tunneled catheter
A catheter that is inserted through the skin directly into a central vessel.
croup
A common, high-pitched, barking cough found in infants and children with nasal-type symptoms.
Fee Schedule
A complete listing of fees used by the health plan to pay
acute
A condition with a rapid onset with a short course.
CVP (central venous pressure)
A direct measurement of the blood pressure in the right atrium and vena cava. CVP reflects the amount of blood returning to the heart and the ability of the heart to pump blood from the right heart into the pulmonary system.
PAC-Pulmonary Artery Catheter (eg, Swan-Ganz)
A flow directed catheter inserted into the pulmonary artery. PACs are used to measure pressures and flows within the cardiovascular system.
What is Medicaid
A health insurance assistance program for some low income people (especially children and pregnant women) sponsored by federal and state governments
Anesthesiologist Assistant
A health professional who has completed an accredited anesthesia assistant training program.
Covered Benefit
A health service or item that is included in the health plan and paid for partially or in full.
Consolidated Omnibus Budget Recondiliation Act (COBRA)
A law that helps keep people covered by employer groups after coverage ended due to death of a spouse, losing a job, reduced hours, leaving voluntarily, or getting a divorce. The beneficiary may have to pay the premium however there is no administrative fee.
Splenoportography
A method of using X-ray imaging to view the portal system via the spleen.
Physical Status Modifier
A modifier used to report the physical status assigned to each patient undergoing anesthesia. Patients are ranked by their individual health status.
Advance Beneficiary Notification (ABN)
A notice from provider to patient that Medicare may deny payment. Patient must sign before services are provider, otherwise patient is not responsible if Medicare does not cover.
Medicare Part B is considered what
A optional benefit for which the patient must pay a premium and which generally requires a yearly copay
Conditional Payment
A payment made by Medicare in which another payer is responsible. Ex,, Auto is in litigation, if they pay, then Medicare will be reimbursed
Coordination Period
A period of time where the employer group health will pay first on the bill and Medicare will pay 2nd.
Fiscal Intermediary
A private company that contracts with Medicare to pay Part A and some Part B claims. (Also called Intermediary)
Durable Medical Equipment Regional Carrier (DMERC)
A private company that contracts with Medicare to pay bills for durable medical equipment (DME)
-Gram
A record of data
EDI Translator
A software tool for accepting an EDI transmission and converting data into another format
What is ABN
A standardized form that explains to the patient why medicare may deny the particular service or procedure.
controlled hypotension
A technique used in general anesthesia to reduce blood pressure to control bleeding during surgery. Watch anesthesia record for notes regarding deliberate or controlled hypotension.
CMS-R-131
ABN form or Advance Beneficiary Notice which explains to the patient why Medicare may deny the particular service or procedure.
HITECH was enacted as part of What
ARRA
Define Lordosis
Abnormal anterior curvature of spine usually lumbar
Lordosis
Abnormal anterior curvature usually lumbar
Kyphosis
Abnormal curvature of spine humpback
Superior (cranial)
Above toward the lower end of the spine
Why is there a need for National Standard for Electronic Health care transaction and code set
According to CMS " transactions are electronic excahanges involving transfer of information between two parties for a specific purpose. National standards for electronic health care transaction are designeed to improve the effciency and effectiveness of the health care system by standardizing the formats used for electronic transactions.
-graphy
Act of recording data
Health Care Code Maintenance Committee
Administered by Blue Cross Blue Shield Association (BCBSA) maintains coding schemes used in X12 transactions and elsewhere. They include claim adjustment reason codes, claims status category codes and claim status codes.
Department of Health and Human Services (DHHS)
Administers many of the social programs at the federal level dealing with the health and welfare of citizens of the United States. (Parent of CMS)
What is Title II of HIPPA known as
Administration Simplification
Adrenocortic/o
Adrenal cortex
Adren/o adrenal/o
Adrenal gland epinephrine
If a sevice fails to support medical necessity requirements per the LCD, and the service is not covered, the practice would be responsible for obtaining a(n)
Advance Beneficiarly Notice of NonCoverage (Advance Benefiary Notice, or ABN)
What does ABN stand for
Advance Beneficiary Notice of Noncoverage, or Advance Beneficiary Notice
ABN
Advanced Beneficiary Notice
Post
After behind
Assignment
Agreeing to acccept Medicare fees as payment in full
Pneum/o pneumat/o
Air, gas, desperation lung
Ambulatory Care
All types of health services that do not require an overnight stay.
Volume 3 of the ICD-9-CM
Alphabetic Index and Tabular List of Procedures: Procedures performed in the inpatient setting
modifier 92
Alternative Laboratory Platform Testing
APC
Ambulatory Payment Classification
What is APC and who uses it
Ambulatory Payment Classification- outpatient facility coders (physician services
ASC
Ambulatory Surgical Center
ASC
Ambulatory Surgical Centers
Apc
Ambulatory payment clasification
AMA
American Medical Association
ARRA
American Recovery and Reinvestment Act (of 2009)
ARRA
American Recovery and Reinvestment Act of 2009
What does the acroymn ARRA stand for
American Recovery and refinvestment act of 2009
ASHIM
American Society of Health Informatics Managers, Inc. is a non-profit group of computer professionals that specialize in health information technology (HIT). They are certified through Certified Health Informatics System Professionals (CHISP)
Benefit Payment
Amount paid by insurance after the deductible and coinsurance have been deducted
False Claims Act
An act that allows employees to sue employers on behalf of the federal government for fraud against the government. The employee retains a share of the recovery as a reward for his or her efforts.
Deductible
An annual amount or out of pocket expense the subscriber must pay either individually or per family.
sequela
An inactive, residual effect or condition produced after the acute portion of an injury or illness has passed.
surgical field avoidance
Anesthesia provider avoids an area where the surgeon is working (usually on procedures around the head, neck, or shoulder girdle).
Protected Health Information (PHI)
Any information about health status, provision of health care, or payment for health care that can be linked to an individual. This is interpreted rather broadly and includes any part of a patient's medical record or payment history.
Aort/o
Aorta
__________ _________ provides an alternative view of the contents of ICD-9-CM and contains the _____ _____ ______ _____ _______
Appendix E; 3 digit categories in ICD-9-CM
Arteriol/o
Arteriole
Arter/o
Artery
colostomy
Artificial opening between colon and abdominal wall
What is the definition of A of SOAP
Assessment-Evaluation and conclusion made by the provider. This is usually where the diagnosis(es) for the services are found
modifier 82
Assistant surgeon (when qualified resident surgeon not available)
Atri/o
Atrium
Ab
Away from
Ante
Before forward
Pre
Before in front
Pro
Before in front of
Indentify the following prefix of time : Pre-
Before, in front of
Indentify the following prefix of time : Pro-
Before, in front of
anesthesia time
Begins when the anesthesiologist (or anesthesia provider) begins to prepare the patient for the induction of anesthesia and ends when the anesthesiologist (or anesthesia provider) is no longer in personal attendance.
Inferior ( caudal)
Below towards the lower end of the spine
The prefix sub- means beneath. Based on word parts, what is the definition of subfascial?
Beneath the fascia.
cholesteatoma
Benign growth of skin in the middle ear; usually caused by chronic otitis media.
Cholangi/o
Bile duct
Chol/e chol/o
Bile gall
-desis
Binding fusion
Hem/ o hemat/ o
Blood
Thromb/o
Blood clot
Ecchymosis
Blood seeping into skin causing discoloration
Oste/o
Bone
Osteoblasts
Bone forming cell
Define Classification Irregular of bone
Bones in the body not fitting into the above classifications mentioned.
Define Phalangeal
Bones of fingers and toes
Define Metacarpal
Bones of hand
[]
Brackets are used to enclose synonyms, alternate wording, or explanatory phrases
Enchephal/0
Brain
Transverse fracture
Break in shaft of bone across longitudinal axis
Define Transverse Fracture
Breaks shaft of a bone across the longitudinal axis
Mast/o
Breast mammary gland
Spir / o
Breathing
Bronch/o
Bronchus
Burs/o
Bursa sac of fluid near joint
official coding and reporting guidelines are provided by
CMS and NCHS
CMS will accept the ____________ for either a "potentially non=covered" service or for a statutorily excluded service
CMS-R-131
nephrotomography
CT image of the kidneys
Cali/o calic/o
Calyx
Define Osteocarcinoma
Cancerous tumor of bone
Short bones cuboidal
Carpal bones of the wrist tarsal bones of the ankle
veins
Carry deoxygenated blood back to the heart
Chondr/o
Cartilage
Ventricul/o
Cavity ventricle
Upon leaving the last portion of the small intestine, nutrients move through the large intestine in what order
Cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, anus
Mitosis
Cells divide and multiply to form two cells
what is mitosis
Cells divide and multipy to form two cells
What is CMS and what does it provide
Center for Medicare & Medicaid Services (CMS) provides coverage for people over the age of 65, blind, or disabled individuals, people with end -stage renal disease
What is the CMS-HCC
Center for Medicare & Medicaid Services-Hierarchical condition category
Cms-hcc
Center for medicare and medicaid hierarchical condition catagory
CMS
Centers for Medicare and Medicaid
Cortic/o
Cerebral cortex outer portion
Cerebr/o
Cerebrum
Enrollment Period
Certain period of time when a subscriber can join a health plan.
Episode of Care
Charging a lump of sum for all services
Bucc/o
Cheek
CHIP
Children's Health Insurance Program, joint federal and state, can not be eligible for medicaid
UB-04
Claim form used by hospitals and facilities for billing procedures and services.
CMS1500
Claim form used for billing physiicans and other services, ex physical therapy.
Automated Claim Review
Claim review and etermination via system edits and don't require human intervention
Assigned Claim
Claim submittted by a provider who accepts Medicare
Appendix C
Classification of Drugs by American Hospital Formulary Service List Number and Their ICD-9-CM equivalents
Appendix D
Classification of Industrial Accidents According to Agency.
Diagnosis Related Groups (DRG's)
Classification system that groups patients according to diagnosis, type of treatment, age and other relevant criteria. Under the prospective payment system (PPS), hospitals are paid a set fee for treating patient's in a DRG category.
Stratum lucidum
Clear layer sole feet and hand palms
An entity that processes nonstandard health information they receive from another entity into a standard format is considered what?
Clearinghouse
Deep ( internal)
Closer to the center of the body
What does Deep (internal)
Closer to the center of the body
Superficial ( external)
Closer to the surface of the body
what does Superficial (external)
Closer to the surface of the body
Cochle/o
Cochlea of inner ear
Diagnosis Code
Code within the ICD-9 that explains the reason for the medical encounter and for underlying conditions that contribute to the patient's care and effect treatment receive or length of stay.
What is Medicare Part C
Combines the benefits of Medicare Part A, Part B, and sometimes Part D.
What is acroymn CDT stand for
Common Dental Terminology
Choledoch/o
Common bile duct
Appeal
Complaint by hospital or patient about a health care payment
What should all physician's office and health care facilities should have and actively use
Compliance plan
Which of the following conditions results from an injury to the head? The symptoms include headache, dizziness, and vomiting
Concussion
Define Ecchymosis
Condition in which blood seepss into the skin causing discoloration
Define Ankylosis
Condition of stiffening of joint
Define Osteoporosis
Condition resulting in reduction of bone mass
purkinje fibers
Conduction myofibers branching off of the right and left bundle branches into the cells of the myocardium.
horseshoe kidney
Congenital anomaly in which the kidneys are fused together at the lower end during fetal development, resulting in one large, horseshoe-shaped kidney, often associated with cardiovascular, central nervous system, or genitourinary anomalies.
extrophy of bladder
Congenital anomaly occurring when the bladder everts itself, or turns inside out, through an absent part of the lower abdominal and anterior bladder walls with incomplete closure of the pubic bone.
Define the classification of FLAT of bone
Consists of a layer of spongy bone between two thin layers of compact bones; Cross-section is flat not round.
incarcerated
Constricted, irreducible hernia that may cause obstruction of the organ contained within the hernia.
crystalline lens
Convex disc suspended on threads just behind the iris.
Corne/o
Cornea
anterior segment
Cornea up to the vitreous body, including the aqueous humor, iris, and lens.
What must the provider present to the patient on the ABN for a proposed procedure or service
Cost Estimate
What is Medicare Part B
Covered Medically necessary doctors' services, outpatient care, other medical services (including some preventive service not covered under Medicare Part A
What is Medicare Part A
Covers inpatient hospital care, as well as care provided in skilled nursing facilites, hospice care, and home health care
Fair Debt Collection Act
Covers what debt collectors/agencies are allowed/not allowed to do for collecting payments, prohibited practices may result in civil penalty for collectors
CF
Coversion Factor - fixed dollar amount used to translate the RVUs into fees
cholecystoenterostomy
Creation of a connection between the gallbladder and intestine
-tripsy
Crushing
CPT
Current Procedural Terminology
What is acroymn CPT stand for
Current Procedural Terminology
Cdt
Current dental terminology
Frontal ( coronal)
Cuts a a right angle to the midline cut from side to side and divides the body into front anterior and back section
Transverse (horizontal) axial
Cuts horizontally through the body and separates the body into upper and lower section
Saggital
Cuts through the midline of the body from front to back and divides the body into right and left sections
Federal Register
Daily publication for rules of federal agencies and organizations as well as executive orders and other presidential documents.
Melan/o
Dark black melanin
Stratum basle
Deepest of five layers made of basle cells
What is Stratum basale composed of
Deepest of the 5 layers, made of basal cells
Appendix B
Deleted 10/1/2004 - contained Glossary of Mental Disorders.
Total Body Hypothermia
Deliberate reduction of a patient's total body temperature, reducing the general metabolism of the tissues. Watch anesthesia record for notes regarding total body total body hypothermia. Generally, temperature is reduced 20 percent to 30 percent below a patient's normal temperature. This may not be reported separately when the code indicates it is included.
DNA
Deoxyribonuclic acid
What does the acroymn HHS
Department of Health & Human Services
HHS
Department of Health and Human Services
Demographic Data
Describes the characteristics of the enrollee populations within a managed care entity, age, sex, race, etc
What is the National Coverage Determinations Manual
Describes whether specific medical items, services, treatment procedures or technologies can be paid under Medicare
Fully Accredited
Designation that all standards have been met and approved by Center for Medicare and Medicaid Services (CMS) without any other actions.
Encounter Data
Detailed data about the patients services provided by a managed care entity. Similiar to that of a claim form. Sometimes called "shadow claims"
Guidelines
Developed by appropriate groups to assist providers with decisions in specific clinical situations.
DRG
Diagnosis Related Group
Admitting Diagnosis
Diagnosis code indicating patient's diagnosis at admission
What does the first coding tip mean for the operative report for a coder ?
Diagnosis code reporting- Use the post-operative diagnosis for coding unless there are further defined diagnoses or additional diagnoses found in the body or finding of the operative report.
Phren/o
Diaphragm
Diagnosis
Disease, signs, or symptoms that indicate the patient's condition and support medical necessity for services provided.
Modifier 59
Distinct procedural service
modifier 59
Distinct procedural service
Case Mix
Distribution of patients into categories reflecting severity of illness or resource uses.
Board Certified
Doctor specializing in certain area of medicine and who passes an advanced exam. Primary care and specialists can both be board certified
Notice of Privacy Practices
Document informing a patient of when and how their PHI can be used.
What is a medical record
Documentation is the recording of pertinent facts and observation about an individual's health history, including past and present illness, tests, treatments and outcomes
Closed fracture
Does not involve a break in skin
Define Closed fracture
Does not involve a break in the skin
Ot/o
Ear
Salping/o
Ear tube rust schism tube
Where are the Bartholin's glands found?
Either side of the introitus in the female
EHR
Electronic Health Record
Charge Description Master (CDM)
Electronic billing table where charge amounts are kept in a centralized place.
What is EHR
Electronic health record
Endocrin/o
Endocrine glands or system
concha bullosa
Enlargement of the nasal turbinate
what is included in the Health care clearinghouse covered enitity
Entities that process nonstandard health information they receive from another entity into standard format or vice vesa
Health Plan
Entity that assumes the risk of paying for medical treatment.
Epididym/o
Epididymis
Benefit Period
Episode of care within hospitals & skilled nursing facilities (SNF). Begins on admission and ends 60 days after care has ended
What is the Mucous Membrane Composed of
Epithelium overlaying a layer of connective tissue called Lamina Propria
Adjusted Average Per Capita Cost (AAPCC)
Estimate of how much Medicare will spend in a year for an average beneficiary
E/M
Evaluation and Management
E/M OR E&M
Evaluation and Management
What are some different types of services documented in medical record
Evaluation and management Operative reports X-Rays
-scopy
Examination of
Electronic Data Interchange (EDI)
Exchange of transactions from one computer to another in a standard format
epiglottidectomy
Excising the covering of the larynx.
-ectomy
Excision surgical removal
Explanation of Benefits EOB(Remittance Advise (RA)- Medicare)
Explanation from insurance with details of payment, denials, etc.
exteriorization
Exposing an internal structure outside the body for observation, surgery, or experimentation, such as creating a passage from the bladder to the abdominal wall.
What is the coder role in a physician's office
Extremely important to proper reimbursement and the livelihood of the physican
Blephar/o
Eyelid
Community Mental Health Services
Facility provides outpatient services for children, elderly, chronically ill, & residents discharged from inpatient treatment at a mental health facility. 24 hour day emergency care, partial hospitalization or psychosocial rehab, & screening for admission to inpatient facility.
CMS rules require the provider to present the ABN to patient when
Far enough in advance that the beneficiary or representative have time to consider the options and make an informed choice.
Distal
Farther to the point of attachment or given reference point
Fasci/o
Fascia
Medicare
Federal health insurance company, 65 or older, or people w/ certain disabilities or ESRD
What is Medicare
Federal health insurance program- Administerd by the Center for Medicare &Medicaid Services (CMS)
Long bones/ tubular
Femur humerus,
apheresis
Filtering of blood to remove stem cells.
Dactylic
Finger or toe
Copayment
Fixed amount patient pays upfront
after-cataract
Following cataract removal, the physician opts to retain the posterior outermost shell, so an organic separation remains between the posterior and anterior chambers. This remaining shell later may develop opacities called "after-cataract."
brachytherapy
Form of radiation therapy in which radioactive pellets or seeds are implanted directly into the tissue being treated to deliver their dose of radiation in a more directed fashion.
What is Smooth muscle
Found in the walls of all the hollow organs of the body except the heart. It condtraction reduces the size of these structures; movement generally is considered Involunatry
HITECH has how many categories of violation
Four
Indentify the following prefix of number : Quadri-
Four
Quadri
Four
Epidermis
Four to five layers call stratum
Fraud and Abuse
Fraud is to purposely bill services not given or for higher reimbursement than give. Abuse is payment for services billed by mistake but should not have been paid for.
Cholecyst/ o
Gallbladder
Gangli/o ganglion/o
Ganglion
bariatric surgery
Gastric restrictive procedures that are used to treat morbid obesity.
conduction system
Generates and distributes electrical impulses over the heart and along the septum to stimulate contraction, allowing blood to move throughout the body
allogenic
Genetically different, but obtained from the same species.
GPCI
Geographic Practice Cost Index
Glomerul/ o
Glomerulus
What is stratum Granulosum composed of
Granular layer of cells
Stratum granulosum
Granules layer of cells accumulate two types of granules kerathoyLine and lamelated granules
Trich/o
Hair
Accredited
Having seal of approval after being evaluated and demonstrating quality standards
What will most operative notes have
Header and Body
What does the acroymn HITECH stand for
Health Information Technology for Economic and Clinical Health Act
HICN
Health Insurance Claim Number
Adjudication
Health Insurance Claims process at the insurance company
HIPAA stands for
Health Insurance Portability and Accountability Act of 1996
What is HIPAA
Health Insurance Portability and Accountability Act of 1996
What is HMO
Health Maintenace Organizations
HMO
Health Maintenence Organization
Episode of Care
Health care services given during a certain period of time, usually during a hospital stay.
Additional Benefits
Health care services not covered by Medicare and are offered through the Medicare Advantage Organization for no additional premium. The benefits must equal the ACR (Adjusted Community Rating)
Administrative Data
Health insurance information stored in automated information system about enrollment, eligibility, claims, etc.
Group Health Plan
Health plan providing coverage to employees & families and supported by employer.
HCPCS
Healthcare Common Procedure Coding System
What is acroymn HCPCS stand for
Healthcare Common Procedure Coding System
Cardi/o
Heart
Hippa
Heath information portability and accountability act
rectocele
Herniation of the rectal wall through the posterior wall of the vagina
What does the fourth coding tip mean for the operative report for a coder?
Highlight unfamiliar words- Words you are not familiar with should be highlighted and researched for understanding
Stratum corneum
Horny layer
Metabolism
How drug breaks down in preparation to leave body
Ex ix yx
Ices : index indices
Claim Adjustment Reason Codes
Identifies the reason for any difference in charge and payment. This code set is used in the X12 835 Claim Payment & Remittance Advice and the X12 837 Claim transactions and is maintained by Health Care Code Maintenance Committee
Claim Status Code
Identifies the status of a claim. This code set is used in the X12N 277 Claim Status Inquiry and Response transactions and is mainted by the Health Care Code Maintenance Committee
Immun / o
Immunity, immune system
implantable defibrillator
Implantable device that delivers an electrical shock to restore a normal heart rhythm.
Hypothermic Circulatory Arrest
Implies a temperature of 20 degrees centigrade or less.
Smooth muscle
In the walls of all hollow organs except the heart contracts and is involuntary
en bloc
In total or in full; as a single piece.
End/o
In with in
Disability
Inability to engage in activity for medical reasons expected to last more than 12 months
-tomy
Incision cutting
Basic Benefit
Includes Medicare covered benefits (except hospice) and additional benefits
modifier 22
Increased procedural services
Never code directly from the
Index to Disease
Volume 2 of the ICD-9-CM
Index to Diseases: Diagnosis codes organized in an alphabetic index
Allowed Charge
Individual charge determination by carrier for a covered service or supply.
condyloma
Infectious tumor-like growth caused by the human papilloma virus, with a branding connective tissue core and epithelial covering that occurs on the skin and mucous membranes of the perianal region and external genitalia.
Pediculosis
Infestation of lice
Define Pediculosis
Infestation with lice
balanoposthitis
Inflammation and/or infection of the glans penis and prepuce.
Define Osteochondritis
Inflammation of bone and cartilage
Osteochondritis
Inflammation of bone and cartilage
Define Bursitis
Inflammation of bursa
Define Onchitis
Inflammation of nail matrix
Onychitis
Inflammation of nail matrix
Define Tendonitis
Inflammation of tendon
cystitis cystica
Inflammation of the bladder characterized by the formation of multiple cysts.
Comprehensive Inpatient Rehabilitation Facility
Inpatient rehabilitation to patient's with physical disabilities.
-tome
Instrument for incising
indentify the following suffix: -tome
Instrument for incising (cutting)
-meter
Instrument for measuring
-graph
Instrument for recording data
-scope
Instrument for viewing or examination
Indentify the following suffix: -meter
Instrument of measuring
Facility Charge
Insurance companies pay less and charge a cost for the facility where services where rendered.
Sebacious glands are a part of which anatomic system?
Integumentary
Cardiac muscle
Interlocking involuntary striated muscle and smooth muscle allow the passage of electrical impulses
ICD-9-CM
International Classification of Disease, 9th Clinical Modification
Enter/0
Intestines
What is the function of the thyroid gland
It secretes hormones regulation body metabolism and blood calcium
Which of the following is true about the tympanic membrane
It separates the external ear from the middle ear
Arth/o
Joint
Arthropathy
Joint disease
Kerat/o
Keratin/ horny layer of skin
Nephr/o
Kidney
Ren/o
Kidney
The loop of Henle is locate in which structure
Kidney
Hair papilla
Knob like indentation at bottom of hair follicle containing blood supply to hair root
Define Hair Papilla
Knoblike indentation at bottom of hair follicle containing the bloody supply to hair root
What is an NCD interpreted at the MAC level considered?
LCD Each MAC (Medicare Adminstrative Contractor) is responsible for interpreting national policies into regional policies, or Local Coverage Determinations
Which structure of the ear is considered the inner ear?
Labyrinth
Dacryocyst/o
Lacrimal sac
Disproportionate Share Hospital
Large share of low income patients. States subside under Medicaid and Medicare inpatient payments are higher.
Laryng/o
Larynx
CMS regulations often serves as ____ word in coding requirement for Medicare and Non-Medicare payers alike
Last
Define Scoliosis
Lateral Curvature of spine
Freedom of Information Act (FOIA)
Law requiring US government to give information to the public when it receives a written request, only records of executive branch. NOT congress, federal courts, state or local governments or private groups.
HIPAA Privacy Rule
Law that regulates the use and disclosure of patients' protected health information (PHI).
Flat bones
Layer of spongy bones between two thin layers of compact bone skull, ribs
The heart circulates blood through the lungs and is sent back into the left atrium of the heart via which vessel(s)?
Left and right pulmonary veins
Which chamber of the heart is considered the one working the hardest?
Left ventricle
A patient sustaining an injury to her great saphenous vein would have sustained injury to which of anatomical site?
Leg
Act/ Law/ Statute
Legislation passed through Congress and signed by President or passed over his veto
Phak/o phac/o
Lens
Attending Physician
Licensed physician who certifies the patient services via medical necessity and is primarily responsible for the patient's medical care and treatment.
What is limiting charge
Limits set on what can be charged for each CPT code, no matter if the physican is Par or Non-Par
Chromosome
Linear strand made of dna carrying genetic information
Where is Mucous Membrane Lined
Lined the interior walls of the organs and tubes opening to the outside of the body
Labi/o
Lip
Appendix E
List of 3 digit categories
Formulary Drugs
Listing of prescription medications that are approved for use and/or covered by plans
Lunula
Little moon area of nail
Hepat/o
Liver
LCD
Local Coverage Determinations
Prefixes often (not always) indicate what
Location, Time, number
Edit
Logic within Standard Claims Processing System that selects claim data and determines the payment
What does the third coding tip mean for the operative report for a coder?
Look for key words- Key words may include locations ana anatomical structures involved, surgicial approach, procedure method, procedure type, siiz and number and the surgical instruments used during the procedure
Define Alopecia
Loss of hair
Define Osteopenia
Lower than average bone density, can be a precursor to osteporosis
En: Ina
Lumen: lumina
Pneumon/o
Lung
Pulm/ o
Lungs
Lymph/o
Lympatic
Lymphaden/o
Lymph node
Lymphangi/ o
Lymph vessel
If an NCD doesn't exist for a particular item, its up to the ______ to determine coverage.
MAC
epispadias
Male anomaly in which the urethral opening is abnormally located on the dorsum of the penis, appearing as a groove with no upper urethral wall covering.
MP
Malpractice
Health Care Prepayment Plan (HCPPP)
Managed care organization that pays for all in network services after a monthly premium, deductible and copayment. Out of network services are payable by the patient.
Poly-
Many much
Indentify the following prefix of number : Poly-
Many, much
what is MAC
Medical Administrative Contractor
Durable Medical Equipment (DME)
Medical Equipment ordered by a doctor for use in the home. Must be reusable, ex. walker, wheelchair.
MS-DRG
Medical Severity-Diagnosis Related Group
Current Dental Terminology (CDT)
Medical code set of dental procedures maintained and copyrighted by American Dental Association (ADA) and adopted by the secretary of Health and Human Services (HHS) as a standard for reporting dental services and transactions
Current Procedural Terminology (CPT)
Medical code set of physician and other services, maintained and copyrighted by American Medical Association (AMA) and adopted as a standard for reporting physician and other services.
Designated Code Set
Medical code set or administrative code set required to be used by the adopted implementation specification for standard transaction
Health Common Procedural Coding System (HCPCS)
Medical code set that identifies health care procedures, equipment and supplies for claim submission purposes. Level I is Current Procedural Terminology (CPT) maintained by the AMA. Level II is alpha numeric identifying items not found in CPT and maintained by Center for Medicare and Medicaid Services (CMS) and Blue Cross Blue Shield Association (BCBSA) and the Health Insurance Association of American (HIAA)
Ambulatory Care Sensitive Conditions (ACSC)
Medical condtions that if treated immediatly and managed properly should not require hospitalization.
Indian Health Services
Medical services are provided free of charge to American Indians & Alaska Natives who are members of federally recognized tribes
What is the most significant government insurer
Medicare
What are the parts of Medicare
Medicare A Medicare B Medicare C Medicare D
MAC
Medicare Administrative Contractor
Medicare Part C is also called
Medicare Advantage
What is Medicare Part C also called
Medicare Advantage
Which plan covers PPO and HMO
Medicare Part C
Mac
Medicare administrative contractor
Ms-drg
Medicare severity diagnostic related group
Ambulatory Payment Classification (APC)
Medicare's outpatient prospective payment system in which services are grouped based on the resources needed and payment is fixed within each group
Administrative Costs
Medicare, Medicaid, CMS refer to this as their expenses to have the program, operating expenses, program management, etc.
Medull/o
Medulla oblaengata inner section middle soft marrow
Mening/o meninge/o
Meninges
Men/o mens
Menstruation
Mes/o
Middle
Psych/o
Mind
Comminuted fracture
More that two separate bones components segmental fracture bony fragments
Appendix A
Morphology of Neoplasms
Or/0
Mouth
Stoma stomat/o
Mouth
Kin/o kinesi/o
Movement
coronary circulation
Movement of blood through the tissues of the heart
antegrade
Moving forward or with the usual direction of flow.
In order, starting with the innermost layer, what are the four walls of digestive tract?
Mucosa, submucosa, muscle, serosa
Modifier 51
Multiple procedures
Muscul/o
Muscle
My/o
Muscle
Myle/o
Muscle
papillary muscles
Muscles attached to the lower portion of the interior wall of the ventricles and connected to the chordae tendineae.
diaphragm
Muscular wall separating the abdominal and thoracic cavities.
The ICD-9-CM Coordination and Maintenance Committee, which is co-chaired by the
NCHS (National Centers for Health Statistics) and the CMS (Centers for Medicare & Medicaid Services)
Onych/o
Nail
NCD
National Coverage Determination
NCD
National Coverage Determinations
What does the acroymn NDC stand for
National Drug codes
Procimal
Nearer to the point of attachment or given reference point
Which of the following is a renal calculus? * Pyelectasia * Hydroureter * Nephrolithiasis * Pyonephrosis
Nephrolithiasis
Neur/o
Nervous system,nervous tissue
Gli/o
Neuroglia cells
Administrative Code Sets
Non medical code sets that characterize a general business situation rather than a medical condition.
Custodial Care
Non-skilled personal care attendance (PCA) to help with Activities of Daily Living (ADL) like eating, bathing, etc.
Rhin / o
Nose
Exclusions
Not covered by insurance carrier, ex. prescriptions, eye care
NEC
Not elsewhere classifiable
NOS
Not otherwise specified
excludes2
Note in the Tabular List to indicate the terms listed are to be reported from another category and may be reported with the current selected code if both conditions exist.
excludes1
Note in the Tabular List to indicate the terms listed are to be reported with a code from another category and are not to be reported with the current selected code
What is CMS instruction stipulate on Cost estimate
Notifiers must make a good faith effort to insert a reasonalble estimate...the estimate should be within $100 or 25% of the actual costs, whichever is greated.
Health Insurance Claim Number (HICN)
Number assigned to insurance carrier/ beneficiary identifying them as the insurance subscriber.
NP
Nurse Practitioner
Who enforces HIPAA privacy rule
OCR (Office of Civil Rights)
What OIG document should a provider review for potential problem areas that will receive special scrutiny in the upcoming year?
OIG work plan
autologous
Obtained from the patient
medical supervision
Occurs when an anesthesiologist is involved in five or more concurrent anesthesia procedures, or fails to meet required medical direction criteria.
Epiphyseal fracture
Occurs when matrix is calcifying and chondrocytes are dying seen in children
Define Epiphyseal fracture
Occurs when matrix is calcifying and chondrocytes are dying. Common in Children
What month of each year does the OIG release a work plan outlining its priorities for the fiscal year ahead?
October
When does the OIG release a work plan outlining its priorities for the fiscal year ahead?
October
When will ICD-10-CM be effective
October 1, 2013
OCR
Office for Civil Rights
Ocr
Office for civil rights
OCR
Office of Civil Rights
What does the acroymn OCR stand for
Office of Civil Rights
OIG
Office of Inspector General
What does the acroymn OIG stand for
Office of Inspector General
OIG
Office of the Inspector General
Code of Federal Regulations
Official compiliation of federal rules and requirements
Mon/o
One single
Green stick
Only one side of shaft is broken other is bent
Define Greenstick Fracture
Only one side of the shaft is broken, and other is bent. Common in children
what is the HIPPA Minimum necessary requirement
Only the minimum necessary protected health information should d to satisfy a particular purpose. if the information is not required to satisfy a particular purpose, it must be withheld.
Center for Disease Control and Prevention (CDC)
Organization that protects public health through monitoring disease trends, investigation outbreaks, implementing illness, and injury control.
What term is used for pus draining from the ear?
Otopyorrhea
Ec ecto
Out outside
Indentify the following prefix of location: Ec-, Ecto-
Out; outside
Comprehensive Outpatient Rehabilitation Facility (CORF)
Outpatient rehabilitation
Ambulatory Surgery Center (ASC)
Outpatient surgery center not located in the hospital. Patient's may stay a few hours up to 1 night.
Oophor/o
Ovary
Salping/o
Oviduct tube
O/o
Ovum egg cell
Ov/o ovul/o
Ovum egg cell
Define Chondralgia
Pain around and in the cartilage
Insul/o
Pancreatic islets
Parathyr/o parathyroid
Parathyroid gland
Medicare Part C combines the benefits of
Part A and Part B and sometimes Part D
If an inbuilding pharmacy delivers medication (for home use) to an individual receiving outpatient chemotherapy, which part of Medicare should be billed for the pain medication by the pharmacy?
Part D
Administrative Simplification
Part of HIPAA authorizing HHS (Health and Human Services) to 1. adopt standards for transactions & code sets; 2. adopt standard identifiers for health plans; 3. adopt standards to protect security & privacy of personally identifiable health information.
Emergency Room (Hospital)
Part of hospital where emergency diagnosis and treatment of illness is provided 24 hours a day
What is the largest Sesamoid bone
Patella
Exceptions to Privacy Rule
Patient authorization is not required to use and disclose PHI for treatment, payment, & healthcare operations (TPO)
Ppaca
Patient protection and affordable care act
Independent Practice association
Patients contract with many different providers
Sesamoid bones
Pattela made of cartilage in early life becomes Osseous in adults
Coinsurance
Percentage of medical bill the beneficiary is responsible for paying.
Health Care Provider
Person trained and licensed to give health care and has a licensed place to treat patients. Doctors, nurses, or hospitals are examples.
Dual Eligibility
Persons covered under Medicare and Medicaid
Define Subcutaneous
Pertaining to below the skin
Chondral
Pertaining to cartilage
Define Chondral
Pertaining to cartilage
Define Coccygeal
Pertaining to coccyx
Define Femoral
Pertaining to femur or thigh bone
Define Dactylic
Pertaining to finger or toe
Define Patellar
Pertaining to patella
Define Iliac
Pertaining to the ilium
Define cutaneous
Pertaining to the skin
Define Hypodermic
Pertaining to under the skin
Define Intradermal
Pertaining to within the skin
Define Carpal
Petaining to the wrist bones
Pharyng/o
Pharynx
On: a
Phenomenon phenomena
Phrenic/o
Phrenic nerve
PA
Physician Assistant
PE
Physician Expense
PFS
Physician Fee Schedule
Where is Medicare Part B usually used
Physician offices (Outpatient Facility)
Define dermatologist
Physician specializing in diseases of the skin and subcutaneous tissue
Case Management
Physician, nurse, or other person tracks use of facilities and resources of a patient to be sure they are receiving the care they need.
Define Melanin
Pigment giving color to the skin
Define Melanoma
Pigmented tumor of the skin
Pituitar/o
Pituitary gland
Hypophys/o
Pituitary gland hypophysis
What is the definition of P of SOAP
Plan-Course of Action. Here, the provider will list eh next steps for the patient, whether it is ordering additional test, or taking over the counter medication
-plasty
Plastic repair plastic surgery reconstruction
Thrombocyt/o
Platelet, thrombocytes
Pluer/o
Pleura
What is PPO
Preferred Provider Organizations
What is Medicare Part D
Prescription drug coverage program available to all Medicare beneficiaries. Private companies approved by Medicare provide the coverage.
Decubitus
Pressure ulcer
Define Decubitus
Pressure ulcer/bedsore
Stratum spinosum
Prickle cells
Commerical carriers are considered what
Private payers that offer both group and individual plans.
modifier 63
Procedure Performed on Infants Less than 4 kg
angioplasty
Procedure to open narrow or blocked vessels
add-on codes
Procedures commonly carried out in addition to the primary procedure performed. Add-on codes may not be reported alone, and are identified with a + sign.
Discharge Planning
Process of deciding what a patient needs to move smoothly from one level of care to another, ex. hospital to nursing home.
PLI
Professional Liability Insurance
American Medical Association (AMA)
Professional organization maintains CPT code sets, secretariat to National Uniform Claim Committee (NUCC) which consults under HIPAA. ASC payment group rate.
Ancillary Services
Professional services by a hospital or inpatient facility. Xrays, drugs, labs, etc.
Is :Es
Prognosis : prognoses
Demonstrations
Projects and contracts that CMS has signed with various health care organizations. Used to evaluate the effects and impact of various health care initiatives and the cost of implications to the public.
Compound fracture
Projects through skin w/ possible infection
Define Compound fracture
Projects throught the skin with a possibility of infection
Prostat/o
Prostate
What is the acroymn PHI stand for
Protected health infomation
What is the Patient Safety Rule according to the OCR
Protects indentifiable information being used to analyze patient safety event and improve patient safety
What does the OCR do
Protects the privacy of individually indentifiable health information; HIPAA Security Rule Patient Safety Rule
diverticulum
Protrusion of the intestinal wall
Custodial Care Facility
Provides room and board, and other personal assistance on a long term basis but does not include medical care.
Health Care Clearinghouse
Public or private entity that processes data from nonstandard to standard and/or receives standard transactions from another entity to convert
-centesis
Puncture tap
How often do Practices should check policies to maintain compliance
Quarterly
cholangiopancreatography
Radiographic recording of the biliary system and pancreas.
duodenography
Radiographic recording of the duodenum, or the first part of the small intestine.
cineradiography
Radiography of an organ in motion (for example, a beating heart)
Cost Rate
Ratio of cost of the program on an incurrerd basis during a year to the taxable payroll for the year.
What does the fifth coding tip mean for the operative report for a coder?
Ready the body- All procedure reported should be documented with the body of the report. The body may indicate a procedure was abandoned or complicated, possibly indicating the need for a different procedure code or reporting of a modifier
reanastomosis
Reconnecting a previous connection between two places organs or spaces
Proct/o
Rectum
Erythr /o erythrocyt/ o
Red blood cell
Downcode
Reduce the value and code of a claim when documentation does not support the level of service billed by provider.
modifier 90
Reference (outside) laboratory
monitored anesthesia care
Refers to a continuum a technique for many surgical procedures that do not require deep sedation or a general anesthetic. The anesthesia provider must be prepared to convert to general anesthesia, if necessary.
epicardial
Relating to the innermost layer of the heart wall.
RUC
Relative Value Update Committee
Pyel/o
Renal pelvis
modifier 91
Repeat clinical diagnostic laboratory test
modifier 77
Repeat procedure by another physician or other qualified health care professional
modifier 76
Repeat procedure or service by same physician or other qualified health care professional
Cost Report
Report required from providers on an annual basis in order to make proper determination of amounts payable under Medicare program.
American Hospital Association (AHA)
Represents concerns of instituitional providers. They host the National Uniform Billing Committee (NUBC) which consults under HIPAA
Health Insurance Association of America (HIAA)
Represents the interest of commercial health care insurers. Participates in HCPCS Level II code data sets.
Claim
Request for payment for services or benefits received. Claims are called bills through Medicare Part A
Emergency Medical Treatment and Active Labor Act (EMTALA)
Requires Medicare participating hospitals provide appropriate screening examination to any patient that requests such an exam. The patient must be stabilized before transferring care.
RBRVS
Resource Based Relative Value System
Retin/o
Retina
The ABN form is entitled
Revised ABN CMS-R-131 and is available with instructions as a free download on the CMS website.
RNA
Ribonucleic acid Transcribed from DNA by enzymes and plays a crucial role in protein synthesis
Dextr/o
Right
Bones are composed of what
Rigid connective tissue
Tinea
Ringworm
Define Tinea
Ringworm; a fungal infection of the skin
What does the CMS-HCC provide
Risk adjument model provides adjusted payment based on a patient's disease and demographic factors.
define the classification SHORT of bone
Roughly cube shaped bones
Civilian Health and Medical Program (CHAMPUS)
Run by department of defense. Used to give medical care to active duty but now this is called TRICARE
What is SOAP
S- Subjective O-Objective A- Asssessment P-Plan
Evaluation and Management services are provided in what standard format
SOAP
Define Hair Follicles
Sacs holding the root of hair fibers
Sail/o
Saliva, salivary glands
Scler/o
Sclera
Osche/o
Scrotum
Seb/o
Sebum sebaceous gland
Sperm/0 spermat/o
Seman spermatozoa
Semin/o
Semin
Vesicul/o
Seminal vesicle
decortication
Separating the pleura adhering to lungs to assist with expansion of the lungs.
Catastrophic Illness
Serious and costly health problem that could be life-threatening or cause disability. Costs can cause patient financial hardship.
Um a
Serum sera
Covered Services
Services for which a carrier pays as defined and limited by coverage or statute. physician care, outpatient hospitals, diagnostic tests, DME, ambulance, and other health services.
Covered Charges
Services or benefits for which a health plan makes either partial or full payment.
Code Set
Set of codes used to encode data elements terms, codes, concepts, required under HIPAA
Health Employer Data and Information Set (HEDIS)
Set of standard performance measures that give you information about the quality of a health plan. Center for Medicare and Medicaid Services (CMS) collects HEDIS data for Medicare patients.
What is the HIPPA Security Rule according to the OCR
Sets national standards for the security of electronic protected health information and the confidentiality provision of the patient Safety Rule
Define Comminuted Fracture
Shatter affected part into bony fragments
Administrative Simplification Act
Signed 12/17/01 allows HHS (Health & Human Services) to exclude providers from Medicare for HIPAA non-compliance of electronic claims and prohibit paper claims except in certain situations
modifier 25
Significant Separately Identifiable E/M Service by the Same Physician on the Same Day of the Procedure or Other Service
ipsilateral
Situated on the same side
Derm/o
Skin
Dermat/o
Skin
What does the axial skeleton consist of
Skull, hyoid/cervical spine, ribs, sternum, vertebrae, sacrum
Somn/o Somn/i
Sleep
Critical Access Hospital
Small facility that gives limited outpatient and inpatient hospital services in rural areas
Nucleus
Small round structure within the cell containing chromosomes and nucleoplasm DNA and RNA
CMS developed polices regarding medical necessity are based on regulations found in title XVIII, $1862(a) of the
Social Security Act
Business Associate
Someone performs a function on behalf of a covered entity but is not part of the covered entity's workforce, outside business manager.
Caregiver
Someone who cares for a patient who is ill, disabled, or aged. Can be relatives, friends or someone who is paid.
Define Follicles
Specialized structures required for hair growth
Genev
Specific segment of base pairs in chromosomes functional unit. Of heredity
What is a gene
Specific segment of base pairs in chromosomes; functional unit of heredity
Capitation
Specified amount of money is paid to a health plan or doctor regardless of the services rendered in that period. One lump sum.
Myle/o
Spinal cord
Radical/o
Spinal nerve root
Splen/ o
Spleen
What procedure is performed when the spleen is removed?
Splenectomy
Define Spiral Fracture
Spread along length of bone and produced by twisting stress
Spinal fracture
Spread along length of bone and produced by twisting stress
4 HMO models
Staff, Group, Independent practice association, Network
modifier 58
Staged or Related Procedure or Service by the Same Physician During the Postoperative Period
Soap
Standard format for EM services subjective objective assessment plan
What does the second coding tip mean for the operative report for a coder?
Start with the procedures listed- For the coder who is new to coding a procedure , one way of quickly starting the research process is by focusing on the procedures listed in the header. Read the note in its entirety to verify the procedures performed. Procedures listed in the header may not be listed correctly and procedures documented with the body of the report may not be listed in the header at all. It will help a coder with a place to start
CMS Agent
State survey agency who participates in Medicare surveys and certification process. ex. private physician consulting with the State Agency (SA) or CMS regional office.
Advanced Directive
Statement written by patient on how they want medical decisions to be made. May include a Living Will or Durable Power of Attorney for healthcare.
embezzlement
Stealing money that has been entrusted to your care
Gastr/0
Stomach
Skeletal muscle
Striated muscle , voluntary control
Cytology
Study of cells
What is cytology
Study of cells including the formation, structure and function of cells
Narc/o
Stupor numbness sleep
The lymphatic ducts empty their contents into what structure?
Subclavian veins
turbinates
Superior, middle, and inferior bony structures found in each right and left nasal cavity to assist with air movement.
Health Care Quality Improvement Program (HCQIP)
Supports mission of CMS to assure health security for beneficiaries and improving quality of care.
-stomy
Surgical creation of an opening
-Pexy
Surgical fixation
Athrodesis
Surgical fixation of a joint
dacryocystorhinostomy
Surgical procedure that restores the flow of tears into the nose from the lacrimal sac when the nasolacrimal duct does not function.
annuloplasty
Surgical reconstruction of the ring (annulus) of the heart valve.
sialolithotomy
Surgical removal of a stone located in the salivary gland or duct.
Cell membrane
Surround and protects the individual cell
Osteorrhaphy
Suture of bone
Hird/o
Sweat/perspiration
Synov/i
Synovial fluid, joint or membrane
Volume 1 of the ICD-9-CM
Tabular List: Diagnosis codes organized in order by code
foley catheter
Temporary indwelling urethral catheter held in place in the bladder by an inflated balloon containing fluid or air.
Ten/o tendin/o
Tendon
Pump Oxygenator
Term used when a cardiopulmonary bypass (CPB) machine is used to function as the heart and lungs during heart surgery.
Orchi/o orchid/0
Testis
Test/o
Testis testicle
HITECH
The Health Information Technology for Economic and Clinical Health Act
Center for Medicare & Medicaid Services (CMS)
The Heath & Human Services (HHS) agency responsible for Medicare & parts of Medicaid. Maintains UB-04, oversight of HIPAA and maintains HCPCS code set & Medicare remittance advice (RA) remark codes. They promote higher quality care
DRG Coding
The MS-DRG categories used by hospitals on discharge billing.
What was published in the Federal Register on October 5, 2000
The OIG Compliance Program for Individual and Small Group Physician Practice
Date of Service
The actual date a particular service was performed
Deductible (Medicare)
The amount a beneficiary must pay for health care before Medicare begins to pay, either Part A or Part B. These amounts vary every year.
Actual Charge
The amount the provider charges for medical services or supplies. Not always paid in full.
Case Mix Index
The average Diagnostic Related Groups (DRG) relative weight for all Medicare admissions
Medical Records
The complete history and current assessment, providing continuity of care, documenting med. necessity, defense against malpractice, used for billing
Cost Sharing
The cost of medical care the patient must pay, coinsurance, deductible, etc.
Admission Date
The date the patient was admitted for inpatient care, outpatient, or start of care.For hospice, enter effective date of election of hospice benefits.
Admitting Physician
The doctor responsible for admitting a patient to the hospital or other inpatient health facility
Approved Amount
The fee Medicare sets as reasonable and pays to the provider.
Catastrophic Limit
The highest amount a beneficiary is required to pay out of pocket during a certain period of time for certain covered charges.
Vital Capacity (VC)
The maximum volume of air a person can exhale after maximum inhalation. The measure is used in diagnostic pulmonary testing.
Benefits
The money or services provided through an insurance policy
Beneficiary
The name of a person who has health care insurance through the insurance program
Fixed Capital Assets
The net worth of facilities and other resources
Coordination of Benefits
The process of determining which policy is first when a patient has 2 health care plans.
What does ABN protect
The provider's financial interest by creating a paper trail that CMS requires before a provider can bill the patient for payment if Medicare denies coverage for the stated service or procedure
Work RVUs reflect
The relative levels of time and intensity associated with furnishing a Medicare PFS service and account for ~50% of the total payment associated with a service.
Descriptor
The text defining a code in a code set
cardioversion
The use of defibrillator paddles to restore normal rhythm of the heart by electrical shock.
What does purpose of connective tissue
They support and connect tissue of the body
Stratum reticulare
Thick layer dense irregular connective tissue
Stratum papillare
Thin superficial layer interlocked with the epidermis
Indentify the following prefix of number :Tri-
Three
Tri
Three
Us I
Thrombus thrombi
Indentify the following prefix of location : Per-
Through
Per
Through
Trans
Through across
Dia
Through complete
Indentifiy the following prefix of location : Dia-
Through; complete
Thym/o
Thymus gland
Thyr/o thyroid/o
Thyroid gland
Define Connective
Tissue connecting or binding together
What is the important title concerning the position of a medical coder
Title II-Preventing Health care Fraud and Abuse; Administrative Simplication; Medical Liability Reform
Under what regulations is medically necessity found under
Title XVIII 1862 (a) (1) of the Social Security Act
Ton/o
Tone; pressure
Gloss/0
Tongue
Lingu/o
Tongue
Tonsil/o
Tonsil
Ad
Toward near
Lateral
Toward the Side of the body
Posterior (dorsal)
Toward the back
Anterior (ventral)
Toward the front
Medial
Toward the midline of the body
What does Lateral mean
Toward the side of the body
What does Medial mean
Towards the midline of the body
Trache/ o
Trachea
What does acroymn TPO stand for
Treatment Payment and Health Care Operations
Tpo
Treatment Payment and healthcare operations
True or Fale Cartilage is nonvascular or has no blood vessels
True
Bi
Two twice
Tympan/o
Tympanic cavity middle ear tympanic membrane
Myring/o
Tympanic membrane
Covered Entity
Under HIPAA, this is a health plan, clearninghouse, or provider who transmits any health information in electronic format in connection with HIPAA transaction.
Relative Value Unit (RVU)
Unit of measure assigned to a medical procedure based on the time required to perform it. This system is composed of three elements: work, practice expense, and liability insurance.
Modifier 78
Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the postoperative Period
modifier 78
Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the postoperative Period
Modifier 79
Unrelated procedure or service by the same physician during the postoperative period
Ureter/0
Ureter
Urethr/o
Urethra
Which anatomical structure in the urinary system differs in position and length between male and female, but serves the same function with regard to urine, and is often treated the same?
Urethra
Cyst/o
Urinary bladder
Vesic/o
Urinary bladder
Urin/o
Urine
Ur/o
Urine urinary tract
What is the result of a ureteral blockage?
Urine will not be able to flow from the kidney to the bladder
direct endoscopy
Use of an endoscope to look directly at the larynx.
indirect endoscopy
Use of mirrors with a rigid laryngoscope to view the larynx.
Off label
Used for a purpose for which the drug has not been FDA approved
Hyster/o
Uterus
Metr/o metr/o
Uterus
Uvul/o
Uvula
Colp/o
Vagina
Valv/o valvul/o
Valve
Private Payers contracts may
Vary but may include hospitalization, basic and major medical coverage.
The structure of the male anatomy carrying sperm out of the epididymis is called
Vas Deferens
Vas/o
Vas deferens ductus deferens also vessel duct
Phleb/o
Vein
Ven/o ven/i
Vein
chordee
Ventral (downward) curvature of the penis due to a fibrous band along the corpus spongiosum seen congenitally with hypospadias, or a downward curvature seen on erection in disease conditions causing a lack of distensibility in the tissues.
Define Compression Fracture
Vertebra Collapse due to trauma, tumor or osteoporosis
Compression fracture
Vertebra collapse
A ae
Vertebra: vertebrae
Irregular bones
Vertebrae facial
Angi/o
Vessel
Vas/o vascul/o
Vessel
peritoneoscopy
Visualization of the abdominal cavity using a scope placed through a small incision in the abdominal wall.
Episi/0
Vulva
When should an ABN be signed?
When a service is not expecgted to be covered by Medicare. RATIONALE: This form explains to the patient why a service MAY be denied by Medicare. The ABN form should be completed for services potentially con-covered by Medicare to advise the patient of potential financial responsibility.
When is a physican considered a "participating physician"
When contracted with a insurance carrier whether that be a private insurance company or a governmental.
Emergency Care
When patient's health is in serious danger and every second counts
When seeing the instruction to use additional code, which code goes first?
When sequencing codes, the codes listed under the "use additional code" are secondary
if a NCD does not exist what are CMS guidelines
Where coverage of an item or service is provided for specified indications or circumstances but is not explicitly excluded for others, or where the item or service is not mentioned at all in the CMS Manual System, the Medicare contractor is to make the coverage decision, in consultation with its medical staff and with CMS when appropriate, based on the laws, regulations, ruling and general program instructions.
Leuk/ o leukocyt/ o
White blood cell
Gym/o gynec/0
Woman
Erg/o
Work
Colles fracture
Wrist effects distal radius bone
Care Plan
Written plan of services patient will receive to ensure the patient's best care physically, mentally & socially
portography
X-ray visualization of the portal circulation using radiopaque material
Can a Medical record serve as legal document
YES
Define Jaundice
Yellowness of skin
Formula for Calculating Facility Payment amounts
[(Work RVU * Work GPCI) + (Transitioned Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * CF
Formula for Non-Facility Pricing Amount
[(Work RVU * Work GPCI) + (Transitioned Non-Facility PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * (CF)
arterial line
a catheter inserted into an artery, used most commonly to measure real-time blood pressure, and obtain samples for arterial blood gas
Which of the following best describes psoriasis
a chronic condition characterized by red, dry elevated lesions covered by silvery scales
chronic
a condition that develops slowly and persists over a period of time
Joint and articulating surfaces provide what
a connection between two or more parts of skeleton
conscious sedation
a decreased level of consciousness in which the patient is not completely asleep
Pre-existing Condition
a diagnosed condition that a person had before the health insurance policy
What is a operative report
a document the detail of a fprocedure performed on a patient
Controlled substance
a drug that contains a narcotic and has potential for addiction
What is the OIG
a government agency tasked to protected the integrity of Department of Health & Human Services programs, as well as the health and welfare of the beneficiaries of those programs
What are systems
a group of rogans working together to perform a complex body function
panel
a group of tests performed together and listed in the code description
Medicaid is a
a health insurance assistance program for some low-income people
anesthesiologist assistant
a health professional who has completed an accredited anesthesia assistant training program
what is the serous membrane composed of
a layer of simple squamous epithelium overlaying a layer of loose connective tissue.
subcutaneous layer is not considered
a layer of skin.
Cartilage is made of
a matrix of chondrocytes, collagen, cells called proteoglycans depending on the type of cartilage
physical status modifier
a modifier used to report the physical status assigned to each patient undergoing anesthesia. patients are ranked by their individual health status.
diaphragm
a muscle that separates the chest from the abdominal cavity
velocity flow mapping
a non-invasive method to image blood flow through the heart by displaying flow data on the two-dimensional echocardiographic image
What is connective tissue
a number of different tissues with common feauture.
chronic obstructive pulmonary disease (COPD)
a progressive lung disease restricting air flow, which makes breathing difficult. Chronic bronchitis and emphysema are the two main components of COPD. Most COPD is a result of cigarette smoking.
indentify the following suffix :-gram
a record of data
SRNA (student registered nurse anesthetist)
a registered nurse training in an accredited nurse anesthesia program
carina
a ridge of cartilage in the trachea that occurs between the division of the two main bronchi
define the classification SESAMOID of bone
a short bone formed within tendons; cartilaginous in early life and osseous in adult.
a combination code indicates
a single code is used to classify 2 diagnoses, a diagnosis with an associated secondary process (manifestation), or a diagnosis with an associated complication
Medicaid administed on
a state-by-state basis and coverage varies- although each of the state programs adheres to certain federal guidelines
anastomosis
a surgical connection between two hollow or tubular structures
The musculoskeletal system is
a systems of muscles, joints, tendons, ligament
cardiopulmonary bypass (CPB)
a technique used during heart surgery to take over temporarily the function of the heart and lungs
controlled gypotension
a technique used in general anesthesia to reduce blood pressure to control bleeding during surgery. watch anesthesia record for notes regarding deliberate or controlled hypotension
modality
a therapeutic agent or application
what does the cutaneous membrane consist of
a thin outer layer of stratified squamous epithelium attached to a thicker underlying layer of connective tissue.
What is cartilage
a type of flexible connective tisssue
doppler
a type of ultrasound, especially useful for imaging blood flow. The doppler can create images either in shades of gray or, when processed by a computer, in color.
conversion factor
a unit multiplier to convert anesthesia units into a dollar amount for anesthesia services. CMS annually reviews conversion factors. conversion factors also may be negotiated with insurance companies
What is a compliance plan
a written set of instructions outlining the process for coding and submitting accurate claims and what to do if mistakes are found.
compliance plan
a written set of instructions outlining the process for coding and submitting accurate claims, and what to do if mistakes are found.
reducible
able to be corrected or put back into a normal position
Leukocytosis is
abnormal condition of WBC
Define Kyphosis
abnormal curvature of thoracic spine (humpback)
hydroureter
abnormal enlargement or distention of the ureter with water or urine caused by an obstruction
Barrett's esophagus
abnormal growth of stomach or intestinal cells at the distal end of the esophagus.
fistula
abnormal opening from one area to another area in the body or outside fo the body
hyperplasia
abnormal proliferation in the number of normal cells in regular tissue arrangement
What does Superior (cranial) mean
above; toward the head
indentify the following suffix: -graphy
act of recording data
Healthcare operations
activities necessary for a covered entity to run its business.
Major Medical
addition insurance for unusually large medical expenses
If a coder does not include all pertinent diagnoses and co-morbidities, the provider may lose out on what
additional reimbursement for which he/she is entitled.
Portions of HITECH strengthen HIPAA rules by
addressing the privacy and security concerns assoicated with the electronic transmission of health information
Tumor of a gland
adenoma
The difference between the physican's fee and the insurance carriers allowed amount is
adjusted by the participating provider
Endocrine glands that are above each kidney
adrenal
ICD-10 accommodates
advancements in medical knowledge of disease and disease processes, where ICD-9_CM has become outdated and insufficient.
Physician specialist
advances training in a particular area of medicine. (neuro., derm.)
bipolar disorder
affective disorder with alternating mood swings from euphoria to depression
p.c
after meal
Indentify the following prefix of time :Post-
after, behind
Medicare Part D is available to
all Medicare beneficiaries.
What is Cardiac muscle
also called heart muscle, it contains interlocking involuntary striated muscles as wellas smooth muscle, which allow the electrical impulses to pass quickly across the muscle fibers
What is skeletal muscle
also called striated muscle, it is attached to the skeleton by tendons; contraction of skeletal muscule is under voluntary control
Deductible
amount paid annually, insurance pays after it is met, higher deductible and lower premium,
HITECH allows patients to request
an audit trail showing all disclosures of their health information made through an electronic record.
Accreditation
an examination process the healthcare facility goes through to evaluate the facilities policies, procedures, and performance to meet higher standards.
The term episiotomy best describes a procedure of what type
an incision made in the perineum to enlarge the passage for the fetus during delivery
esophagitis
an inflammation of the lining of the esophagus
modifier 47
anesthesia by surgeon
surgical field avoidance
anesthesia provider avoids an area where the surgeon is working
Policy holder
another name for patient
immune globulin
antibodies derived from blood plasma providing short term protection against certain infections
The definition of a Health plan in the HIPPA regulations excludes
any policy, plan or program that provides or pays for the cost of excepted benefits
includes
appears immediately after a three-digit code title to further define or clarify the category
Topical
applied directly to skin or mucous membrane
Coordination of Benefits
applies when an individual is covered by more than one insurance policy
The meaning of atherosclerosis is
artery plaque
The combining form meaning "joint" is
arthro
prosthetic
artificial body part
PRN
as needed
Appendix C is available to
assist in coding of adverse effects
modifier 80
assistant surgeon
h.s
at bed time
orientation
awareness; ability to comprehend and to adjust in an environment
Indentify the following prefix of location : Ab-
away from
trachoma
bacterial infection of the eyes
flat fee
based on the physician fee schedule. Payments are made under the relative value unit. Time is not a consideration for payment.
a.c
before meal
Indentify the following prefix of time : Ante-
before; forward
The fifth digit in a morphology code indicates
behavior of the neoplasm
What does Inferior (caudal) mean
below; toward the lower end of the spine
vestibular schwannoma
benign tumor arising from nerve cells of the auditory nerve, also called acoustic neuroma
acoustic neuroma
benign tumor on the auditory nerve (8th cranial nerve) that causes vertigo, tinnitus, and hearing loss
The prefix meta means
beyond
modifier 50
bilateral procedure
-desis
binding, fusion
indentify the following suffix: -desis
binding, fusion
The study of life is
biology
The term "hemic" specifically refers to what bodily fluid?
blood
hematospermia
blood in seminal fluid
Flat bones have marrow but lack what
bone marrow cavity
Define Osteoblast
bone-forming cell
define the classification LONG of bones
bones longer than they are wide and found in the limbs. The bones are named for their elongated shape, not their size.
septum
bony structure that separates the left nasal cavity from the right nasal cavity
bronchi
bottom portion of the trachea that splits into airways to the right and left lung; the right is shorter and wider than the left.
Slow heartbeat
bradycardia
atherosclerosis
buildup of plaque or fatty paste inside arterial walls
po
by mouth
dacryolith
calculus on the lacrima
Enlargement of the heart
cardiomegaly
critical care
care provided for a critical illness or injury which acutely impairs one or more vital organ systems and is an imminent or life-threatening condition
arteries
carry oxygenated blood away from the heart
what does the serous membrane line
cavities including the thracic cavity and internal organs
Which term relates to the brain
cerebral
If a woman has a PAP smear performed by her gynecologist, what part of the female anatomy is involved?
cervix
Treatment using drugs
chemotherapy
aqueous humor
clear fluid filling the area behind the cornea, in front of the iris
what is stratum lucidum composed of
clear layer
occlusion
closure
Abuse
coding practices that lead to improper reimbursement by error because they do not meet medical necessity, ex. changing diagnosis to be covered by insurance
epididymis
coiled tube on the back of the testis that is the site of sperm maturation and storage and where spermatozoa are propelled into the vas deferent toward the ejaculatory duct by contraction of smooth muscle
pneumothorax
collapsed lung
empyema
collection of pus between the lung and the lining of the lung (pleural space)
:
colon is used in Volume I (tabular list) after an incomplete term requiring one or more of the descriptions that follow to make it assignable to a given category
Group policy
company offered insurance policy to employees
What is stratum Spinosum composed of
composed of prickle cells
exstrophy
condition in which an organ is turned inside out
NIH (national institute of health)
conducts research, trains research scientist, and distributes health info. to the public
microtia
congenital deformity of the ear
what is synovial membrane composed of
connective tissue
tenon's capsule
connective tissue surrounding the posterior eyeball
Larynx
connects the nasopharynx to the trachea, covered by the epiglottis during swallowing to prevent aspiration
Skill coders may become
consulatants, educators or medical auditors
Proper code assignment is determined by
content of the medical record and by the unique rules that governs each code set
Participating provider
contracts with health insurance companies to provide services to members at agreed upon rate
Section I of the official guidelines includes
conventions, general coding guidelines, and chapter specific guidelines
Pigment cells are in what layer of the shaft
cortex
Health Insurance
cover some or all medical/ surgical cost
Incision of the skull
craniotomy
Managed care organziations
created to manage cost of healthcare, in-network providers into agreement w/ MCO, Five models: HMO,PPO,EPO,IDS,POS
An ABN protects the provider's financial interest by
creating a paper trail that CMS requires before a provider can bill the patient for payment if Medicare denies coverage for the stated service or procedure.
percussion
creating sounds form the body by tapping
jejunostomy
creation of an artificial opening between the jejunum and the abdominal wall
gastrostomy
creation of an artificial opening into the stomach
xeroradiography
creation of radiographs by photoelectric process using metal plates coated with a semiconductor
Release of information
critical for continuity of care, federal and state law governed, greater protection for HIV, AIDS, Mental Health, and Substance abuse
-tripsy
crushing
Indentify the following suffix: - tripsy
crushing
orthotic
custom made mechanical appliance used in orthopedics
What does Frontal (coronal) plane mean
cuts at a right angle to the midline cut , from side to side and divides the body into front (anterior) and Back (posterior) sections
What does Transverse (horizontal) plane mean
cuts horizontally through the body and separates the body into upper (superior) and lower (inferior) sections
What does Sagittal plane mean
cuts through the midline of the body from the front to back and divides the body into right and left sections
qd
daily
infarction
death of tissue
modifier 57
decision for surgery
Intramuscular
delivered deep into muscle
burns are classified by
depth, extent, agent
fulguration
destruction of living tissue with an electric spark
decompensation
deterioration; exacerbation fo an illness or condition
Preauthorization
determines coverage and medical necessity
Birthday Rule
determines which insurance is primary and which is secondary when child is covered by both parents. Which ever parents b-day is earlier
A word that means "complete separation" and is the process of separating wastes from blood.
dialysis
Referring Physician
directs patient to another physician for diagnosis and treatment
modifier 53
discontinued procedure
arrhythmia
disorder of the heart rate or rhythm
DAW
dispense as written
hydronephrosis
distention of the kidney caused by an accumulation of urine that cannot flow out due to an obstruction. it may be caused by conditions such as kidney stones or vesicoureteral relflux
The transverse plan
divides the body into upper and lower portions
bifurcation
division into two
Medical record chronologically
documents patient care to assist in continuity of care between providers, facilitate claims review and payment
Drug classification
drugs are grouped by therapeutic use, body system they treat, and chemical structure
neurogenic baldder
dysfunctional bladder due to a central or peripheral nervous system lesion that may result in incontinence, residual urine retention, infection, stones, and renal failure.
Who is responsible for interpreting national policies into regional polices, called LCDs?
each MAC (Medicare Administrative Contractor)
A record of electricity in the brain is
electroencephalogram
parentheses are used to
enclose supplementary words that may be present or absent in the statement of a disease or procedure without affecting the code number to which it is assigned
Brackets are used in tabular list to
enclose synonyms, alternate wording, or explanatory phrases
Which of the following does not circulate fluids throughout the body
endocrine system
anoscopy
endoscopic examination of the anus
proctosigmoidoscopy
endoscopic examination of the sigmoid colon and rectum
Increased accuracy of physician documentation in result of a compliance program actually may assist what
enhancing patient care
A healthcare clearing house is a
entity that processes nonstandard health information they receive from another entity into a standard format
An abnormal collection of blood above the membrane covering the brain
epidural hematoma
Pertaining to skin cells
epithelial
Abuse
errors are not deliberate, 3 categories: inadvertent billing and coding errors, excessive charges, insufficient documentation, penalties are meant to educate.
modifiers
essential modifiers are subterms listed below the main term in alphabetical order, and are indented 2 spaces
The first step in 3rd party reimbursement is
establishing medical necessity
Medical underwritting
evaluating a persons health to decide whether or not to insure them
By statute, all work RVUs, must be examined no less often than
every 5 years
q4h
every four hours
qod
every other day
necropsy
examination fo a dead body to determine cause of death (autopsy)
indentify the following suffix: -scopy
examination of
autopsy
examination of a dead body to determine the cause of death
gross
examination of the entire specimen without sectioning of the specimen into thin slides to be examined without the use of a microscope
indentify the following suffix: -ectomy
excision, surgical removal
EPO
exclusive provider organization, similar to PPO, no OON Benefits
side effects
expected in some people, beneficial or harmful
Exclusions
expenses not covered by insurance company
The ABN is a standardized form that
explains to the patient why Medicare may deny the particular service or procedure.
laparoscopy
exploring the abdomen and pelvic cavities using a scope placed through a small incision in the abdominal wall
esophageal varices
extremely dilated sub-mucosal veins in the lower third of the esophagus
Volume 3 of the ICD-9-CM includes procedure codes and is typically used by
facilities for inpatient services.
azoospermia
failure of the development of sperm or the absence of sperm in semen
hypospadias
fairly common birth defect in males in which the meatus, or urinary opening, is abnormally positioned on the underside of the penile shaft or in the perineum, requiring early surgical correction
prolapse
falling or dropping down of an organ or internal part
hallucination
false sense of perception or reality
Dependent
family member of a health plan member
what does Distal mean
farther from the point of attachment or from a given reference point
Subcutaneous tissue is mostly composed of
fatty or adipose tissue plue some areolar tissue
bone marrow
flexible tissue in the interior of bones
PERILYMPH
fluid in the cochlea that vibrates and creates nerve impulses to the cochlear nerve
injection
fluid introduced into tissue, cavity, or vessel, usually by needle
hysterosalpingography
fluoroscopic imaging of the uterus and Fallopian tubes.
hysterosalpingography
fluoroscopic imaging with contrast of the uterus and Fallopian tubes
refraction
focus and direction of light
loosening of association
frequent change of subject, often with minimal relationship
Anterior means
front
vitreous humor
gel-like mass that fills the large posterior chamber of the eye
Which doctor specializes in treating older patients
geriatrician
The root lies beneath the skin behind the fingernail and extends several millimeters into the finger is also known as
germinal matrix
g
gram
Power of Attorney
grants power to a representative of your choosing to legally act and make decisions on your behalf.
What is the great toe called
hallux
arteriosclerosis
hardening of the arteries
Therapeutic concentration
having enough medication in system to be considered therapeutic
where is greatest concentration of follicles
head
HMO
health maintenance organization, PCP selected, only responsible for Copay, must stay in network
Administrative Law Judge (ALJ)
hearing officer who presides over appeal conflicts between providers or beneficiaries, and Medicare contractors (MAC's)
A myocardial infarction is a
heart attack
A condition in which blood is held back
hematuria
Blood protein found in red blood cells
hemoglobin
diaphragmatic hernia
hernia of the diaphragm
cystocele
herniation of the urinary bladder into the vagina
Schedule 2
high potential for abuse, dangerous, 30 signed prescription with no refills, opiods, dilaudid
The first 4 digits of a morphology code identify the
histological type of the neoplasm
hyoid bone
horseshoe-shaped bone situated in the anterior midline of the neck between the chin and the thyroid cartilage
Abstractor
hospital employee who converts documented procedurs and diangoses into medical codes
Pharmokinetics
how a drug moves through your body, absorption, distribution, metabolism, excretion
E codes are used to report
how an injury occurred and where the injury occurred.
absorption
how drug enters blood stream
Excretion
how drug leaves body
Distribution
how drug travels to target site
Pharmocodynamics
how drugs work on the body, 3 main effects: therapeutic, side effects, adverse reaction
Excessive amount of sugar in the blood is
hyperglycemia
allergy
hypersensitivity caused by exposure to an antigen
What is another name for subcutaneous layer
hypodermis
Which later is not considered part of the skin
hypodermis
presumptive identification
identification of a microorganism based on the growth patterns, color, and success in culturing the specimen in certain media
definitive identification
identification of the genus and species of the microorganism
what action can the provider take if the patient refuses to sign the ABN
if the patient still request the procedures and services but refuses to sign a properly-presented ABN, the provider should cocument the patient's refusal. The provider and a witness should then sign the form.
ductogram
imaging of the ducts in the breast
epidurography
imaging of the epidural space in the spine
hypothermic circulatory arrest
implies a temperature of 20 degrees c or less
strabismus
improper alignment of the eyes
Enteral
in mouth or GI tract (orally or rectally)
Indentify the following prefix of location: End/o-
in; within
disorientation
inability to estimate direction or location
indentify the following suffix: -tomy
incision, cutting
modifier 22
increased procedural services
slanted brackets
indicate multiple codes are required
brackets are used in the alphabetic index to
indicate multiple codes are worried
Define Arthritis
inflammation of joint
endocarditis
inflammation of the inner lining of the heart
epididymo-orchitis
inflammation of the testicles and epididymis
cystitis
inflammation of the urinary bladder
Medicare part A helps to cover:
inpatient hospital care care provided in skilled nursing facilities hospice care home health care
Medication admin Records
inpatient recordss
catheterization
insertion of a catheter into a body structure
Code first
instruction used in categories not intended to be the principal diagnosis. These codes are written in italics with a note. The note requires the underlying disease (etiology) be recorded first and the particular manifestation be recorded second. This note only appears in the tabular index
indentify the following suffix: -graph
instrument for recording data
Indentify the following suffix: -scope
instrument for viewing or examining
Secondary
insurance covering patient as dependent
Primary
insurance covering the patient as policy holder
formularies
insurance plans drug list, updated by committee and pharmacist
IDS
integrated delivery system, MCO coordinates all aspects of patient care, can include medical, vision, dental, and prescription, claims processing and workers comp.
What is largest organ system called
integumentary system
panic attack
intense anxiety; feels like a loss of control
As a part of Health Care Reform, the Affordable Care Act of 2010 amended the definition of fraud to remove the __________ requirement
intent
Fraud
intent is deliberate, federal offense, targets medicare, penalties are meant to punish
what does the serous membrane support
internal organs
eventuation of intestines
intestinal protrusion of the intestines through the abdominal wall
autonomic
involuntary, relating to the autonomic nervous system
what is the job of epithelium in mucous membranes
involved in absorption and secretion
Vertebrae are considered what
irregular bones
Office of the Inspector General (OIG)
issues antifraud compliance programs to help providers eliminate billing/coding errors, protects integrity of medicare and Medicaid programs
Which of the following is not true of the thoracic diaphragm
it is a frequent site of a spigelian (lateral ventral) hernia
In order for a V code to be listed first,
it must meet the definition of a principle or first-listed diagnosis code
Fee for Service
itemize and bill every item and service separately
anastomosis
joining of two blood vessels to allow flow from one to the other
Network HMO
joins together any number of staff models
what does synovial membrane line
joint cavities
Define Arthropathy
joint disease
Medicaid
joint federal and state program, people with limited income and resources, eligibility differs between states
What is a fingernail made of
keratin
Reno and nephro both mean
kidney
Visual examination of the abdomen by make a small incision near the navel is called?
laparoscopy
HIPAA Security Rule
law requiring covered entities to establish safeguards to protect health information, focuses on ePHI
minimum necessary standard
least amount of info required
A medically necessary service is the
least radical service/procedure that allows for effective treatment of the patients' complaint or condition
Indentify the following prefix of location: Sinister/o
left
modifier F1
left hand, second digit
modifier LT
left side
The myocardium is thickest around which chamber of the heart?
left ventricle
Policy
legal contract between a person or group and insurance company
Federal Registration
legal newspaper published every business day by the National Archives and records admin.
Which of the following has a refraction function in the eye? macula retina lens iris
lens
first trimester
less than 14 weeks
desensitize
lessening of sensitivity by administration of a specific antigen in low doses
auscultation
listening to body organs
What is areolar tissue
loose connective tissue consisting of a meshwork of collagen, elastic tissue and reticular fibers.
Schedule 4
low potential for abuse and dependency ex: Ativan, valium
Schedule 5
low potential for abuse, contain limited amount of certain narcotics, ex: Lyrica, lomotil
modifier E2
lower left eyelid
The mediastinum contains all of the following except
lungs
What is the nail and the nail bed and its edges called
lunula
Which of the following does not contribute to refraction in the eye?
macula
exenteration
major operation during which an organ and its adjacent structures are removed
The tunica vaginalis is part of which system?
male reproductive
Incus, stapes, _____
malleus
modifier 32
mandated services
molecular diagnostics
measurement of DNA, RNA, proteins, or metabolites to detect genotypes, mutations, or biochemical changes
pachymetry
measurement of corneal thickness
pelvimetry
measurement of the dimensions and capacity of the pelvis
Benefits
medical expenses that insurance company covers
Volumes 1 and 2 are used to assign diagnosis codes that establish
medical necessity for services rendered.
on call
medical personnel with special training and skills available to provide services when summoned
Medicare Part B helps to cover
medically necessary physicians' services ouptatient care other medical services (including some preventative services) not covered under Part A
What layer give hair its charactertistic color
medulla
Which part of the brain controls blood pressure, heart rate and respiration
medulla
oval window
membrane covered window from the inner ear to the middle ear
gait trainig
method of restoration of balance, extremity swings, stance
psychotherapy
method of treating mental disorders. treatment may involve education, pharmacology, suggestion, psychoanalysis
cilia
microscopic, hair-like projections that propel mucus toward the upper airway so that it can be expectorated
Indentify the following prefix of location : Mes/o
middle
choroid
middle layer between the retina and the sclera in the eye's posterior segment. nourishes the retina
Tricare
military health plan that provides services for active duty personnel and their families, survivors of military personnel and retired military personnel and their families
mg
milligram
modifier 81
minimum assistant surgeon
Schedule 3
moderate to low potential for abuse, high psychological dependency, ex: suboxone, Tylenol with codeine
Toenails grow what
more slowly
the root produces of what of the nail
most of volume
What does the muscloskeletal system provide
movement, form, strength and protection
modifier 99
multiple modifiers
modifier 51
multiple procedures
bundle of his
muscle fibers in the heart's conduction system that branch off to the right and left sides of the heart
Court order
must be responded to or provider may be fined
A benign tumor of muscle is
myoma
onych/o
nail
What does Proximal mean
nearer to the point of attachment or to the given reference point
Hemiplegia is a disorder caused by a defect in which anatomic system?
nervous
What is affected by myasthenia gravis
neuromuscular junction
modifier NU
new equipment
ileostomy
new opening of the ileum to the outside of the body
Non- Participating Provider
no agreement with insurance company to provide service and does not accept fee
Schedule 1
no current accepted use, high potential for abuse, most dangerous, es: heroin, LSD
uninsured
no insurance
NEC
not elsewhere classifiable
Medicare and many insurance plan may deny payment for a service that is
not reasonable or necessary according to the Medicare reimbursement rules.
npo
nothing by mouth
parenteral nutrition
nutrients delivered intravenously to patients who are postoperative, in shock, or otherwise unresponsive
enteral nutrition
nutrients for patients with impaired ability to chew/swallow or ingest food, typically delivered by gastric or nasogastric tube
What is the definition of O of SOAP
objective-The provider assesses and documents the patient's illness using observation, palpation, auscultation and percussion. Test and other services performed may be documented here as well
Mallory-Weiss syndrome
occurs in the mucous membrane of the esophagus, where it connects to the stomach; usually caused by forceful or long-term vomiting, coughing, or epileptic convulsions
Define Colles' Fracture
occurs in wrisit and affects the distal radius bone
Fingernail grow at an approximate rate
of 3mm per month
Generic name
official name of drug, simpler than chemical name, not copyrighted
Guardianship
one individual can legally act on the behalf of a minor or incompetent adult.
Indentify the following prefix of number : Mon/o
one; single
A key provision in HIPAA is the Minimum Necessary requirement. this means
only the minimum necessary protected health information should be shared to satisfy a particular purpose.
meatus
opening or passage into the body
Modifier BO
orally administered nutrition, not by feeding tube
oz
ounce
medication list
outpatient records
Parenteral
outside GI tract (injection)
extracranial
outside the skull
extraspinal
outside the spine
Define Arthralgia
pain in joint
orthopantogram
panoramic, radiographic image of the entire dentition, alveolar bone, and other adjacent structures on a single film; taken extra-orally
Stark law
part of social security act, applies to physician's who refer medicare/ Medicaid patients to facilities they have a financial interest in, addresses potential for overutilization, applies to referrals deemed medically unnecessary
hiatal hernia
part of the stomach pushes through wall into the diaphragm, into the chest
A doctor who perform autopsies and examines biopsy samples is a
pathologist
Staff HMO
patient employs their own physician
Consent
patient gives permission
Group HMO
patient is in contract with physician group
subpoena
patient must be notified so they can object to the disclosure
coinsurance
patient pays a percentage of the cost of the service
Assignment of Benefits
patient signs authorization form to allow insurance to pay benefits directly to provider rather to than to patient.
new patient
patient who has not been seen by a provider of the same specialty, in the same group, within the past three years
established patient
patient who has seen a provider of the same specialty, in the same group, within the past three years
observation status
patient's condition requires monitoring, but the decision to admit to inpatient status has not been made
Reimbursement
pay for service rendered
Abuse consists of
payment for items or services that are billed by providers in error that should not be paid for by Medicare.
omentum
peritoneal connection between the stomach and other internal organs
chronic intersitial cystitis
persistently inflamed lesion of the bladder wall, usually accompanied by urinary frequency, pain, nocturne, and a distended bladder
Policy holder
person insurance policy is issued to
Anaphylactic shock
person loses ability to breath, most severe allergic reaction
Individual
person purchased insurance on their own
HIPAA provides federal protections for
personal health information when held by covered entities.
hemic
pertaining to blood
atrioventricular
pertaining to the atria and the ventricles
gastrointestinal
pertaining to the stomach and the intestine
Resource costs for RBRVS are divided into three componentes:
physican work practice expense professional liability insurance
clinical laboratory
place where tests are performed on clinical specimens to get information about the health of a patient as pertaining to the diagnosis, treatment and prevention of disease
clinical laboratory
place where tests are performed on clinical specimens to get information about the health of a patient as pertaining to the diagnosis, treatment, and prevention of diseae
shuntogram
placement of a radioactive isotope in the shunt reservoir in the head to measure the speed with which it moves to the abdomen. shuntogram is the term used for angiography of an a/v fistula for renal dialysis
nephrostomy
placement of a stent, tube, or catheter to form a passage from the exterior of the body into the renal pelvis or calyx, often for drainage of urine or an abscess, for exploration, or calculus extraction
indentify the following suffix: -plasty
plastic repair, plastic surgery, reconstruction
POS
point of service, Combination of HMO and PPO, receive in and OON benefits at different level of cost
Guaranteed Issue
policy issued to a person regardless of age or pre-existing condition
Modifier 58
post operative-planned prospectively at the time of the original procedure, more extensive than the original procedure, for therapy following a diagnostic procedure
modifier 55
postoperative management only
PPO
preferred provider organization, MCO contracts with providers, patients do not have to have PCP, can see any provider, cost are lower for in network
modifier 56
preoperative management only
home care
prescribed medical care provided in a patient's home
Medicare Part D is a
prescription drug coverage program
hematuria
presence of blood in the urine
comorbidity
presence of two or more illnesses the same time. there may be an association between the illnesses
PCP
primary care physician, provides comprehensive care
Medicare Part D is a coverage provided by
private companies approved by Medicare
Commercial (non-Medicare) may develop their own medical policies which do not follow Medicare guidelines and are specified in
private contracts between the payer and practice or provider
Medicare Part C plans are managed by
private insurers approved by Medicare.
fluoroscopy
procedure for viewing the interior of the body using x-rays and projecting the image onto a television screen
goniotomy
procedure where an opening is made in the trabecular meshwork of the front part of the eye. The provider uses a goniolens during the procedure
Modifier 26 & TC
professional component
modifier 26
professional component
Prediction about the outcome of treatment
prognosis
If an organ slides or falls forward, the condition is
prolapse
A part of the male genital system sitting below the urnary bladder and surrounding the urethra is called the
prostate
PHI
protected health information
CDC (center disease control and protection)
protects public health of the nation and responds to public health emergencies
Claim
providers request of medical payment from insurance company
CMS (center for medicare/Medicaid services)
provides oversight of the medicare program and federal portion of Medicaid program
Federal Employees Compensation Act
provides workers compensation insurance for civilian employees of the federal government
Treatment
provision coordination and management of healthcare (consults and referrals)
evisceration
pulling the viscera outside of the body through the incision
through which vessel is oxygenated blood returned to the heart from the lungs
pulmonary vein
-centesis
puncture, tap
indentify the following suffix: -centesis
puncture, tap
clinical laboratory improvement amendments (CLIA)
quality standards for all laboratory testing to ensure the accuracy, reliability, and timeliness of patient test results, CLIA waived tests-simple tests that may be performed in non laboratory settings
barium enema
radiographic examination of the rectum and colon after administration of barium sulfate into the rectum
aortography
radiographic image of the aorta and branches using contrast material
cholangiography
radiographic image of the bile duct
bronchography
radiographic image of the bronchi of the lungs using contrast material
corpora cavernosography
radiographic image of the corpora cavernous and draining veins using contrast medium
discography
radiographic image of the dic of the spine
cephalogram
radiographic image of the head
dacryocystography
radiographic image of the lacrimal drainage system
sialography
radiographic image of the salivary ducts and glands
myelography
radiographic image of the spinal cord
vasography
radiographic image of the vas deferent and ejaculatory duct following dye injection
angiography
radiographic imaging of blood vessels
pyelography
radiographic imaging of the renal pelvis of a kidney following injection of a radiopaque substance through the ureter or into a vein
cholangiography
radiographic recording of the bile ducts
cholecystography
radiographic recording of the gallbladder
hepatography
radiographic recording of the liver
splenoportography
radiography of the splenic and portal veins; includes injection of a radiopaque medium
urethrocystography
radiography of the urethra and bladder using a radiopaque substance
Adverse Effects
rare, always harmful, should inform FDA
therapeutic index
ratio or window between therapeutic and toxic
onset of action
reaching the peak effect, takes time
GPCI is used to
realize the varying cost based on geographic location
medical necessity
reasonable and necessary services to bring a cure or a change in the condition for which the patient is being seen.
modifier 52
reduced services
define the classification TUBULAR of bone
referred to as long bones
Define the classification CUBOIDAL of bone
referred to as short bones
monitored anesthesia care
refers to a continuum a technique for many surgical procedures that do not require deep sedation or a general anesthetic. the anesthesia provider must be prepared to convert to general anesthesia, if necessary
nystagmus
reflexive jerky eye movements as a response to the messages of the inner ear
Chron's disease
regional enteritis
payment
reimbursing healthcare providers for service
myocardial
relating to the myocardium
enterolysis
releasing of adhesions of intestine
exenteration
removal of a complete structure
pneumonectomy
removal of a lung
debridement
removal of dead or damaged tissue to promote healing
dialysis
removal of toxins from the blood by diffusion over a membrane or filter in patients with renal impairment or failure
fundoplasty
repair of the bottom of an organ or muscle
Modifier 76 & 77
repeat procedures
compulsion
repetitive behavior with ritualistic characteristics; uncontrolled impulse
hydration
replenishment of fluids
HIPAA Title II
requires written consent and permission from the patient to share information
Medicare payments for physician services are standardized using a
resource-based relative value scale (RBRVS)
Confidentiality
responsibility to protect patient information from unauthorized use or disclosure. Legal and ethical concept
retinal detachment
retina is freed from the blood-rich choroid at the back of the eye. when the retinal layer floats away, it loses its supply of nutrients. nutrients must me returned, or vision is lost
Discharge of fluid from the nose
rhinorrhea
Indentify the following prefix of location : Dextr/o
right
limbus
ring where the cornea meets the sclera; also known as the sclerocorneal junction
HIPAA (Health Insurance Portability and Accountability Act)
safe guards PHI, allows patient the right to control the use and disclosure of personal health info.
Removal of a fallopian tube
salpingectomy
examples of common reasons to report V codes:
screening tests routine physicals personal or family history of a disease or disorder
review of systems
series fo questions regarding signs and symptoms that are associated with the patient's chief complaint
what are does the meninges do
serve as a protective covering
modifier Q6
service finished by a locus tennis physician
What does the appendicular skeleton consist of
shoulder girdle, pelvic girdle, extremities
use additional code
signals the coder an additional code should be used, if the information is available, to provide a more complete picture of the diagnosis.
contralateral
situated on or affecting the opposite side of the body
what is another for the cutaneous membrane
skin
intussusception
slipping of one part of intestine into another part
capillaries
smallest branches of the coronary arteries and veins
retrobulbar
space behind the eye
pleural cavity
space between the folds of the pleura
Which of the following are auditory ossicles
stapes and incus
Medicaid is adminisitered on a
state by state basis adhering to certain federal guidelines.
Workers Compensation
state mandated insurance program, statutes vary by state, employers required to compensate employees who were injured on job
Appendix D is used primarily for
statistical purposes. It provides information about employment injuries.
what is another name for the nail bed
sterile matrix
Authorization
stipulates which PHI to disclose and to whom
chord tendineae
string-like attachments connected to the AV valves
in vivo
studies performed within the living body
forensics
studies used or applied in the investigation and establishment fo facts or evidence in a court of law
neuro psychology
study and treatment of psychiatric and neurological disorders
psychology
study of behavior, thoughts, feelings
cytopathology
study of cellular changes in disease
mycology
study of fungi
cytogenetics
study of genes to determine whether disease has inherited components and to identify the specific genetic components of certain disease and processes, so they can be better treated
genetics
study of heredity
Pharmacology
study of how drugs work, are made, interact, etc
parasitology
study of parasites
cytopathy
study of the cellular changes in disease
hematology
study of the components and behavior of blood
immunology
study of the immune system, its components, and function
gastroenterology
study of the stomach, intestine, esophagus, liver, gallbladder, and pancreas
virology
study of viruses
what lies underneath the dermis
subcutaneous layer
What is the definition of S of SOAP
subjective- The patient's statment about his or her health, including symptoms
What is the fibrous connective tissue that is included in this layer
superficial fascia
Which of the following is a function of the pancreas? * supplies digestive enzymes manufactures melatonin * stimulates growth * secretes vasopressin
supplies digestive enzymes
All services provided to a patient is
supported and documented in the medical record
anuria
suppression, cessation, or failure fo the kinds to secrete urine
modifier 54
surgical care only
indentify the following suffix: -stomy
surgical creation of an opening
Define arthrodesis
surgical fixation of a joint
Define Sternotomy
surgical incision of sternum
marsupialization
surgical procedure that creates an exterior pouch from an internal abscess
atherectomy
surgical removal of plaque buildup from the interior of an artery
enucleation
surgical removal of the eyeball
cholecystectomy
surgical removal of the gallbladder
blepharoplasty
surgical repair of the eyelid
indentify the following suffix: -rraphy
surgical repair, suture
pneumonolysis
surgical separation of the lung from the chest wall to allow the lung to collapse
modifier 66
surgical team
indentify the following suffix: -pexy
surgicial fixation
Define Osterrhaphy
suture of bone
modifier 95
synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system
ICD-10-C
table of drug
modifier TC
technical component
pump oxygenator
term used when a cardiopulmonary bypass (CPB) machine is used to function as the heart and lungs during heart surgery.
excludes
terms following "excludes" notes are to be reported with a code from another category.
qualitative
test determining the presence or absence of a drug
quantitative
test identifying the amount of an analyze within a specified range but does not identify a specific quantity
pulmonary function tests
tests to diagnostic breathing problems
HITECH was enacted as part of
the American Recovery and Reinvestment Act of 2009 (ARRA)
Maintenance of hte ICD-9-CM is performed by
the Coordination and Maintenance Committee
NEC is used when
the ICD-9-CM system does not provide a code specific for the patient's condition.
What was ARRA and HITECH promote
the adoption and meaningful use of health information technology
Participating Providers (Par Providers are required to accept
the allowed payment amount determined by the insurance carrier as the fee for payment and follow all other guidelines stipulated by the contract
The classification system determines what
the amount health care providers will be reimbursed if the patient is covered by Medicare, Medicaid, or other insurance programs using the system
trachea
the cartilaginous and membranous tube that descends from the larynx and branches into the right and left main bronchi
use addtional code, if applicable
the causal condition note indicates this code may be assigned as a diagnosis when the causal condtion is unknown or not applicable. If a causal condition is known, the code should be sequenced as the principal diagnosis.
NOS is used only when
the coder lacks the information necessary to code to a more specific 4th or 5th digit subcategory
What are the categories depending on
the covered entity's level of culpability for releasing protected information and minimum and maximum penalties.
Where does nail bed extend to
the edge of the lunula to the hyponychium
The OIG is mandated by public law to engage in activities to test
the efficiency and economy of government programs to include investigation of suspected health care fraud or abuse.
Whose responsibility is it to develop and implement policies, best suited to its particular circumstances, to meet HIPAA requirements.
the entity covered by HIPAA
What is stratum corneum composed of
the horny layers, outermost layer
Certification
the hospital passed a survey done by a state government agency. Medicare only covers hospital stays in hospitals that are certified or accredited.
Administration Simplification speaks to what
the increasing use of technology in the health care industry
what does the serous membrane companrtmentalize
the large vavities to hinder spread of infection
Generally what a medically-necessary service is
the least radical service/procedure that allows for effective treatment of the patient's complaint or condition
What does the cutaneous membrane forms
the outer covering of the body
Medicare Part B premiums are paid by
the patient
V codes are commonly used when
the patient presents for treatment with no complaints.
mediastinum
the portion of the thoracic cavity between the lungs containing the heart, aorta, esophagus, trachea, and thymus gland, as well as blood vessels and nerves
alveoli
the primary units for the exchange of oxygen and carbon dioxide in the lungs
Coding is
the process of translating this written or dictated fmedical record into a series of numeric or alpha-numeric codes
Selecting a code with the NEC classification means
the provider documented more specific information regarding the patient's condition, but there is not a code in ICD-9-CM that reports the condition accurately
chief complaint
the reason the patient presents for an encounter
pleura
the serous membrane covering the lungs and lining the thoracic cavity
Define dermatology
the study of the skin
Joints are classified accord to what
the type of connective tissue at the articulating surfaces
glottis
the vocal cords and the opening between them
LCDs have jurisdiction only within
their regional area
infusion
therapeutic agent introduced into the body by a vein
HITECH requires that an individual be notified if
there is an unauthorized disclosure or use of his or her health information.
what is stratum reticulare composed of
thick layer of dense, irregular connective tissue
what is stratum papillare composed of
thin superficial layer interlocked with epidermis
eponym
this term indicates the code describes a disease or syndrome named after a person
cognitive
thoughts or thinking, learning, or memory processes
How many lobes make up the right lung
three
tid
three times a day
ossicles
three tiny bones of the middle ear
Indentify the following prefix of location : Trans-
through; across
manipulation
thrusting movement to achieve realignment of joints or spine
stapes
tiny bone (ossicle) in the middle ear
What is the tasked for a coder with an operative report
to break down the information and applying the correct code.
instill
to introduce gradually in order to establish securely
fraud
to purposely bill for srevices that were never given or to bill for a service that has a higher reimbursement than the service provided.
What is the coders required to with the medical records
to read and understand the documentation in the medical record in order to accurately code the services rendered.
atherectomy
to remove plaque from an artery
palpation
touching the body
What does Posterior or Dorsal mean
toward the back of the body
What does Anterior or Ventral mean
toward the front of the body
Indentify the following prefix of location: Ad-
toward; near
brand name
trade mark protected by drug manufacturer or pharmaceutical company.
biofeedback
training technique for development fo a person's ability to control his or her autonomic nervous system
chemotherapy
treatment of disease by means fo chemical substances or drugs; usually cancers
chiropractic
treatment predominately using manipulation of spinal and musculoskeletal structures and recuperative powers of the body
polyp
tumor on a pedicle that bleeds easily and may become malignant
bid
twice daily
volvulus
twisting of the intestine on itself
What are Organs
two or more kinds of tissue together performing special body functions
modifier 62
two surgeons
Indentify the following prefix of number : Bi-
two, twice
Capitation
type of reimbursement paid per number of patients on the membership roster. Paid regardless of services rendered
echoencephalography
ultrasound image of the brain
sonohysterography
ultrasound imaging of the uterus
Emancipation of Minors
under age child is granted decision making rights and financial responsibility of themselves
Where is the dermis located
under the epidermis
Sub Q
underskin, for meds the body needs to absorb slowly
relative value unit
unit measure used to assign a value to services. determined by assigning weight to factors such as physician work, practice expense and malpractice expense.
gradiosity
unrealistic concept of self-importance
modifier 24
unrelated e/m by the same physician or other qualified healthcare professional during a postoperative period
NOS is the equivalent of
unspecified
modifier 23
unusual anesthesia
atria
upper chambers of the heart
The tube leading from the bladder to the outside of the body is
urethra
doppler study
use of a n ultrasound prove to determine blood flow
video-assisted thoracoscopic surgery (VATS)
use of endoscope and video to perform diagnostic and surgical procedures on the thoracic cavity
boldface type
used for all codes and titles in the Tabular list
Italicized type
used for all exclusion notes and to identify codes that should not be used for describing the primary diagnosis
code first
used in categories not intended to be the principal diagnosis
An ectopic pregnancy is a complication n which the fertilized ovum is implanted in a any tissue other than the
uterine wall
phleb/o
vein
artery
vessel carrying blood from the heart to the tissues
modifier GA
waiver of liability statement issued as required by payer policy, individual case
modifier GU
waiver of liability statement issued as required by payer policy, routine notice
lavage
washing out an organ
Premium
what a person pays for their policy
NCD explain
when Medicare will pay for items or services.
combination code
when a single code is used to classify two diagnoses
The number of stratum varies based on what
where the epidermis is located
what is medical necessity relates to
whether a procedure or service is considered appropriate in a given circumstance
The term "medical necessity refers to
whether a procedure or service is considered appropriate in a given circumstance.
duration of action
whole time drug is effective in body
where are meninges found
with the dorsal cavity
Intravenous
within a vein directly in blood stream, fastest but most dangerous
intracoronary
within the heart
peritoneal
within the lining of the abdominal cavity
Subpoena Duces Tecum
written document directing individuals or organizations to also furnish relevant documentation and records
What is the meaning of xantho
yellow
Does Medicare Part B generally require a yearly deductable and copayment?
yes