D521-Introduction to Medical Coding
Questions and Answers Rated A+
advanced beneficiary notice (ABN) - ANSWER-a waiver of liability for the patient to sign
if the provider deems Medicare will not pay for a service
American Health Information Management Association (AHIMA) - ANSWER-a
professional organization for health information management (HIM) professionals
American Hospital Association (AHA) - ANSWER-Non profit group or alliance of
member hospitals and health care organizations that promote the interests of hospitals.
It is an advocacy group for health care organizations, particularly hospitals
charge description master (CDM) - ANSWER-a database of all billable items, revenue
codes, and CPT/HCPCS codes that describe a service provided within a hospital
claim adjudication - ANSWER-the process used by payers to evaluate a medical claim
for reimbursement
claim denial - ANSWER-the refusal of a payer to reimburse the healthcare provider for
services billed
Common Diagnosis coding process errors - ANSWER-Illegible physician handwriting
Illogical physician diagnosis documentation
Lack of physician documentation
Transcription errors by typist or voice-recognition systems
Content of the rest of the patient's medical record does not support the diagnosis
documented
Lack of specificity
Comorbidity - ANSWER-a secondary condition that is present on admission and causes
an increase in length of stay (LOS)
Complication - ANSWER-a secondary condition that arises during hospitalization and
causes an increase in length of stay (LOS)
Current Procedural Terminology (CPT) - ANSWER-coding system is published and
maintained by the American Medical Association (AMA). the standardized classification
system for reporting medical procedures and services. It consists of five characters that
, report outpatient procedures, including anesthesia, surgery, radiology, pathology and
laboratory, Evaluation and management, medicine services
Diagnosis - ANSWER-identification of a disease by a licensed provider
discharged not final billed (DNFB) - ANSWER-a measure of patient accounts that are
held up due to either coding delays or other issues that prevent claim submission
Episode-of-care reimbursement - ANSWER-payments are made for all services
provided for a specific time period or illness
evaluation and management (E&M) - ANSWER-a section of CPT codes used to report
services provided by a physician or other qualified healthcare professional
explanation of benefits (EOB) - ANSWER-a statement from the payer that summarizes
the costs of healthcare services billed, what is covered by the insurance plan, and how
much is the patient's responsibility to pay
facility billing - ANSWER-the hospital's charge for technical services provided in an
outpatient department of a hospital
fee-for-service reimbursement - ANSWER-Issues payments to healthcare providers on
the basis of the charges assigned to each of the separate services that were performed
for the patient
Healthcare Common Procedure Coding System (HCPCS) - ANSWER-A group of codes
and descriptors used to represent health care procedures, supplies, products, and
services. Consists of Level I (CPT codes) and Level II (HCPCS codes). The AMA
manages the Level I codes, and the Centers for Medicare and Medicaid Services (CMS)
publishes annual updates to the Level II codes. The Level II codes consist of five
alphanumeric characters used to report durable medical equipment, prosthetics,
medications, orthotics, and other provider services that are not found in CPT. HCPCS
codes allow for more accurate reporting of services rendered during a patient
encounter.
History of Present Illness (HPI) - ANSWER-eight categories that constitute a
chronological description of an illness.
History of Present Illness (HPI) eight categories - ANSWER-How long have you had the
sore throat? (duration)
What part of your throat hurts? (location)
Is the pain continuous? Does it become better or worse? (timing)
How does it compare to other sore throats you have had? (severity)
Questions and Answers Rated A+
advanced beneficiary notice (ABN) - ANSWER-a waiver of liability for the patient to sign
if the provider deems Medicare will not pay for a service
American Health Information Management Association (AHIMA) - ANSWER-a
professional organization for health information management (HIM) professionals
American Hospital Association (AHA) - ANSWER-Non profit group or alliance of
member hospitals and health care organizations that promote the interests of hospitals.
It is an advocacy group for health care organizations, particularly hospitals
charge description master (CDM) - ANSWER-a database of all billable items, revenue
codes, and CPT/HCPCS codes that describe a service provided within a hospital
claim adjudication - ANSWER-the process used by payers to evaluate a medical claim
for reimbursement
claim denial - ANSWER-the refusal of a payer to reimburse the healthcare provider for
services billed
Common Diagnosis coding process errors - ANSWER-Illegible physician handwriting
Illogical physician diagnosis documentation
Lack of physician documentation
Transcription errors by typist or voice-recognition systems
Content of the rest of the patient's medical record does not support the diagnosis
documented
Lack of specificity
Comorbidity - ANSWER-a secondary condition that is present on admission and causes
an increase in length of stay (LOS)
Complication - ANSWER-a secondary condition that arises during hospitalization and
causes an increase in length of stay (LOS)
Current Procedural Terminology (CPT) - ANSWER-coding system is published and
maintained by the American Medical Association (AMA). the standardized classification
system for reporting medical procedures and services. It consists of five characters that
, report outpatient procedures, including anesthesia, surgery, radiology, pathology and
laboratory, Evaluation and management, medicine services
Diagnosis - ANSWER-identification of a disease by a licensed provider
discharged not final billed (DNFB) - ANSWER-a measure of patient accounts that are
held up due to either coding delays or other issues that prevent claim submission
Episode-of-care reimbursement - ANSWER-payments are made for all services
provided for a specific time period or illness
evaluation and management (E&M) - ANSWER-a section of CPT codes used to report
services provided by a physician or other qualified healthcare professional
explanation of benefits (EOB) - ANSWER-a statement from the payer that summarizes
the costs of healthcare services billed, what is covered by the insurance plan, and how
much is the patient's responsibility to pay
facility billing - ANSWER-the hospital's charge for technical services provided in an
outpatient department of a hospital
fee-for-service reimbursement - ANSWER-Issues payments to healthcare providers on
the basis of the charges assigned to each of the separate services that were performed
for the patient
Healthcare Common Procedure Coding System (HCPCS) - ANSWER-A group of codes
and descriptors used to represent health care procedures, supplies, products, and
services. Consists of Level I (CPT codes) and Level II (HCPCS codes). The AMA
manages the Level I codes, and the Centers for Medicare and Medicaid Services (CMS)
publishes annual updates to the Level II codes. The Level II codes consist of five
alphanumeric characters used to report durable medical equipment, prosthetics,
medications, orthotics, and other provider services that are not found in CPT. HCPCS
codes allow for more accurate reporting of services rendered during a patient
encounter.
History of Present Illness (HPI) - ANSWER-eight categories that constitute a
chronological description of an illness.
History of Present Illness (HPI) eight categories - ANSWER-How long have you had the
sore throat? (duration)
What part of your throat hurts? (location)
Is the pain continuous? Does it become better or worse? (timing)
How does it compare to other sore throats you have had? (severity)
