23 hours ago A patient was diagnosed with asthma. which coding system is used to report this condition on a claim? Preventive The type of health care that helps individuals avoid health and injury problems is >> Go To The Portal
| Asthma classification | Status | Code |
|---|---|---|
| Severe persistent | Status asthmaticus | J45.52 |
The coder in the physician's office should: code for chest congestion. The physician documented Jacob's diagnosis as a chest cold. The coder assigned a code for bronchitis. This is an example of:
The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has a particular condition is sufficient.
T/F: The Medicare Catastrophic Coverage Act of 1988 originally mandated the reporting of diagnosis codes on Medicare claims. What automates the coding process using computerized or web-based software? Which part of the ICD-10-CM would be used to classify a homicide attempt?
The decision to code or not to code cannot be based on clinical indicators but must be based only on physician documentation. It is commonly referred to as “Guideline 19” from the Official Guidelines for Coding and Reporting, which can be found on p. 13 under the heading “Code Assignment and Clinical Criteria:”
ICD-10-CM (International Classification of Diseases, 10th revision, Clinical Modification) Healthcare professionals use these codes to report diagnoses and disorders. The ICD-10-CM is maintained by the National Center for Health Statistics (NCHS).
The medical coding systems currently used in the United States are ICD-10-CM/PCS and HCPCS (Level I CPT codes and Level II National Codes). The Healthcare Common Procedure Coding System (HCPCS) is used to report hospital outpatient procedures and physician services.
Which insurance covers losses to a third party caused by the insured, by an object owned by the insured, or on premises owned by the insured? Deductibles, copayments, and coinsurance are covered by what type of plan? Which is entered in Block 11c of the CMS-1500? accident.
Current Procedural Terminology (CPT): Coding system published by the American Medical Association that is used to report procedures and services performed during outpatient and physician office encounters, and professional services provided to inpatients.
1. CPT is a code set to describe medical, surgical ,and diagnostic services; HCPCS are codes based on the CPT to provide standardized coding when healthcare is delivered.
The CPT-4 is a uniform coding system consisting of descriptive terms and identifying codes that are used primarily to identify medical services and procedures furnished by physicians and other health care professionals.
National Provider Identifier (NPI)Box 32a: If required by Medicare claims processing policy, enter the National Provider Identifier (NPI) of the service facility.
The CMS-1500 form is the standard claim form used by a non-institutional provider or supplier to bill Medicare carriers and durable medical equipment regional carriers (DMERCs) when a provider qualifies for a waiver from the Administrative Simplification Compliance Act (ASCA) requirement for electronic submission of ...
non-NPI identity of the Billing providerBox 33b contains the non-NPI identity of the Billing provider. The source for the actual non-NPI value is the text entered into the field labeled 'Box 33B:' under the 'HCFA-1500/UB-92' tab of the Payers screen (of the payer to whom this claim is being sent).
DRG codes are used to classify inpatient hospital services and are commonly used by many insurance companies and Medicare. The DRG code, the length of the inpatient stay and the CPT code are combined to determine claim payment and reimbursement. You cannot search our site using DRG codes at this time.
The three main coding systems used in the outpatient facility setting are ICD-10-CM, CPT®, and HCPCS Level II. These are often referred to as code sets.
By DeVry UniversityApril 22, 2022. ... Right now, there are five major types of medical coding classification systems that are used by medical coding professionals — ICD-11, ICD-10-CM, ICD-10-PCS, CPT and HCPCS Level II.More items...•
Each year the CMS reviews the ICD-10-CM coding manual and an update is posted on October 1
Medical coding began as medical classification in 17th-century England
ICD-10 has two sections: a Tabular List and Alphabetic Index
Accepted healthcare services that are appropriate for the evaluation and treatment of a disease, condition, illness or injury and are consistent with the applicable standard of care.
Software that will apply diagnostic or procedure codes to medical conditions or procedures.
United States is the only country in the world that uses coding for health insurance reimbursement purposes
These terms follow the main term and are enclosed in parentheses. They are supplementary words or explanatory information. They do not need to be in the actual diagnostic statement.
The first-listed code is also called the: principal diagnosis. A statement in which the physician uses the word versus between two diagnostic statements is known as a: differential diagnosis. When both acute and chronic conditions are listed as the diagnosis and there is no combination code available, you should:
code any condition that has not been documented.
Dizziness is an example of a: symptom. The seven steps of accurate coding include: coding only documented conditions. If there is unclear information in the documentation, the coder should: query the physician. Justifying a procedure code with a diagnosis code is known as: medical necessity.
An external cause code is used when a patient has: an adverse effect. an injury. been poisoned. (All of these) A cause-and-effect relationship between an original condition, illness, or injury and an additional problem caused by the original condition is known as a (n): manifestation.
She was admitted to the medical floor and Dr. Jones was called in to examine her. After examination, Dr. Jones determines that Sally has acute cholecystitis.
T/F: The cooperating parties for the ICD-10-CM/PCS approved guidlines that have been prepared for coding and reporting using the ICD-10-CM/PCS and consist of these organizations: AHA, AHIMA, CMS, and NCHS.
A coder locates a code in the disease index, which contains the abbreviation NEC. Upon verification of the code in the tabular list, the coder assigns that code. Which coding convention explains this code assignment?
The coder is directed to an "other specified" code by the index when a specific code is not available in the tabular list. Whenever a specific code is not available in the index for a condition, the coder is directed to the "other specified" code in the tabular list.
Use of a more general code is indicated when the coder is unsure about information contained in documentation. The coder is directed to an "other specified" code by the index when a specific code is not available in the tabular list.
the business record for a patient encounter (inpatient or outpatient) that documents health care services provided to a patient.
According to HIPAA, health plans that do not accept standard code sets are required to modify their systems to accept all valid codes or to contract with a (n): medical nomenclature. A vocabulary of clinical terms used by health care providers to document patient care.
T/F: In the ICD-10-PCS the operative approach is considered an integral part of the procedure, and it is coded.
Current Procedural Terminology (CPT) is a coding system developed by the American Medical Association (AMA) to convert widely accepted, uniform descriptions of medical, surgical, and diagnostic services into ____-digit numeric codes.
indicate that a person who is not ill is being seen for a specific reason, such as for a pre-employment examination. All of these are indicated with Z codes. all of these are indicated with Z codes.
The main term represents the diseases, conditions, nouns, and adjectives that you might see in the patient record. The main term is the first place you go to locate the code for the patient's disease or condition. Subterms or essential modifiers are located beneath the main term. All of the above. All the above.
Coding for inpatient and outpatient services uses coding guidelines are interchangeable, so it's acceptable to only memorize one set of codes.
It is an acceptable practice for coders to both reference and code directly from the index.
Coding for inpatient and outpatient services uses the same coding guidelines. Coding for inpatient and outpatient services uses coding guidelines are interchangeable, so it's acceptable to only memorize one set of codes. Coding for inpatient and outpatient services uses different coding guidelines. None of the above.
The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis.
What coding professionals can do is hold the documentation against the Uniform Hospital Discharge Data Set (UHDDS) guidelines that say reportable diagnoses must be:
As stated in Coding Clinic, Fourth Quarter 2018, p. 90, “ Coding Clinic itself doesn’t advise you follow the ICD -10 index entry for emaciation to the nutritional marasmus code but rather they recommend defaulting to the reporting of cachexia when in doubt. (See Coding Clinic, Third Quarter 2017.)
Extend the length of stay. Therefore, a coding professional can omit a code if, let’s say, a physician documented sepsis, but there’s no evidence of the diagnosis being evaluated, treated, or tested, and there’s no evidence of the diagnosis extending the patient’s length of stay or expending additional nursing services.
Remember, you absolutely can have your physician advisor set clinical criteria for when a query should be placed. Query criteria are unrelated to the problem of code assignment based on clinical criteria.
A: You are correct. The decision to code or not to code cannot be based on clinical indicators but must be based only on physician documentation. It is commonly referred to as “Guideline 19” from the Official Guidelines for Coding and Reporting, which can be found on p. 13 under the heading “Code Assignment and Clinical Criteria:”.
Practically speaking, this means that a coding professional reviewing a record in which a physician uses Sepsis-3 criteria cannot omit the sepsis code based on the fact that they prefer Sepsis-1 criteria. Similarly, a coding professional reviewing a record with the diagnosis of acute kidney injury cannot omit the code if they think ...