Procedural Coding
What is the format of most CPT codes?
Five Digit Code
How are the first three characters structured in an ICD-10 code?
One letter followed by two digits
What insurance plan provides care for low-income individuals and children?
Medicaid
What type of insurance plan covers most full-time employees?
Group Insurance
Why do MA's have to know medical coding guidlines?
To link procedure codes to correct diagnosis codes
How are Category II and Category III CPT codes structured?
Four digits and one letter
When removing a lesion, what might influence selecting the correct diagnosis code?
Type, Size, Location, & Method of removal of the lesion
Which federal insurance plan provides for services for the elderly and disabled?
Medicare
What is a formulary?
It is a list of approved medications often published by managed care organizations to list prescription drug benefits.
How does a classification system become a coding system?
Replacing names to numbers and letters.
What types of codes are used for Medicare and Medicaid Services, including equipment?
HCPCS Level II
What is the purpose of a diagnosis code?
To track diseases, classify diseases, & collect data for medical research.
What insurance plan covers a disabled service member's wife and children?
CHAMPVA
What is Worker-comp insurance?
Insurance that covers wages for employees due to injury, illness, or accidents in the workplace.
What is a service covered by insurance called?
Benefit
What specification of a procedure would require an MA to switch from the index to the tabular list of a CPT manual?
Anatomic Location
What does "10" stand for in ICD-10?
10th edition
What services are covered under Medicare Part A?
Hospital Stays
What form does the physician have to fill out to directly receive reimbursement from an insurance company?
Assignment of Benefits
What is the term for the amount of money that must be paid each year for services before the insurance company begins to pick up the payments?
Deductible
What would be added to a procedure code if it unexpectedly required an assistant?
A two-digit modifier
How do insurance companies use diagnosis codes?
To decide whether the care given corresponds to the patient's disease
What is the percentage that Medicare pays after reaching your annual deductible?
80%
What is the process for when insurance companies determine medical necessity?
Utilization Review
What is the term used for the payment a patient makes to pay a percentage of their medical services?
Coinsurance