Business of Medicine
Diagnosis codes found in ICD-10-CM.
Which code set is used by risk adjustment coders?
System impacted by Angina pectoris.
What is cardiovascular?
Starting point for dx.
What is the alphabetic index?
Risk adjustment model is typically used for Medicaid patients.
What is CDPS?
A group of clinicians who have created a Medicare Advantage Organization that utilizes only providers affiliated with their group.
What is an Alternative Payment Model (APM)?
Translating a written or dictated medical record into a series of alphanumeric codes.
What is medical coding?
Documentation states: PAST SURGICAL HISTORY: She had a lumpectomy of the breast for DCIS 12 years ago which successfully eradicated the CA.
This should be reported as.
What is Personal history of breast cancer?
Classified my body system.
What is tabular list?
Based on the tables above, if the documentation states a type 1 diabetic member has both ketoacidosis and diabetic nephropathy.
17 Diabetes with Acute Complication
18 Diabetes with Ophthalmologic or Unspecified Manifestations
What is HCC 17?
Which MIPS performance category promotes the secure exchange of health information and the use of certified electronic health record technology (CEHRT) for coordination of care.
What is Quality?
Part A and Part B combined. Reimbursed based on risk adjustment models.
Which part of Medicare is also called Medicare Advantage?
Toward the midline of the body.
What is medial?
A patient with diabetes type 2 presents with ED. After examination, the provider diagnosis the patient with ED due to diabetic autonomic neuropathy.
What is E11.43, N52.1?
Review includes a review of current year combined with the prior year’s dates of service.
What is concurrent review?
HEDIS MEASURES UESED: In a medical record review, the doctor has documentation in a single encounter of an eye exam, a BUN test, and HbA1c testing.
What is Controlling high blood pressure?
Reporting a diagnosis or co-morbidity that does not exist to obtain higher reimbursement.
What is fraud?
Farther from the point of attachment or from a given reference point.
What is distal?
A patient with chronic DVT in the lower right leg requires heparin to maintain therapeutic anticoagulation levels. He has regular PTTs drawn to monitor his level of anticoagulation.
What is I82.5Z1, Z79.01?
Risk adjustment model is typically used for patients enrolled in a commercial plan through a healthcare exchange.
What is Health and Human Services Hierarchical Condition Category (HHS HCC)?
Predictive modeling and the results were:
The member had a DME claim for oxygen
The member had an Rx claim for Pulmicort Flexhaler
The member had a medical claim which included airway obstruction treatment
What is Rib fracture?
Federal and State government sponsored health insurance assistance program.
What is Medicaid?
This organ refers to the pulmonary system.
What is the lungs?
A patient with CKD, stage 5 is evaluated by the provider and receives peritoneal dialysis. The provider evaluates the patient once before dialysis begins.
What is N18.6, Z99.2?
Risk adjustment model is used for patients enrolled in a Medicare Advantage Plan.
What is Medicare Hierarchal Condition Category (CMS HCC-C)?
The affordable care act set a requirement for CMS to make quality bonus payments to Medicare Advantage Plans based on the plan’s quality rating.
What is RADV?