RED
The process of converting narrative descriptions of procedures, diseases, medical equipment and procedures to numeric/alpha/alpha-numeric codes.
Medical Coding
What are the 2 types of Medical Coding?
Diagnosis Codes & Procedure Codes
These codes denotes diseases, injuries, illnesses and other reasons for visiting a provider.
Diagnosis Codes
This type of medical coding is used to identify specific procedures - may it be surgical, medical or diagnostic interventions.
Procedure Codes
Place of Service (POS) Codes
What does CPT stand for and what is it's format/structure?
Current Procedural Terminology; 5 numeric codes
What does ICD-10 stand for and what character does it start (alpha or numeric)?
International Classification of Diseases 10th Revision; Alpha
Diagnosis codes are developed & maintained by _____, while _____ is for procedure codes.
World Health Organization (WHO); American Medical Association (AMA)
When necessary or when there are changes, diagnosis codes are revised and updated every ____ and ____.
April 1st and October 1st
This is another procedure code category that identifies products, medical equipment/supplies and others. (Provide the full name)
Healthcare Common Procedure Coding System (HCPCS) Code
This is a code added to a procedure code to give additional meaning or adjust care description to provide extra details on a procedure rendered.
Modifier
(True/False) Modifiers are 2 digit codes that can either be alpha or numeric.
True
What are the 2 types of Modifiers? And give 1 example for each.
Pricing and Information/al Modifier
These are codes that provide additional information such as how the injury occurred, the intent, or where it happened. These codes cannot be used as a primary diagnosis on a claim.
External Causes of Morbidity Codes (V00-Y99)
These codes are used to bill patient visits with reasons other than a disease/injury/illness. An example would be a visit to the doctor to get immunization as preventive measure.
Z Codes
This is a process by which an agent is qualified to do so grants formal recognition to and records such as status of entities meeting pre-determined and standardized criteria.
Credentialing
Specialist will fall under _____ Credentialing while Ambulatory Surgery Centers will fall under ____ Credentialing.
Practitioner; Facility
Providers who want to join the insurance plan for the first time will undergo _______ while those who are currently within the network already will have _______ every 2-3yrs or depending on the plan's policy.
Initial Credentialing; Re-Credentialing
This is a complete listing of all the fees assigned per procedure code as per the provider's contract.
Fee Schedule
This is a type of provider compensation where providers will be paid a fixed amount on a monthly basis.
Salary
This is a type of provider compensation where facilities are paid based on a grouping system developed by Medicare.
This is a type of provider compensation where doctors will be paid on a Per Member Per Month basis.
Capitation
This is a payment method where hospitals are paid at a flat rate for a particular type of service regardless of the actual cost or duration of the service.
Case Rate
This is a type of provider compensation where facilities are paid for each day of the inpatient stay regardless of the services rendered.
Per Diem
This is a payment method wherein the plan gives numerical value to each procedure and is multiplied by a dollar amount agreed by the provider and insurance.
Resource Based Relative Value Scale (RBRVS)