Determining coverage
Diagnostic Coding
The ICD-10-CM code book
CPT
HCPCS/CPT
100

Under what rule is a child's primary coverage under the father's plan when both parents have coverage?

gender rule

100

ICD-10-CM diagnosis codes have how many characters?

3-7

100

21 chapters of disease descriptions and their codes

Tabular List

100

When selecting an Evaluation and Management code, three components are considered:

history

physical examination 

medical decision making.

100

Durable medical equipment (DME) is reported using

HCPCS

200

Under what rule is a child's primary coverage determined based upon which parent's day of birth is earlier in the calendar year?

birthday rule

200

A category in ICD-10-CM is how ___ characters

three

200

provides code numbers for neoplasms based on their anatomical site

Neoplasm Table

200

E/M codes have four types of examinations that a physician can perform

Problem focused

Expanded Problem Focused

Detailed

Comprehensive

200

coding system that describes specific products, supplies, and services

HCPCS

300

The first health plan to pay when more than one plan is in effect

primary insurance.

300

subcategory code in ICD-10-CM is _____ characters

4-5

300

a list of drugs and chemicals

Table of Drugs and Chemicals

300

CPT codes from the Anesthesia section have what two types of modifiers?

standard modifiers and physical status modifiers

300

List the E/M code key components

Extent of History

Extent of Examination

Medical Decision Making

400

 Another common term for encounter forms

superbills

routing slips 

charge slips

400

ICD-10-CM stands for

International Classification of Diseases, tenth revision, Clinical Modification

400

Alphabetic Index is organized by

condition.

400

In CPT, a plus sign (+) next to a code indicates

add-on code.

400

In CPT the surgery section is organized by

body system

500

The steps in establishing financial responsibility

Verify the patient’s eligibility for insurance benefits. 

Reason for encounter covered by policy

Preauthorization required

Patients responsibility $$

500

physician’s description of the main reason for a patient encounter

diagnostic statement.

500

a list of the disease descriptions

Alphabetic Index

500

CPT codes are used to report the following

medical services.

surgical procedures.

diagnostic procedures.

500

Using a single payment for two or more related procedure codes

bundling