Coding Overview
Organizes medical nomenclature according to similar conditions, diseases, procedures, and services, and contains codes for each?
classification system
The primary purpose of the patient record is to provide for __________.
patient continuity of care
Administrative agency in the federal Department of Health and Human Services
Centers for Medicare and Medicaid Services (CMS)
uses computer software to automatically generate medical codes by "reading" transcribed clinical documentation
computer-assisted coding (CAC)
Determination that a service or procedure rendered is reasonable and necessary for the diagnosis or treatment of an illness or injury
medical necessity
Used to classify diagnoses in any health care setting?
CPT
For medical necessity purposes, the patient record must support codes submitted for third-party payer reimbursement, and patient diagnoses must __________.
justify diagnostic and/or therapeutic procedures or services provided
CMS-1450
UB-04
What does CPT stand for?
Current Procedural Terminology
reporting multiple codes to increase reimbursement when a single combination code should be reported.
unbundling
Used to classify procedures in an inpatient hospital setting?
ICD-10-PCS
Which type of record uses computer technology?
automated
Claim submitted by physician's offices to third-party payers
CMS-1500
Routinely assigning lower-level CPT codes for convenience instead of reviewing patient record documentation and the coding manual to determine the proper code to be reported.
downcoding
reporting codes that are not supported by documentation in the patient record for the purpose of increasing reimbursement.
upcoding
The HIPAA small code set collects information concerning _____.
race, ethnicity, type of facility, and type of unit
collection of information by a number of providers at different facilities about a patient
electronic health record
Numerical and alphanumerical characters that are reported to health plans for health care reimbursement and to external agencies.
Code
Software that automates the coding process
encoder
What type of codes will you find in the CPT manual?
procedures
BlueCross BlueShield
third-party payer
The UB-04 claim is submitted by __________ to health plans for reimbursement purposes.
hospitals
Assignment of codes to diagnoses, services, and procedures based on patient record documentation.
Coding
Coding system that classifies equipment, injectable drugs, transportation services not classified in the CPT.
HCPCS Level II
What type of codes will you find in the ICD-10-CMS code manual?
diagnosis codes