MOM ICD-9 Coding (and much more for test)
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MOM ICD-9 Coding (and much more for test)
How many concurrent diagnoses can there be on an insurance form?
3 (4 diagnoses altogether)
What is first volume of ICD-9 codes? Where is it used?
numerical index; used in doctor's office
What does ICD-9 stand for?
Int'l Classification of Diseases, 9th Edition
Where is volume 3 of the ICD-9 book used?
in hospitals only
What did the US originally use ICD-9 codes for?
Reporting causes of disease, prepping mortality stats
Where and when did the ICD system begin?
1700s in England
How many supplements and appendices are there to volume 1 of the ICD-9 book?
2 supplements, 5 appendices
Who uses this book for reporting mortalities?
State Health Depts and US Public Health
What are the 5 appendices of the ICD-9 book?
1. M codes
2. Glossary of Mental Disorders
3. Classification of drugs by American Hospital Formulatory Service and the IDC-9 equivalents
4. Classification of Industrial Accidents according to agency
5. List of 3-digit categories
When did coding become a requirement for all federally sponsored insurance programs?
Who updates the ICD-9 annually?
NCHS-- National Center for Health Stats
How many Volumes are are in the ICD-9 book?
What kind of supplemental classification would you use for an annual physical exam?
When does Medicare require you to start using the newest ICD-9?
A working diagnosis that has not been proven and includes words like, "suspected", "rule out", "possible", "questionable":
What is an 'M' code?
Morphology code (tumor tissue type) of neoplasms
*** appear on hospital reports
What is a 'V' code?
Codes that are used when a definitive Dx cannot be stated, but there is a valid reason for the patient to seek medical care
Give a couple examples of a V code
Well baby check
Annual physical exam
Family history of cancer
Evaluation by cardiologist before surgery
What is an E code?
Code for external causes of injury and poisoning (also criminal activity)
What is a disorder that does not always affect prognosis of primary condition?
Dx listed first on the claim form:
When can new editions of the ICD book be used? (What start date)
disorder that coexists with primary condition that complicates treatment of primary condition
When are new ICD books issued?
Instead of coding the qualified diagnosis, what would you code?
Do E codes expedite the processing of injury claims?
For PRIVATE INSURANCE COMPANIES, when must you begin using the newest ICD-9 book?
Where is the only place M codes will appear?
Can you code a qualified Dx?
no, just the symptoms
Do E codes affect 3rd party payment?
Codes used when there is no definitive Dx but the patient has a valid reason to be seen...
Two supplemental classifications of Vol I of ICD-9 book:
V and E codes
What is the first step in using the index of the ICD-9 book?
locate the main term in volume 2
What should you do if you cannot find the condition listed (first)?
Try a broader condition (syndrome, disease, disorder)
What is another name for a modifier?
Which volume do you look to first when trying to locate a disease?
How do you make a code more specific after the first 3 digits?
add a decimal and one or two additional digits
Would you ever code the PRE-OP Dx instead of the POST-OP Dx?
No, always Post-op
What are nonessential modifiers?
Qualifying words that do not have to be included in the Dx statement for the code # to apply
Where is a subterm located?
Indented two spaces beneath main term
Where do you look after finding the disease in Vol II?
Vol I, numerical index
Where would you look if you couldn't find a code using major terms and after trying to find a broader condition?
Vol I is organized in how many digits?
When do you code using only Vol II?
Do you need to wait for pathology/lab reports before coding on an insurance form?
Yes, to make sure you have an accurate Dx
Is there a need for proofreading when coding?
Term that qualifies the main terms or conditions by describing differences in site or etiology
Is the doctor usually aware of coding changes?
What do the two digits after a decimal point do?
They define the disease more specifically
How are the main terms of ICD-9 codes printed?
In boldface type
Either the presence of one or more disorders (or diseases) in addition to a primary disease or disorder, or the effect of such additional disorders or diseases.
Which coding book has V codes?
Which coding book has E codes?
Name the 6 sections of the CPT book
What are the two types of coding?
CPT and ICD-9
Define fiscal intermediary/agent.
A fiscal Intermediary (FI) refers to an entity or a private company that
has a contract with the center for medicare and medicaid services to determine and to pay part A and some part B bills
What is meant when you say "spreading the risk"?
Spreading the risk
: The selling of insurance in multiple areas to multiple policyholders to
minimize the danger that all policyholders will have losses at the same
Define Insurance Claims Register.
A log that allows you to see at a glance if a claim has been filed and also if it has been paid.
When should you follow up on a claim?
30-45 days on all claims if they have not been paid
Authorization to release information form is used when?
To show Medicare/Medicaid the person or persons you have designated to access your health information
Four reasons why CPT codes were developed
*To track disease processes
*For insurance processing (faster)
*To classify medical procedures
Usual, customary, reasonable
What do HMOs place a strong emphasis on?
well-care and early detection to reduce later cost
Three uses for ICD-9 code book?
*used to code, store, computerize, and retrieve large volumes of information from a pt record
*lengthy terminology is reduced to 3-5 digits
*Used for participation in Medicare, Medicaid, all other insurance programs
3 key components of E/m codes
*Medical decision making
Define assignment of benefits.
The doctor agrees to accept payment from an insurance company first and then bill the patient for any after-insurance
balances. (SO INSURANCE PAYMENT GOES DIRECTLY TO DOCTOR)
Define utilization review.
A utilization review is when a health insurance company reviews a request for medical treatment.
Person who provides health care services at the lowest possible cost and avoiding nonessential care
Define non-duplication of benefits.
A provision in some types of health insurance policies which specifies that the insurer will not pay benefits for any amount that is reimbursed by others.
Dates on insurance forms are recorded using how many digits?
Information contained in an authorization letter (when a patient is referred to a specialist):
*Date received by UR, date approved, and exp date
*Name, address, phone of specialist
*# of authorized visits
What is catastrophic coverage?
Catastrophic coverage is insurance coverage that is designed to protect the consumer from financial disaster in the case of a serious medical emergency.
What is the standard insurance form called?
A system of payment in which providers are paid a fixed per capita fee for each enrolled patient is known as:
Employer ID # is also referred to as:
Tax ID #, IRS ID
Reference initials on the CMS 1500 should be where on the form?
Lower left hand corner
HMO stands for:
Health Maintenance Organization
Who revises the CPT-4 book?
AMA (published annually)
Define preadmission certification.
Approval by a case manager or insurance company representative (usually a nurse) for a person to be admitted to a hospital or in-patient facility, granted prior to the admittance.
Define Quality Assurance.
assesses the quality of care provided in a health care setting
Coordination of benefits is also called:
non-duplication of benefits
What does worker's compensation insurance cover?
Work related injuries or illnesses
Coding deliberately to be able to receive a higher reimbursement
Describe the concept of RBRVS. (Resource-Based Relative Value Scale)
It is used to determine how much providers should be paid. It works by assigning units. It is needed to standardize payment (provide national uniform payments)
Define DRGs (Diagnostic Related Groups)
This system classifies patients into groups based on the principal Dx, type of surgical procedure, presence or absence of significant comorbidities/complications, and other relevant criteria.