-
Blood Studies- Indicators(Need to know 5)
Liapse
Test used in the evaluation of pancreatic disease.
-
Blood Studies- Indicators(Need to know 5)
Glucose tolerance
- assist diagnosis of diabetes mellitus.
- evaluates patients with hypoglcemia
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Blood Studies- Indicators(Need to know 5)
Ferritin
Most sensitive test that determines iron-deficiency anemia.
-
Blood Studies- Indicators(Need to know 5)
Bilirubin
Used to evaluate liver function part of the evaluation of adult patients w/hemolytic anemias and newborns w/jaundice
-
Blood Studies- Indicators(Need to know 5)
Arterial Blood Gases(ABG)
- Measurement of arterial blood gases.
- Provides information to asses and manage patients respiratory and metabolic homeostasis.
-
Blood Studies- Microscopic Studies
Sputum Cytology
Cytologic examination is indicated for any patient diagnose of cancer of the lung considered.
-
Blood Studies-Microscopic Studies
Herpes Simplex (Type I and Type II)
Performed to diagnose acute initial herpes infections.
-
Blood Studies-Microscopic Studies
Blood Culture & Sensitivity
Blood cultures are obtained to detect the presence of bacteria in the blood.
-
Blood Studies-Cardiovascular Studies
Triglycerides
- Identify risk developing coronary heart disease.
- Includes measurement of cholesterol and lipoproteins. Also performed on patients w/fat metabolism disorders.
-
Blood Studies-Pulmonary Studies
SARS Viral Testing
Used to diagnose severe acute respiratory syndrome
-
Blood Studies-Hepatobiliary Studies
Bilibrubin (direct)
used to evaluate liver function in adult patients w/hemolytic anemias and newborns w/jaundice
-
Specimen
Ch.17
- pg772
- tissue submitted for laboratory or patholgoical evaluation
- examinations
- -biophysical
- -chemcial
- -cytological
-
Pathologists
Ch.17
- pg774
- oversee clinical lab and assume overall responsibility for test results
-
Clinical Laboratory Improvement Act of 1988 (CLIA)
Ch.17
perform certain pathology and laboratory tests (and to submit claims to medicare and medicaid), physician office labs must obtain certification
-
Separate or Multiple Procedures
Ch.17
- pg776
- Appropriate to separately code & report multiple pathology & laboratory procedures that are provided on the same date of service
-
Modifier -51
Ch.17
- pg777
- (multiple procedures)
- not added to pathology & laboratory codes
-
Modifier -91Ch.17
pg777
- (Repeat Clinical Diagnostic Laboratory Test) is added
- to pathology and laboratory codes when procedures or services are repeated on
- the same date of service to obtain multiple results.
-
Qualitative Assays
Ch.17
- pg.779
- detects whether a particular substance is present
-
Quantitative Assays
Ch.17
- Pg.779
- detect the amount of a substance in a specimen
-
Evocative
Ch.17
- pg779
- cause a specific response
- Describes various tests intended to cause production of hormones or other secretion
-
Transfusion Services
Ch.17
- pg785
- Report appropriate CPT code as well as a HCPCS Level II code for the blood product transfused
-
Microbiology
Ch17
- pg785
- Study of microbes (bacteria, parasites, viruses)
- -source
- -handling method
- -stains performed
- -identification technique used
-
Cytopathology
Ch17
- pg786
- Study of diseased cells
- Brushing, washing, needle biopsy or fine-needle aspiration
-
Presumptive Identification
Ch.17
- pg786
- identification by colony morphology, growth on selective media, gram stains, or up to three tests (Catalase, Oxidase, Indole or Uresase)
-
Definitive Identification
Ch17
- pg786
- identification to the genus or species level that requires additional tests (Biochemical panels or Slide Cultures)
-
Cytogenetics
Ch17
- Pg788
- the study of the cell and its heredity-related components, including chromosomes.
-
Surgical Pathology
Ch17
- Pg789
- a specimen is tissue submitted to the pathology department for evaluation; it is also the unit of service used to report surgical pathology codes.
- Determined:
- -type of exam
- -type of tissue
-
Medicine Section
Ch18
- Pg799
- classifies procedures & services that are procedure-oriented that apply to various medical specialities & apply to different types of health care providers
-
Bundled Medicine Codes
Ch18
- Pg800
- Reporting codes for outpatient hospital service & physician office use outpatient code editor (OCE) software or national correct coding initative (NCCI) software to identify bundled codes for procedure.
- Bundled procedure and service codes are NOT sep coded and reproted w/major procedure report component code in addition to the major proc is considered unbundling, fraud.
-
Reporting E/M Service Codes w/Vaccines/Toxoids Codes
Ch17
- Pg803
- depends on provider performed a medically necessary E/M service in addition to the immunization administration. Assign an E/M code in addition to immunization administration code, the E/M service must exceed services included w/immunization on administration codes.
-
Psychiatric Diagnostic Interview Services Include
Ch17
- Pg804
- -History and examination
- -Mental status examination
- -Patient disposition
- -Communication with the family or other source
- -Ordering and medical Interpretation of Laboratory or other Diagnostic studies
-
Complete Mental Status Examination
Ch17
- Pg805
- -Orientation to time, place, and person
- -Recent and remote memory
- -Attention span and concentration
- -Language (naming objects and repeating phrases)
- -Fund of knowledge (awareness of current event, past history, and vocabulary)
- -Mood and affect (depression, anxiety, agitation or mania)
-
Psychiatric Therapeutic Procedures
Ch18
- Pg806
- -Type of psychotherapy (behavior modifying)
- -Place of Service (office vs inpatient)
- -Face-to-Face time with patient
- -Whether E/M services were provided with psychotherapy
-
Dialysis
Ch18
- Pg808
- -Hemodialysis
- -Miscellaneous dialysis procedures
- -End-stage renal disease services
- -Other dialysis procedures
-
Renal Dialysis
Ch18
- Pg808
- Artificially removes toxic waste products from the body when the patient's kidneys are unable to perform this function because of disease or deterioration.
-
Hemodialysis
Ch18
- Pg808
- Process of removing waste products, toxins, and excess fluids from the blood; patients blood is diverted into a dialyzer, where it is treated and returned into the patients circulation by another tube inserted into different blood vessel
-
Peritoneal Dialysis
Ch18
- Pg808
- Soft catheter is inserted into abdominal cavity and dialysate fluid is infused an intermittent times
-
Therapeutic Services & Procedures
Ch18
- Pg814
- performed during a heart catheterization, after the dianostic images are obtained, are reported in addition to the heart catheterization codes (balloon angioplasty)
- Procedures
- -Caridopulmonary Resuscitation
- -Transcutaneous Pacing
- -Cardioversion
- -Circulatory Assist Procedures
- -Thrombolysis
- _Transcatheter Placement of Stints
-
Reporting Codes for Cardiac Catheterization Procedures
Ch18
- Pg818
- review the patient-record documentation
- -catheter placement
- -injection procedure
- -supervision and interpretation of fluroscopic guidance
-
Sleep medicine Testing
Ch18
- Pg821
- include sleep studies & polysommography, performed continous monitoring & recording sleep 6 or more hours
-
Sleep Laboratory
Ch18
- Pg821
- healthcare facility managed by a sleep technologist who explains and performs the sleep studies
-
Sleep Studies
Ch18
- Pg822
- evaluate adult and pediatric patients during sleep by monitoring brainwaves, heat rate, and eye movement; they are performed to diagnose sleep disorders, which include breathing, movement, and neurologic disorders that occur at night. videotaped while asleep
-
Multiple Sleep Latency
Ch18
- Pg821
- is the observation of a patient during at least a six-hr period of sleep and includes assessment of sleep latency (dormancy) and/or wakefulness after the sleep period.
-
Polysommnography
Ch18
- Pg822
- a sleep study that includes sleep staging with additional parameters of sleep
-
Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and other Highly Complex Drug or Highly Compelx Biologic Agent Administration
Ch18
- Pg825
- -Hydration
- -Therapeutic, prophylactic, diagnostic injections and infusions
- -Chemotherapy and other highly complex drug or highly complex biologic agent administration
- NOT Separately coded:
- -administration of local anesthesia
- -intravenous injection
- -access to indwelling IV, subcutaneous catheter, or port
- -routine syringe, tubing, and other supplies
- -flushing performed upon completion of infusion
-
Hydration
Ch18
- Pg826
- reported for the intravenous infusion of prepackaged fluids and electrolytes
- review patient record
- -patient assessment (history and examination)
- -Patient consent (discussion of risks benefits)
- -patient safety (proper dose was administered)
- -the nursing staff (staff members who provide infusion services)
-
Physical Medicine and Rehabilitation
Ch18
- Pg829
- a branch of medicine that focuses on the prevention, diagnosis, and treatment of disorders of the musculoskeletal, cardiovascular, and pulmonary systems that may produce temporary or permanent impairment
-
Physiatrist
Ch18
- Pg829
- a physician who specializes in physical medicine and rehabilitation and treats acute/chronic pain and musculoskeletal disorders
-
Medical Nutrition Therapy
Ch18
- pg830
- -Type of assessment
- -individual or group therapy
- -length of time
-
Moderate (Conscious) Sedation
Ch18
- Pg. 832
- codes classify a drug-induced depression of consciousness that requires no intervention to maintain airway patency or ventilation
-
Health Insurance Policy Ch19
- Pg845
- an agreement between an individual and a third-party payer (or insurance company) that contains a list of reimbursable medical benefits
-
Types of Third-Party Payers Ch19
- Pg845
- -Blue Cross Blue Shield (BCBS)
- -Commerical Insurance Companies
- -Employer self-insurance Plans
- -Government-Sponosored Programs (Medicare, Medicaid, TRICARE)
-
Claims and Coding Systems According to Type of Health Setting
Ch19
- Pg849
- CMS1491:ICD-9-CM or ICD-10-CM diagnosis codes and HCPCS level II (ambulance services)
- CMS-1500: ICD-9-CM or ICD-10-CM diagnosis codes and HCPCS level II--non-institutional providers and suppliers
- -ambulatory surgery centers
- -anesthesiologists who administer hospital-based inpatient and outpatient anesthesia
- UB-04: ICD-9-CM or ICD-10-PCS procedure codes---institutional providers (inpatient)
- -acute care hospitals
- -long-term care facilities
-
Roster Billing
Ch19
- Pg849
- a simplified process available to public health clinics and other non-institutional entities that offer mass immunization programs, hospice also submit claims for the administration of penumococcal pneumonia, influenzia virus and hepatitis B vaccines
-
Government Sponsored Programs
Ch19
- Pg850
- -CHAMPVA-Federal employee Health Benefits Program
- -Indian health services
- -Medicaid
- -Medicare
- -Military Health System
-
Managed Care
Ch19
- pg852
- combines the financing and delivery of health care services to replace conventional fee-for-service health insurance plans with more affordable care for consumers
- -exclusive provider organization
- -health maintenance organization
- -point of service plan
- -preferred provider organization
- -triple option plan
-
Capitation
Ch19
- Pg852
- a method of reimbursement in which the physician or facility receives a fixed amount each month for each patient enrolled in the plan, regardless of the amount of care that the patient receives
-
Integrated Delivery System (IDS)
Ch19
- Pg852
- an organization of affillated provider sites (hospitals, ambulatory surgical centers, or physicians group)
- -accountable health plans
- -delivery systems
- -health delivery networks
-
Physician-Hospital Organization (PHO)
Ch19
- Pg853
- owned by hosptials and physician groups that obtain managed care plan contracts; physicians maintain their own practices and provide health care services to plan members
-
Management Service Organization (MSO)
Ch19
- Pg853
- usually owned by physicians or hosptial; provides practice management and adminsitrative and support services to individual physician practices
-
Group Practice without walls (GPWW)
Ch19
- Pg853
- establishes a contact that allows physicians to maintain their own offices and share services such as appointment scheduling and billing.
-
Integrated Provider Organization (IPO)
Ch19
- Pg853
- manages the delivery of health care services offered by hosptials, physicians who are employees of the IPO, and other health care organizations such as ambulatory surgery clinics and nursing facilities.
-
Medical Foundation
Ch19
- Pg853
- nonprofit organization that contact with and acquires the clinical business asset of physician practices; the foundation is assigned a provider number and manage the practices business.
-
Health Maintenance Organization (HMO)
Ch19
- Pg853
- an alternative to traditional group health insurance coverage that provides comprehensive health care services to voluntarily enrolled members on a prepaid basis.
-
Closed-Panel HMO
Ch19
- Pg853
- health care is provided in an HMO-owned center or satellite clinic, or by physicians who belong to a specially formed medical group that services the HMO
-
Open-panel HMO
Ch19
- Pg853
- health care is provided by individuals who are not employees of the HMO or who do not belong to a specailly formed medical group that services an HMO
-
Consumer-Direct Health Plan (CDHP)
Ch19
- Pg853
- is a sort of 401k plan for health care; the CDHP has become a popular alternative to the increased cost of traditional health insurance premium and the limitations associated with managed care plans.
-
Prospective Payment System (PPS)
Ch19
- Pg857
- a reimbursement methodology that established predetermined rates based on patient category or type of facility
-
Chargemaster
Ch19
- Pg870
- contains
- -department code: refers to the specific ancillary department where the service is performed
- -service code: internal identification of specific service rendered
- -service description: narrative description of the services, procedure, or supply
-
HIPAA legislation is organized according to five titles
Ch19
- Pg876
- -Title I: healthcare access, portability and renewability
- -Title II: preventing healthcare fraud and abuse
- -Title III: Tax-related health provisions
- -Title IV: application and enforcement of group health plan requirements
- -Title V: revenue offsets
-
Preventing Healthcare Fraud and Abuse
Ch19
- Pg877
- fraud is an international deception or misrepresentation that someone makes, knowing it is false. abuse involves actions that are inconsistent with accepted sound, medical, business, or fiscal practices
-
Medicare fraudelent practices are regulated
ch19
- pg879
- -civil monetary penalities act
- -compliance guidelines
- -federal claims collection act of 1996
-
The office of the inspector general (OIG)
Ch19
- Pg880
- voluntary compliance guidelines have been established
- -ambulance industry
- -ambulance suppliers
- -clinical laboratories
- -durable medical equipment prosthetics, orthotics, and supply industry
-
RUGS Categories include
Ch19
- Pg862
- -Rehabilitation
- -Extensive service
- -Special care
- -Clincially complex
- -Impaired cognition
- -Behavior problem
- -Reduced physical functions
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