Test 5

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  1. Blood Studies- Indicators(Need to know 5)
    Test used in the evaluation of pancreatic disease.
  2. Blood Studies- Indicators(Need to know 5)
    Glucose tolerance
    • assist diagnosis of diabetes mellitus.
    • evaluates patients with hypoglcemia
  3. Blood Studies- Indicators(Need to know 5)
    Most sensitive test that determines iron-deficiency anemia.
  4. Blood Studies- Indicators(Need to know 5)
    Used to evaluate liver function part of the evaluation of adult patients w/hemolytic anemias and newborns w/jaundice
  5. 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.
  6. Blood Studies- Microscopic Studies
    Sputum Cytology
    Cytologic examination is indicated for any patient diagnose of cancer of the lung considered.
  7. Blood Studies-Microscopic Studies
    Herpes Simplex (Type I and Type II)
    Performed to diagnose acute initial herpes infections.
  8. Blood Studies-Microscopic Studies
    Blood Culture & Sensitivity
    Blood cultures are obtained to detect the presence of bacteria in the blood.
  9. Blood Studies-Cardiovascular Studies
    • Identify risk developing coronary heart disease.
    • Includes measurement of cholesterol and lipoproteins. Also performed on patients w/fat metabolism disorders.
  10. Blood Studies-Pulmonary Studies
    SARS Viral Testing
    Used to diagnose severe acute respiratory syndrome
  11. Blood Studies-Hepatobiliary Studies
    Bilibrubin (direct)
    used to evaluate liver function in adult patients w/hemolytic anemias and newborns w/jaundice
  12. Specimen
    • pg772
    • tissue submitted for laboratory or patholgoical evaluation
    • examinations
    • -biophysical
    • -chemcial
    • -cytological
  13. Pathologists
    • pg774
    • oversee clinical lab and assume overall responsibility for test results
  14. Clinical Laboratory Improvement Act of 1988 (CLIA)
    perform certain pathology and laboratory tests (and to submit claims to medicare and medicaid), physician office labs must obtain certification
  15. Separate or Multiple Procedures
    • pg776
    • Appropriate to separately code & report multiple pathology & laboratory procedures that are provided on the same date of service
  16. Modifier -51
    • pg777
    • (multiple procedures)
    • not added to pathology & laboratory codes
  17. Modifier -91Ch.17

    • (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.
  18. Qualitative Assays
    • pg.779
    • detects whether a particular substance is present
  19. Quantitative Assays
    • Pg.779
    • detect the amount of a substance in a specimen
  20. Evocative
    • pg779
    • cause a specific response
    • Describes various tests intended to cause production of hormones or other secretion
  21. Transfusion Services
    • pg785
    • Report appropriate CPT code as well as a HCPCS Level II code for the blood product transfused
  22. Microbiology
    • pg785
    • Study of microbes (bacteria, parasites, viruses)
    • -source
    • -handling method
    • -stains performed
    • -identification technique used
  23. Cytopathology
    • pg786
    • Study of diseased cells
    • Brushing, washing, needle biopsy or fine-needle aspiration
  24. Presumptive Identification
    • pg786
    • identification by colony morphology, growth on selective media, gram stains, or up to three tests (Catalase, Oxidase, Indole or Uresase)
  25. Definitive Identification
    • pg786
    • identification to the genus or species level that requires additional tests (Biochemical panels or Slide Cultures)
  26. Cytogenetics
    • Pg788
    • the study of the cell and its heredity-related components, including chromosomes.
  27. Surgical Pathology
    • 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
  28. Medicine Section
    • Pg799
    • classifies procedures & services that are procedure-oriented that apply to various medical specialities & apply to different types of health care providers
  29. Bundled Medicine Codes
    • 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.
  30. Reporting E/M Service Codes w/Vaccines/Toxoids Codes
    • 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.
  31. Psychiatric Diagnostic Interview Services Include
    • 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
  32. Complete Mental Status Examination
    • 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)
  33. Psychiatric Therapeutic Procedures
    • 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
  34. Dialysis
    • Pg808
    • -Hemodialysis
    • -Miscellaneous dialysis procedures
    • -End-stage renal disease services
    • -Other dialysis procedures
  35. Renal Dialysis
    • 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.
  36. Hemodialysis
    • 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
  37. Peritoneal Dialysis
    • Pg808
    • Soft catheter is inserted into abdominal cavity and dialysate fluid is infused an intermittent times
  38. Therapeutic Services & Procedures
    • 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
  39. Reporting Codes for Cardiac Catheterization Procedures
    • Pg818
    • review the patient-record documentation
    • -catheter placement
    • -injection procedure
    • -supervision and interpretation of fluroscopic guidance
  40. Sleep medicine Testing
    • Pg821
    • include sleep studies & polysommography, performed continous monitoring & recording sleep 6 or more hours
  41. Sleep Laboratory
    • Pg821
    • healthcare facility managed by a sleep technologist who explains and performs the sleep studies
  42. Sleep Studies
    • 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
  43. Multiple Sleep Latency
    • 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.
  44. Polysommnography
    • Pg822
    • a sleep study that includes sleep staging with additional parameters of sleep
  45. Hydration, Therapeutic, Prophylactic, Diagnostic Injections and Infusions, and Chemotherapy and other Highly Complex Drug or Highly Compelx Biologic Agent Administration
    • 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
  46. Hydration
    • 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)
  47. Physical Medicine and Rehabilitation
    • 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
  48. Physiatrist
    • Pg829
    • a physician who specializes in physical medicine and rehabilitation and treats acute/chronic pain and musculoskeletal disorders
  49. Medical Nutrition Therapy
    • pg830
    • -Type of assessment
    • -individual or group therapy
    • -length of time
  50. Moderate (Conscious) Sedation
    • Pg. 832
    • codes classify a drug-induced depression of consciousness that requires no intervention to maintain airway patency or ventilation
  51. 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
  52. 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)
  53. Claims and Coding Systems According to Type of Health Setting
    • 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
  54. Roster Billing
    • 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
  55. Government Sponsored Programs
    • Pg850
    • -CHAMPVA-Federal employee Health Benefits Program
    • -Indian health services
    • -Medicaid
    • -Medicare
    • -Military Health System
  56. Managed Care
    • 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
  57. Capitation
    • 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
  58. Integrated Delivery System (IDS)
    • Pg852
    • an organization of affillated provider sites (hospitals, ambulatory surgical centers, or physicians group)
    • -accountable health plans
    • -delivery systems
    • -health delivery networks
  59. Physician-Hospital Organization (PHO)
    • 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
  60. Management Service Organization (MSO)
    • Pg853
    • usually owned by physicians or hosptial; provides practice management and adminsitrative and support services to individual physician practices
  61. Group Practice without walls (GPWW)
    • Pg853
    • establishes a contact that allows physicians to maintain their own offices and share services such as appointment scheduling and billing.
  62. Integrated Provider Organization (IPO)
    • 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.
  63. Medical Foundation
    • 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.
  64. Health Maintenance Organization (HMO)
    • Pg853
    • an alternative to traditional group health insurance coverage that provides comprehensive health care services to voluntarily enrolled members on a prepaid basis.
  65. Closed-Panel HMO
    • 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
  66. Open-panel HMO
    • 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
  67. Consumer-Direct Health Plan (CDHP)
    • 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.
  68. Prospective Payment System (PPS)
    • Pg857
    • a reimbursement methodology that established predetermined rates based on patient category or type of facility
  69. Chargemaster
    • 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
  70. HIPAA legislation is organized according to five titles
    • 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
  71. Preventing Healthcare Fraud and Abuse
    • 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
  72. Medicare fraudelent practices are regulated
    • pg879
    • -civil monetary penalities act
    • -compliance guidelines
    • -federal claims collection act of 1996
  73. The office of the inspector general (OIG)
    • Pg880
    • voluntary compliance guidelines have been established
    • -ambulance industry
    • -ambulance suppliers
    • -clinical laboratories
    • -durable medical equipment prosthetics, orthotics, and supply industry
  74. RUGS Categories include
    • Pg862
    • -Rehabilitation
    • -Extensive service
    • -Special care
    • -Clincially complex
    • -Impaired cognition
    • -Behavior problem
    • -Reduced physical functions
Card Set:
Test 5
2013-12-02 04:02:15

Ch. 17-19
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