National Coverage Determination (NCD) ch. 17 pg. 775
CLIA- perform certain pathology and lab test
NCD- define coverage for services and procedures
List three categories for selecting psychiatric therapeutic procedure codes ch. 18 pg. 814
When reporting codes for cardiac catheterization procedures, you must review the health record to determine three important factors ch. 18 pg. 818
-supervision and interpretation of fluroscopic guidance
Explain "sleep medicine testing" ch. 18 pg. 821-822
include sleep studies that are performed for continuous monitoring and recordings of sleep for 6 or more hours
Explain how to report hydration codes ch. 18 pg. 826
-hydration codes are reported for the IV of prepackaged fluids and electrolytes. Review patient record for documentation that the physician supervised: patient assessment, patient consent, staff members who provided infusion services
List four types of third-party payers ch. 19 pg. 845
-Blue Cross and Blue Shield
-Commerical Insurance Companies
-Employer Self-Insurance Claims
What is the difference between CMS 1491, CMS 1500, UB 04 ch. 19 pg. 849
-CMS 1491: ambulance services
-CMS 1500: non-institutional providers and supplies
-UB 04: institutional providers (inpatient and ouptatient) non-institutional providers
Prospective payment system (PPS) ch. 19 pg. 857
-a reimbursement methodology that established predetermined rates based on patient category type of facility
Inpatient Prospective Payment System ch. 19 pg. 858
-diagnosis-related groups to reimburse short-term hospitals
Skilled Nursing Facility PPS ch. 19 pg. 862
-classifies residents into resource utilization groups.
Explain the purpose of a charge-master ch. 19 pg. 870
a document that contains a computer-generated list of procedures, services & supplies
Advance Beneficiary Notice (ABN)
A waiver signed by the patient acknowledge that because medical necessity for a procedure or service cannot be established.
Includes any health care services provided to a patient who is admitted to facility
Includes radiological procedures and burn excision/debridement
Drug or agent that causes a loss of feeling, awareness and/or consciousness
A procedure done to puncture a joint for fluid removal or medication injection
visual examination of inside joint
Is the transplantation of tissue from the same individual
involves combing the mucous lining of the trachea or bronchus, in order to collect cells.
local anesthesia is injected sacral portion of the spinal cord
Standard claim submitted by physicians offices to third party payers.
The assignment of codes, to diagnosis, services and procedures based on patient record documentation.
Coding compliance program
ensures that the assignment of codes for diagnosis, procedures or services follow established coding guidelines by CMS.
The review of records and/or use of encounter forms or document during a visit or "real time".
Continuity of Care
Primary purpose of the health record
Coordination of care
When the physician makes arrangements with other providers or agencies for services to be provided to a patient
Is organized by alphabetical main terms printed in boldface
Clarify services and procedures performed by providers
Is performed for conditions, such as acne and scarring and general keratosis.
surgical removal of blood clot
endoscope inserted down through the esphagus direct visualization
Is one who has received professional services from the physician or same group practice
Acute inflammation of skin's connective tissue that is caused by infection with bacteria.
First Listed diagnosis
Reported for outpatient care instead of the principal diagnosis, it is the diagnosis, condition, problem or other reason for the encounter/visit.
used for extensive surgeries and patient is unconscious
combat waste, fraud and abuse in health insurance and healthcare delivery
Hospital discharge service
Includes the final examination of the patient and discussion of the hospital delivery.
often internists, who handles a patient's entire inpatient admission.
Arranged in strict chronological date order
visualization of the back of the throat
cluster of bean-shaped nodules that act as body filtration system
The information in the health record must justify diagnostic and/or services provided consistent with standards of good medical practice.
a vocabulary of clinical medical terms
Autologous graft consisting of both skin and muscle tissue form the donor site
National Correct Coding Initiative
Monitors inappropriate reimbursement of MEdicare Part B claims
Nature of presenting problem
Monitors inappropriate reimbursement of Medicare Part B claims.
Is one who has not received any professional services from the physician.
Receives services furnished on a hospitals premises that are ordered by a physician and including use of a bed and clinical services.
Incision into bone
Is a short term, intensive treatment program where individuals who are experiencing an acute episode of an illness.
A tuft of hair that developed as the result of repeated friction, which caused hairs to penetrate the skin.
Place of Service
Refers to the physical location where health care is provided to patients
puncture of the pleural space with a transthroacic needle to drain fluid or obtain material for diagnostic study.
An ulceration of the skin and underlying tissue that occurs over a body prominence.
Physicians services involving patient contacts that are considered beyond the usual services
surgical attachment of a finger; a hand, a toe, a leg, or an arm that has been severed from body
Source oriented record
Organized according to documentation source
Subsequent hospital care
Includes the review of the patient's record for changes in the patient condition.
removal of blood component, cells, or plasma solute
surgical puncture of chest wall with a needle to obtain fluid from the pleural cavity
Type of Service
Refers to the kind of health care services provided to patients
Includes probable, suspected and questionable diagnosis, which are not coded
Unlisted procedure or service
No CPT code and special report must accompany the claim
Is the removal of a portion of lung, less than a "segment"
Is the transplantation of tissue from a different species.