Chapter 16 Kinn's Medical Assistant Quiz

Questions and Answers

What was established in 1946 by the International Commission of the World Health Organization?

The Manual of the International Statistical Classification of Diseases, Injuries, and Causes of Death (ICD).

When did the United States adopt the ICD-10-CM diagnostic coding?

October 1, 2015.

How does diagnostic coding relate to medical necessity?

The diagnostic code tells the insurance company why a procedure was done.

What is a unique characteristic of the ICD-10-CM code structure?

Every ICD-10-CM code begins with an alphabetic letter. Signup and view all the answers

The ICD-10-CM coding manual has a fixed structure regardless of the publisher.

True Signup and view all the answers

What does the ICD-10-CM Alphabetic Index contain?

An alphabetic list of diagnostic terms and related codes. Signup and view all the answers

What is the importance of understanding coding conventions?

They help the coder select an accurate, specific code. Signup and view all the answers

What do the ICD-10-CM Official Guidelines for Coding and Reporting provide?

A set of rules that complement the official conventions. Signup and view all the answers

What does abstracting a diagnostic statement involve?

Analyzing and summarizing the diagnostic statements from a patient's health record. Signup and view all the answers

What are the basic steps required for accurate ICD-10-CM coding?

Eight basic steps, starting with abstracting the diagnostic statement. Signup and view all the answers

How can encoder software assist in assigning diagnostic codes?

It helps determine the most accurate code by matching keywords. Signup and view all the answers

Why is it important to adhere to coding guidelines?

To ensure accuracy and maximize third-party reimbursement. Signup and view all the answers

What should coders do when faced with discrepancies in reference sources?

Refer to the current year's ICD-10-CM coding manual as the final authority. Signup and view all the answers

What can be the consequence of unethical coding practices?

Loss of coding license and potential federal fines. Signup and view all the answers

Study Notes

Historical Use of ICD

Established by WHO in 1946 as a system to classify diseases and injuries.
ICD-9-CM was adopted in the U.S. in 1975, with ICD-10-CM implemented on October 1, 2015.
Diagnostic codes are crucial for insurance reimbursement; mismatched codes can lead to denials based on medical necessity.

Structure and Format of ICD-10-CM

Format varies slightly based on the publisher; however, the foundational structure remains consistent.
Codes start with an alphabetic letter indicating the disease chapter; 'U' is reserved for new diseases.
Most codes consist of 7 alphanumeric characters, with periods separating groupings.

Using the Alphabetic Index

The Alphabetic Index includes diagnostic terms, with main terms and modifiers.
Main terms appear in bold; nonessential modifiers are in parentheses, while essential modifiers are indented.
A hyphen indicates that additional characters are needed for complete code assignment.

Using the Tabular List

Organized into 21 chapters and subcategories with 3-character codes.
Chapters group diseases by type, body systems, or disease process.
Example: Chapter 1 encompasses infectious diseases (A00-B99), while Chapter 15 focuses on pregnancy and childbirth (O00-O9A).

Coding Conventions

Conventions guide coders through abbreviations, symbols, and instructional notes found primarily in the Tabular List.
Understanding conventions is essential for accurate coding and avoiding errors.

Official Coding Guidelines

Guidelines accompany the ICD-10-CM coding manual, offering rules for accurate code assignment.
These guidelines complement conventions and add specificity to coding practices.

Abstracting Diagnostic Statements

Medical assistants must analyze health records to abstract diagnostic statements for coding.
Sources include encounter forms, treatment notes, discharge summaries, and various reports.

Steps for Diagnostic Coding

Follow an eight-step process beginning with abstracting the diagnostic statement.
Use the Alphabetic Index to locate relevant codes, confirming accuracy with the Tabular List.
Knowledge of ICD-10-CM is vital for effective coding and impacts the practice's financial health.

Role of Encoder Software

Encoder software aids coders in identifying the most accurate codes through a search function.
Coders input keywords, and the software proposed relevant codes linked to the Tabular List.

Importance of Coding Guidelines

Manuals provide detailed instructional notes to support accurate code selection.
Coders must resolve discrepancies using the latest coding manual as the definitive source.
Highest level of specificity in coding maximizes third-party reimbursements.

Ethical Standards in Medical Coding

Pressure to engage in fraudulent coding practices exists, yet adhering to ethical standards is essential.
Convictions of fraud can lead to loss of licensing for practices and fines for coders.
Recognition of unethical coding behaviors is crucial for maintaining industry integrity.

Description

This quiz focuses on the historical context of the International Classification of Diseases (ICD) in the United States and its relation to diagnostic coding and medical necessity. Test your knowledge on crucial medical coding concepts and their applications in healthcare.