Podcast
Podcast
Podcast
Something went wrong
Questions and Answers
Questions and Answers
What is the impact of Ambulatory Payment Classifications (APCs) on physicians' services?
What is the impact of Ambulatory Payment Classifications (APCs) on physicians' services?
- They are not affected by APCs (correct)
- They are indirectly affected by APCs
- They are only affected by APCs under admitting services
- They are directly affected by APCs
How are Ambulatory Payment Classifications (APCs) adjusted?
How are Ambulatory Payment Classifications (APCs) adjusted?
- According to the cost of the service
- According to the type of patient
- According to geographical location for the hospital (correct)
- According to the type of service provided
What is the purpose of ICD-10-CM codes in relation to APCs?
What is the purpose of ICD-10-CM codes in relation to APCs?
- To determine the type of patient
- To determine payment
- To determine the type of service
- To determine medical necessity (correct)
What happens when a CPT code and a Diagnosis code do not match?
What happens when a CPT code and a Diagnosis code do not match?
What is a characteristic of combination codes?
What is a characteristic of combination codes?
Where can Ambulatory Payment Classifications (APCs) be found?
Where can Ambulatory Payment Classifications (APCs) be found?
What is the primary purpose of Medical Coding Classification Systems?
What is the primary purpose of Medical Coding Classification Systems?
Which of the following is NOT a component of the International Classification of Diseases (ICD)?
Which of the following is NOT a component of the International Classification of Diseases (ICD)?
What is the purpose of the Uniform Hospital Discharge Data Set?
What is the purpose of the Uniform Hospital Discharge Data Set?
What is the correct way to code diagnostic services from radiology and pathology?
What is the correct way to code diagnostic services from radiology and pathology?
What is the consequence of not following the correct order of codes in a claim submission?
What is the consequence of not following the correct order of codes in a claim submission?
Which classification system is used for reporting care delivered by physicians?
Which classification system is used for reporting care delivered by physicians?
What is the main difference between ICD-10-CM and ICD-10-PCS?
What is the main difference between ICD-10-CM and ICD-10-PCS?
What is the UB-04 form used for?
What is the UB-04 form used for?
What is the primary purpose of a Master Patient Index (MPI)?
What is the primary purpose of a Master Patient Index (MPI)?
What is the minimum duration for which medical records must be retained according to the retention policy?
What is the minimum duration for which medical records must be retained according to the retention policy?
What is the primary goal of data mining in healthcare?
What is the primary goal of data mining in healthcare?
Why is patient identification crucial in medical records?
Why is patient identification crucial in medical records?
What happens to physical documents after they are scanned and uploaded to an Electronic Healthcare Record (EHR)?
What happens to physical documents after they are scanned and uploaded to an Electronic Healthcare Record (EHR)?
What is the primary characteristic of big data in healthcare?
What is the primary characteristic of big data in healthcare?
What is the purpose of health data standards?
What is the purpose of health data standards?
What is required for the release of information (ROI) process?
What is required for the release of information (ROI) process?
What is the primary purpose of the Principal Diagnosis in inpatient coding?
What is the primary purpose of the Principal Diagnosis in inpatient coding?
What is the significance of the 7th character in ICD-10-CM codes?
What is the significance of the 7th character in ICD-10-CM codes?
What is the purpose of ICD-10-PCS?
What is the purpose of ICD-10-PCS?
What is the significance of the first character in an ICD-10-PCS code?
What is the significance of the first character in an ICD-10-PCS code?
What is the purpose of the notes and definitions in the ICD-10-CM book?
What is the purpose of the notes and definitions in the ICD-10-CM book?
What is the difference between the Principal Diagnosis and the Primary Diagnosis?
What is the difference between the Principal Diagnosis and the Primary Diagnosis?
What is the significance of the 9th edition of ICD-CM?
What is the significance of the 9th edition of ICD-CM?
What is the purpose of code sequencing in inpatient coding?
What is the purpose of code sequencing in inpatient coding?
What is the primary purpose of data abstraction?
What is the primary purpose of data abstraction?
What is the significance of the midpoint in time measurement?
What is the significance of the midpoint in time measurement?
What is the primary goal of data cleanliness?
What is the primary goal of data cleanliness?
Which of the following is an official source for coding complicated procedures?
Which of the following is an official source for coding complicated procedures?
What is the importance of documenting procedures and diagnostics?
What is the importance of documenting procedures and diagnostics?
What is the primary method of ensuring data integrity?
What is the primary method of ensuring data integrity?
What is included in health record data for abstraction?
What is included in health record data for abstraction?
What is the significance of time in relation to drug administration?
What is the significance of time in relation to drug administration?
Questions and Answers
Something went wrong
Flashcards
Flashcards are hidden until you start studying
Flashcards
Something went wrong
Study Notes
Study Notes
Clinical Classification Systems
- Time is a measure of the amount of time spent by a healthcare provider face-to-face with a patient, with the unit of time based on when the midpoint has passed, and is relevant to drug administration.
Data Integrity
- Relies on patient identification to eliminate inaccuracies or data anomalies, ensuring data is up-to-date and accurate.
- Data cleanliness is maintained through duplicate matching algorithms, data integrity teams, governance policies, education, and training.
Official Sources for Coding
- Official sources, such as the American Hospital Association (AHA) coding clinic for ICD-10, American Medical Association's (AMA's) CPT Assistant, and Coders desk reference, are recommended for coding complicated procedures and uncertain situations.
Health Record Data for Abstraction
- Elements include patient admit/discharge dates, discharge matching management notes, attending physician matching admit orders, and specific data points for newborn accounts, consulting information, and cause of death.
Data Abstraction
- Extracting relevant information from medical records for statistics, compliance, referrals, discharge information, and more.
Medical Coding Classification Systems
- Definition: a system that captures clinical data for reporting and reimbursement.
- International Classification of Diseases (ICD) identifies morbidity and mortality statistics (current version 10th), with 2 components: ICD-10-CM: Clinical Modification and ICD-10-PCS: Procedural coding system.
- Current Procedural Terminology (CPT) is used for the reporting of care delivered by physicians.
- Healthcare Common Procedure Coding (HCPC) and Diagnostic and Statistical Manual of Mental Disorders (DSM) are also part of the classification systems.
Uniform Data Collection Process
- Uniform Hospital Discharge Data Set (established in 1974 by Health and Human Services HHS) establishes a minimum common core data set, abstracted during discharge for insurance claims.
- Elements include personal identification, admission/discharge dates, types of admission, attending physician ID, operating physician, diagnosis, procedures with dates, patient's disposition, and the expected payer.
ICD-10-CM
- History: traced back to the 16th century, with the 9th edition used for 36 years, and the 10th edition being the current version.
- Changes: new combination codes, added 7th character, expanded codes, trimesters in OB codes, time frames changed, and definitions in notes.
- Needed a procedure book, so ICD-10-PCS was created, with codes ranging from 3-7 characters.
Inpatient Coding
- Principal Diagnosis (PDX): the "driver" behind the DRG, condition established after, and why they are admitted, does not get assigned to outpatient services.
- Code sequencing: PDX must be highest level of specificity, followed by secondary, to find the sequence, coder must review whole document and stay.
Outpatient Coding
- Primary Diagnosis: the reason that the patient is at the hospital, assigned to outpatient services.
- Conventions: knowing general differences, why you need them, what needs a modifier, where to find them, etc. is beneficial for coding.
Ambulatory Payment Classifications (APCs)
- Packaging of items and services found within the Outpatient Prospective Payment System (OPPS), including supplies, anesthesia, operating & recovery room, ancillary services, devices/implants, drugs, lab tests, and imaging services.
- Can be located on CMS.gov, updated annually, under Medicare fee-for-service payment.
CPT & Diagnosis Codes
- Both have to match up, otherwise, it will be denied.
- One Dx coder can support multiple CPT codes.
Medical Record
- Has a personal ID number to differentiate all patients apart.
- Contains full history, surgical history, family history, demographics, shots, drug allergies, and medical directives.
- Patient Identification is number one key because it prevents deaths, errors.
Electronic Healthcare Record (EHR)
- A record of the patient's journey electronically, must be able to maintain meaning for a lifetime.
- Items are assembled by scanning, or manual entry, and then processed through coding and deficiency management.
Big Data and Health Data Standards
- Big Data refers to the sheer volume of data available, the frequency that it is used, and has many forms.
- Health Data standards involve standardization of data elements, units with values.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Study Notes
Something went wrong
