Coding and Billing Procedures Chapter 14

Questions and Answers

When and by who were codes established to define specific infectious diseases, parasites, symptoms, and causes of death?

In 1946 the International Commission of the World Health Organization (WHO) established codes.

How was ICD created and who was it created for?

In 1946 the International Commission of the World Health Organization (WHO) established ICD for insurers, health administrators, hospitals, and military medical providers.

What is the difference between ICD-9 and ICD-10?

ICD-9 had 3-character categories, while ICD-10 has a different format.

The provider must use approved ____________ for these procedures and services to obtain reimbursement.

medical codes Signup and view all the answers

Finish this statement: A __ is the determination of the nature of a condition, illness, disease, injury, or congenital defect; the provider assigns this through _ of the patient.

diagnosis; assessment Signup and view all the answers

The ICD-10-CM code set identifies what?

The disease or injury for which a patient was treated as a code consisting of up to 7 characters. Signup and view all the answers

An ICD-10 can have up to how many characters?

7 characters, with a period after the 3rd character. Signup and view all the answers

There can also be a period after the _____ character of an ICD-10.

3rd Signup and view all the answers

When you use the ICD-10-CM, you will choose a standardized alphanumeric code for the ____ _ assigned by the provider.

diagnostic statement Signup and view all the answers

Where would you find a diagnostic statement?

Operative reports, discharge summaries, H&P reports, and ancillary diagnostic services. Signup and view all the answers

Name three entities that recognize these codes which speeds reimbursement to health care providers.

Practice management software, clearinghouses, and third-party payers. Signup and view all the answers

The ICD-9-CM code set is made up of how many volumes?

Three volumes. Signup and view all the answers

What is in Volume 1 of ICD-9-CM?

The ICD-9-CM Tabular List of Diseases and Injuries. Signup and view all the answers

What is in Volume 2 of ICD-9-CM?

The ICD-9-CM Index to Diseases and Injuries. Signup and view all the answers

What is in Volume 3 of ICD-9-CM?

Used by hospitals to code inpatient procedures and services performed in the hospital environment. Signup and view all the answers

What are GEMs?

General equivalence mappings (GEMs). Signup and view all the answers

What is the purpose of GEMs?

To create a useful, practical, code-to-code translation reference dictionary for both code sets. Signup and view all the answers

How can GEMs be helpful and where can you find them?

GEMs can increase efficiency in ICD-10-CM coding and are available on the CMS website. Signup and view all the answers

What does 'abstract' refer to?

A summary of the diagnostic statement and/or procedures and services performed. Signup and view all the answers

What does 'acute' mean?

The initial assessment and treatment of the disease, condition, or injury. Signup and view all the answers

What does 'chronic' mean?

A disease that manifests over a long period because medical treatment has not resolved it. Signup and view all the answers

What is the Coding Clinic?

An industry journal that provides insight into the coding of complex medical cases. Signup and view all the answers

What is a diagnostic statement?

Information about a patient's diagnosis or diagnoses extracted from medical documentation. Signup and view all the answers

What is an encounter?

Every meeting between a patient and a healthcare provider. Signup and view all the answers

What does 'etiology' refer to?

The cause of a disorder; a claim may be classified according to the etiology. Signup and view all the answers

What does 'histologic' mean?

The microscopic composition of tissue. Signup and view all the answers

What does 'impending' refer to?

A condition that can be imminently threatening. Signup and view all the answers

What does 'manifestation' mean?

An indication of the existence, reality, or presence of something, especially an illness. Signup and view all the answers

What is a neoplasm?

A growth of uncontrolled, abnormal tissue; a tumor. Signup and view all the answers

What are notations?

Instructions or guides for assigning classifications or using subdivision codes. Signup and view all the answers

What does 'reimbursement' refer to?

The process by which the medical office submits a claim to the insurance company for payment. Signup and view all the answers

Study Notes

Establishment of Codes

In 1946, the International Commission of the World Health Organization (WHO) established codes for infectious diseases, parasites, symptoms, and causes of death.
This led to the creation of the International Statistical Classification of Diseases (ICD) for use by insurers, health administrators, hospitals, and military medical providers.

Transition from ICD-9 to ICD-10

ICD-9-CM, introduced in 1975, utilized a code format of 3-character categories, 4-character subcategories, and 5-character subdivisions.
ICD-10-CM, approved in 1995, introduced a more complex format with up to 7 characters and a period after the 3rd character.

Coding Requirements

Healthcare providers must use approved medical codes for procedures and services to obtain reimbursement.
Diagnoses are assigned through the assessment of the patient.

Details of ICD-10-CM

The ICD-10-CM code set assigns a code for diseases or injuries treated, made up of up to 7 characters.
Diagnostic statements are sourced from operative reports, discharge summaries, and ancillary diagnostic service reports.

Entities Recognizing Codes

Key entities such as practice management software, clearinghouses, and third-party payers facilitate coding processes and assist in speeding up reimbursement for healthcare providers.

Volume Structure of ICD-9-CM

The ICD-9-CM code set is organized into three volumes:
- Volume 1: Tabular List of Diseases and Injuries.
- Volume 2: Alphabetic Index to Diseases and Injuries.
- Volume 3: Coding guide for inpatient procedures and services in hospitals.

General Equivalence Mappings (GEMs)

GEMs serve as translation references between ICD-9-CM and ICD-10-CM, providing practical code-to-code mappings.
A complete list of GEMs is available on the CMS website to assist with ICD-10-CM coding.

Key Terminology

Abstract: Summary of diagnostic statements and procedures/services performed.
Acute: Initial assessment and treatment of a condition.
Chronic: Long-term disease due to unresolved medical treatment.
Coding Clinic: An industry journal providing insights into complex medical coding cases.
Diagnostic Statement: Extracted information from medical documentation related to a patient's diagnosis.
Encounter: Documented interactions between a patient and healthcare provider.
Etiology: The cause of a disorder, critical for claim classification.
Histologic: Refers to the microscopic composition of tissue.
Impending: Describes a condition that threatens imminent health, e.g., prediabetes.
Manifestation: Indication of an illness or condition.
Neoplasm: Abnormal tumor growth with specific ICD-10-CM diagnostic codes based on six classification criteria.
Notations: Instructions or guides for coding classifications found in both indexes.
Reimbursement: Claim submission process to insurance for payment of services rendered, using codes instead of textual descriptions.

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This quiz focuses on Chapter 14 of the Coding and Billing Procedures, providing flashcards that cover key concepts like the origins of coding systems and their purposes. Learn about the establishment of infectious disease codes by WHO in 1946 and the creation of ICD. Test your knowledge with these essential terms and definitions!