Questions and Answers
What is the mandated code set for diagnosis under HIPAA?
ICD-10-CM
A code in ICD-10-CM has up to how many characters?
Seven
How many characters does an ICD-10-CM category code have?
Three
How many characters does a subcategory code in ICD-10-CM have?
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What is an example of a subcategory code?
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The correct code set according to CMS is based on what?
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What is the first step to begin coding?
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To code correctly for a disease or diagnosis, where must you first look?
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The Alphabetical Index is organized by what?
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What is another name for the Alphabetical Index in ICD-10-CM?
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Which code number is based on anatomical site and divided by description?
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Define Subterm.
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If a patient presents with blindness following an accident, what is the main term?
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The terms acquired, congenital, and both eyes modify the main term as what?
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If a cross-reference appears after a main term, what must the coder do?
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What type of code describes two diagnoses or a diagnosis with an associated complication?
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What letter is not used in ICD-10-CM coding?
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A valid code must have at least how many characters?
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What does the colon punctuation indicate?
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If the Tabular index has the instruction to 'code first underlying disease,' where is the selected code listed?
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When is the primary diagnosis coding listed?
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If the patient has a co-existing condition, what must the coder do?
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When an established diagnosis has been determined, what must the coder code?
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What can be coded according to the ICD-10-CM outpatient coding guidelines?
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If the medical record mentions a type or form of a condition not listed, how would the code be classified?
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How many chapters does ICD-10-CM have?
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In an outpatient setting, what is the chief complaint referred to as?
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What is the final step in coding?
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What must a coder verify when selecting a code in the Tabular List?
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What does ICD-10-CM offer in terms of detail compared to ICD-9-CM?
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Level 1 codes in HCPCS are referred to as?
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What do CPT Category II codes report?
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When a medical practice receives a revised edition of CPT, what activities should be followed?
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In CPT, which appendix contains the summary of Modifier 51 exempt codes?
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In CPT, what does a '+' sign indicate?
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In CPT, what does a triangle next to a code indicate?
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In CPT, the code listed first for an encounter is the procedure that is what?
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Study Notes
ICD-10-CM Coding
- ICD-10-CM is a mandated code set for diagnoses as per HIPAA regulations.
- Codes can have a maximum of seven characters.
- A basic category code consists of three characters.
- Subcategory codes contain four characters.
Example Codes
- An example of a subcategory code is S81.2.
- The ICD-10-CM code system is updated based on the date of service.
Coding Steps and Tools
- Begin the coding process by consulting the Alphabetical Index.
- To code accurately, always confirm findings in the Tabular List after using the Alphabetical Index.
Index Organization
- The Alphabetical Index is organized by conditions and is referred to as ICD-10-CM for diseases and injuries.
Modifiers and Terminology
- Subterms describe main terms based on anatomical site and description.
- Non-essential modifiers include terms such as acquired, congenital, and both eyes, which modify the main term.
Cross References and Codes
- When a cross-reference appears with "SEE," it indicates the need to look up the following term.
- A combining code is used to describe two diagnoses or a diagnosis with a complication.
Code Structure and Validity
- The letter U is not utilized in ICD-10-CM coding.
- A valid code must contain at least three characters.
Punctuation and Coding Instructions
- A colon (:) indicates an incomplete term.
- If the Tabular Index instructs to "code first underlying disease," that code will be listed second in priority.
Diagnosis and Co-existing Conditions
- The primary diagnosis code is listed first.
- Use a combination code to report both the primary diagnosis and any co-existing conditions.
Established Diagnoses
- Once an established diagnosis is confirmed, the established code should be used.
- Outpatient coding guidelines permit coding of abnormal test results.
Medical Records and Coding Limitations
- If a condition’s type or form mentioned in medical records is not listed, it may be assigned an "other" code.
- ICD-10-CM organizes diseases into 21 chapters.
Coding in Outpatient Settings
- The chief complaint, abbreviated as "CC," represents the main issue during a visit.
- The final step in coding involves checking compliance with relevant guidelines.
Verifying Codes
- Verification during code selection includes referencing the Tabular List, ensuring the correct number of codes, and their proper order.
CPT Coding
- ICD-10-CM improves specificity and detail compared to ICD-9-CM.
- Level 1 codes in HCPCS are known as CPT codes.
- CPT Category II codes report performance measures.
Updating Medical Practices
- Upon receiving a revised edition of CPT codes, practices should update encounter forms, patient billing software, and educate staff regarding changes.
CPT Appendices and Indicators
- Appendix A in CPT contains a summary of Modifier 51 exempt codes.
- A plus (+) sign in CPT indicates an add-on code.
- A triangle next to a CPT code signifies that the descriptor has changed.
Resource Intensity in Procedures
- The CPT code listed first for an encounter represents the most resource-intensive procedure performed during that visit.
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Test your knowledge on ICD-10-CM coding with this quiz. Each flashcard covers essential coding terms and their definitions, helping you to prepare for medical billing and coding challenges. Dive into the nuances of diagnosis coding mandated under HIPAA!