Medical Coding and Classification Systems

Questions and Answers

What organization compiled the first disease classification system in the United States?

American Medical Association (AMA)

How does a classification system become a coding system?

Names are replaced by numbers and letters

What are procedure codes used for?

to classify the type of care given to patients
to identify and/or justify medical services a patient received
to collect statistics about frequency and effectiveness of procedures
to determine how frequently certain diseases occur in the population

How often should the medical office purchase new code books or computer code sets?

Annually Signup and view all the answers

Who publishes the CPT manual for procedure codes?

AMA Signup and view all the answers

CPT category II and Category III codes consist of how many digits and letters?

Four digits and one letter Signup and view all the answers

What coding system is used by the Centers for Medicare and Medicaid Services (CMS) for services and equipment not usually covered by ordinary health insurance?

HCPCS level II Signup and view all the answers

What is the first section of the CPT manual?

Evaluation and Management Signup and view all the answers

What is the format of most CPT codes?

Five digits Signup and view all the answers

What is added to a code for a procedure that was extensive or unusual or that required an assistant?

Two digit modifier Signup and view all the answers

In which section of the CPT manual would the codes for an internist's office visits be found?

Evaluation and Management Signup and view all the answers

What is a key factor determining the level of services for an E/M code?

The extent of the history Signup and view all the answers

What type of history focuses mainly on the chief complaint?

Problem focused history Signup and view all the answers

What defines an established patient?

A patient who has been seen within the past three years Signup and view all the answers

What type of anesthesia does not receive a separate code?

Local anesthesia administered by infiltration Signup and view all the answers

What is a factor used to calculate payment for anesthesia services?

Type of facility where the services were provided Signup and view all the answers

In an anesthesiologist's practice, which type of modifiers indicate the patient's condition at the time of anesthesia administration?

Standard modifiers Signup and view all the answers

What is included in the code for a surgery?

Local or topical anesthesia Signup and view all the answers

What is the definition of a laboratory panel?

A group of laboratory tests that are done at the same time Signup and view all the answers

How should an electrocardiogram (ECG) performed during a routine examination be coded?

As a separate procedure Signup and view all the answers

What may cause insurance claims to be rejected?

The service is not justified with documentation in the patient record Signup and view all the answers

If coding for the removal of a lesion, what factors might influence the selection of the proper code?

<ul> <li>type of lesion</li> <li>size of the lesion</li> <li>location of the lesion</li> <li>method of removal of the lesion</li> </ul> Signup and view all the answers

What is the format of HCPCS level II codes?

One letter followed by four digits Signup and view all the answers

What item would most likely require a HCPCS level II code?

Metal crutches Signup and view all the answers

What was the original purpose of diagnostic coding?

<ul> <li>to track disease processes</li> <li>to classify the cause of disease</li> <li>to collect data for medical disease</li> <li>to evaluate hospital service utilization</li> </ul> Signup and view all the answers

Which organization first published and continues to manage the International Classification of Diseases, 10th Edition?

World Health Organization Signup and view all the answers

How are most diseases or conditions arranged in the tabular section of the ICD-10 manual?

Classification of disease or condition Signup and view all the answers

What is the format of the first three characters of an ICD-10 code?

One letter followed by two digits Signup and view all the answers

How do insurance companies use diagnosis codes?

To decide whether the care given corresponds to the patient's disease Signup and view all the answers

In the ICD-10 code M84.50xA, what is the function of the X?

It is a placeholder for information that is not specified Signup and view all the answers

What is the purpose of external cause codes in the ICD-10?

They are used to gather statistics about causes and severity of injuries Signup and view all the answers

Study Notes

Disease Classification Systems

The first disease classification system in the U.S. was compiled by the American Medical Association (AMA).
A classification system transforms into a coding system when names are substituted with numbers and letters.

Procedure Coding

Procedure codes classify care types, justify medical services received by patients, and gather statistics on procedure frequency and effectiveness.
New code books or computer code sets should be purchased annually.

CPT Manual

Published by the AMA, the CPT manual includes procedure codes starting with Evaluation and Management.
Most CPT codes follow a five-digit format, while Category II and III codes consist of four digits and one letter.
A two-digit modifier is added to indicate extensive or unusual procedures that required an assistant.

Anesthesia Coding

Local anesthesia administered by infiltration does not require a separate code.
The type of facility affects payment calculations for anesthesia services.
In anesthesiology, standard modifiers illustrate the patient’s condition during anesthesia administration.

Laboratory and Other Procedures

A laboratory panel consists of a group of tests performed concurrently.
An electrocardiogram (ECG) during a routine exam is coded as a separate procedure.
Insurance claims may be rejected if services lack proper documentation in patient records.

Coding for Lesions and Equipment

When coding for lesion removal, the type, size, location, and removal method are crucial factors.
HCPCS level II codes consist of one letter followed by four digits, used for items like metal crutches.

Diagnostic Coding Development

Diagnostic coding emerged to track disease processes, classify disease causes, collect medical data, and evaluate hospital service use.
The International Classification of Diseases, 10th Edition, is managed by the World Health Organization.

ICD-10 Code Structure

Diseases in ICD-10 are categorized in the tabular section and the first three characters of an ICD-10 code are formatted as one letter followed by two digits.
Diagnosis codes help insurance companies determine if the provided care aligns with the patient's disease.
In the ICD-10 code M84.50xA, 'X' serves as a placeholder for unspecified information.

External Cause Codes

External cause codes in ICD-10 are employed to collect statistics on the causes and severity of injuries.

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Description

Explore the essential components of disease classification systems and procedure coding in healthcare. This quiz covers the basics of the CPT manual, anesthesia coding, and the impact of facility type on payment calculations. Test your understanding of how medical services are categorized and documented.