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Questions and Answers
What organization compiled the first disease classification system in the United States?
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?
How does a classification system become a coding system?
Names are replaced by numbers and letters
What are procedure codes used for?
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?
How often should the medical office purchase new code books or computer code sets?
Who publishes the CPT manual for procedure codes?
Who publishes the CPT manual for procedure codes?
CPT category II and Category III codes consist of how many digits and letters?
CPT category II and Category III codes consist of how many digits and letters?
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?
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?
What is the first section of the CPT manual?
What is the first section of the CPT manual?
What is the format of most CPT codes?
What is the format of most CPT codes?
What is added to a code for a procedure that was extensive or unusual or that required an assistant?
What is added to a code for a procedure that was extensive or unusual or that required an assistant?
In which section of the CPT manual would the codes for an internist's office visits be found?
In which section of the CPT manual would the codes for an internist's office visits be found?
What is a key factor determining the level of services for an E/M code?
What is a key factor determining the level of services for an E/M code?
What type of history focuses mainly on the chief complaint?
What type of history focuses mainly on the chief complaint?
What defines an established patient?
What defines an established patient?
What type of anesthesia does not receive a separate code?
What type of anesthesia does not receive a separate code?
What is a factor used to calculate payment for anesthesia services?
What is a factor used to calculate payment for anesthesia services?
In an anesthesiologist's practice, which type of modifiers indicate the patient's condition at the time of anesthesia administration?
In an anesthesiologist's practice, which type of modifiers indicate the patient's condition at the time of anesthesia administration?
What is included in the code for a surgery?
What is included in the code for a surgery?
What is the definition of a laboratory panel?
What is the definition of a laboratory panel?
How should an electrocardiogram (ECG) performed during a routine examination be coded?
How should an electrocardiogram (ECG) performed during a routine examination be coded?
What may cause insurance claims to be rejected?
What may cause insurance claims to be rejected?
If coding for the removal of a lesion, what factors might influence the selection of the proper code?
If coding for the removal of a lesion, what factors might influence the selection of the proper code?
What is the format of HCPCS level II codes?
What is the format of HCPCS level II codes?
What item would most likely require a HCPCS level II code?
What item would most likely require a HCPCS level II code?
What was the original purpose of diagnostic coding?
What was the original purpose of diagnostic coding?
Which organization first published and continues to manage the International Classification of Diseases, 10th Edition?
Which organization first published and continues to manage the International Classification of Diseases, 10th Edition?
How are most diseases or conditions arranged in the tabular section of the ICD-10 manual?
How are most diseases or conditions arranged in the tabular section of the ICD-10 manual?
What is the format of the first three characters of an ICD-10 code?
What is the format of the first three characters of an ICD-10 code?
How do insurance companies use diagnosis codes?
How do insurance companies use diagnosis codes?
In the ICD-10 code M84.50xA, what is the function of the X?
In the ICD-10 code M84.50xA, what is the function of the X?
What is the purpose of external cause codes in the ICD-10?
What is the purpose of external cause codes in the ICD-10?
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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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