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Questions and Answers
What does the abbreviation NEC stand for in medical coding?
Which coding convention indicates that a second code may be required?
What does the symbol of a triangle in coding signify?
In medical coding, what do the inclusion notes refine?
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Which of the following best describes Excludes 1 in coding?
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What is the purpose of 'non-essential modifiers' in parentheses?
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What term describes conditions that persist after the acute phase of an illness?
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What does an Bullet next to a coding description typically indicate?
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What is indicated by a plus sign next to a medical code?
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What is the main disadvantage of straight-numeric filing?
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In middle digit filing, which part of the number is considered the primary digit?
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Which type of filing system is particularly advantageous for masking patient identities?
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What error occurs when using diagnosis codes that lack specificity?
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Which type of error involves reporting services that were not documented?
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Which filing method reduces the transposition of numbers effectively?
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What does unbundling in coding refer to?
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Which of these is NOT an error related to the coding process?
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What is the primary benefit of using cross-referencing when filing patient records?
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What is indicated by the term NOS in medical coding?
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What do exclusion notes in coding typically indicate?
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What does the inclusion note refine in medical coding?
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What does a bullet symbol signify in coding?
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Which coding convention indicates that specific codes may be necessary for different conditions?
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What does a tickler file help with in a medical practice?
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Which filing system is characterized by assigning specific numbers at the start of a medical encounter?
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What is the key drawback of utilizing a straight-numeric filing system?
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What type of coding error involves using a procedure code that exceeds the appropriate reimbursement rate?
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In terminal digit filing, which set of digits is treated as the primary digits?
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Study Notes
Coding Conventions
- NEC - Not Elsewhere Classifiable - used when there is no specific code for a condition.
- NOS - Not Otherwise Specified - used when a condition is not fully described in the medical record.
- Code Also - may be found in instructions indicating that a second code is needed.
- Category - Three-character alphanumeric code for a single disease or related condition.
- Subcategory - Four or five-character alphanumeric subdivision of a category.
- Inclusion Notes - Headed by the word "includes" and refine the content of the category.
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Exclusion Notes - Headed by the word "excludes" and indicate conditions not classifiable to the preceding code.
- Excludes1: Used when two conditions cannot exist together.
- Excludes2: Means "not included here" but a patient could have both conditions at the same time.
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Punctuation
- { }: Brackets enclose synonyms, alternative wording, or explanatory phrases. Encloses manifestation codes.
- ( ): Parentheses are used in both the index and tabular list to enclose supplementary words (non-essential modifiers).
- :: Colons are used after an incomplete term that needs modifiers in the Tabular List.
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Sequelae: Conditions remaining after a patient's acute illness or injury (residual effects or late effects).
- Late effects can be documented using "due to an old..." or "due to a previous..."
Filing Systems
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Alphabetic Filing System: Information is filed according to the patient's last name.
- Cross-referencing: Used for hyphenated last names (e.g., Lewis-Davidson). A separate blank file is created for each part of the name.
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Numeric Filing Systems: Use a number assigned to the patient instead of their name.
- Advantages: Masks patient identities, beneficial for sensitive information (HIV/AIDS clinics, drug rehabilitation centers)
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Types:
- Straight-Numeric Filing: Records are assigned specific numbers chronologically.
- Terminal Digit Filing: Three-part system where the last set of numbers are the primary digits, the middle set are the secondary digits, and the first set are the tertiary digits.
- Middle Digit Filing: Three-part system where the middle set of numbers are the primary digits, the first set are the secondary digits, and the last set are the tertiary digits.
Coding Compliance
- Medical Coding: Transforming verbal descriptions into numbers to determine reimbursement of medical fees.
- Claim Denial: Claims can be denied for errors in claim data, missing information, incorrect diagnosis or procedure codes.
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Common Coding Errors:
- Truncated Coding: Using diagnosis codes that are not specific enough.
- Assumption Coding: Reporting items or services that are not documented.
- Altering Documentation: After services are reported.
- Coding without Documentation: Not having appropriate documentation.
- Reporting Services Provided by Unlicensed/Unqualified Personnel:
- Not Satisfying Conditions of Coverage: For a particular service.
- Payer Non-Compliance: With required claim turnaround time.
- Intentional Upcoding: Increasing payment using a higher code.
- Incorrect Use of Acute and Chronic Coding Designations
- Not Coding Multiple Diagnoses Using a Combination Code
- Unbundling: Using multiple codes for a procedure when a single code should be used.
Billing Errors
- Billing Non-Covered Services: Billing for services that are not covered by insurance.
- Billing Over-Limit Services: Billing for services that exceed coverage limits.
- Upcoding: Using a procedure code that provides a higher reimbursement rate than the correct code.
- Downcoding: The documentation doesn't justify the level of service billed.
- Billing Without Signatures: Missing required signatures on billing forms.
Coding Conventions
- NEC (Not Elsewhere Classifiable): used when no specific code exists for a condition.
- NOS (Not Otherwise Specified): used when a condition is not fully described in the medical record.
- Code Also: indicates a second code may be required.
- Category: A three-character alphanumeric code covering a single disease or related condition.
- Subcategory: A four- or five-character alphanumeric subdivision of a category.
- Inclusion notes: refine the content of the category, beginning with the word "includes".
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Exclusion notes: indicate conditions not classifiable to the preceding code, beginning with the word "excludes".
- Excludes 1: used when two conditions cannot exist together.
- Excludes 2: means "not included here," but a patient could have both conditions simultaneously.
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Punctuation:
- Brackets ({}): enclose synonyms, alternative wording, or explanatory phrases. They also identify manifestation codes.
- Parentheses (()): used in both the index and tabular list to enclose non-essential modifiers.
- Colons (:): used in the Tabular List after an incomplete term requiring one or more modifiers.
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Sequelae: conditions remaining after a patient's acute illness or injury has ended, also called residual or late effects.
- A late effect can be documented using phrases like "due to an old" or "due to a previous".
- Example: a deviated septum due to a nasal fracture.
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Symbols used in Coding:
- A bullet (solid circle): indicates a new procedure code in the year it's added.
- A triangle: indicates a change in the code's descriptor in the year it's added.
- Facing triangles: enclose new or revised text, other than the code's descriptor.
- A plus sign (+): next to a code indicates an add-on code.
- A bullet inside a circle: indicates moderate sedation is part of the procedure.
- Lightning bolt symbol: used with vaccines.
Organization and Corporate Compliance Plans
- Alphabetic Filing System: Information is filed based on the last name of the patient.
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Chronological Filing System: Forms are filed in order of date, like a diary.
- Tickler File: a chronological file used as a reminder.
- Cross-referencing: used for hyphenated last names like Lewis-Davidson, creating separate blank files under both possible names (Lewis and Davidson) to direct to the main file.
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Numeric Filing Systems: use patient numbers instead of names, particularly useful for sensitive cases (HIV/AIDS clinics, drug/alcohol rehab centers).
- Straight-Numeric Filing: Records are assigned numbers when the patient starts care, filed chronologically.
- Terminal Digit Filing: A three-part filing system, #18-83-90, where primary digits are 90, secondary digits are 83, and tertiary digits are 18.
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Middle Digit Filing: Also a three-part system, using #18-83-90, primary digits are 83, secondary digits are 18, and tertiary digits are 90.
- Both Terminal and Middle digit systems are more complex but reduce the chance of transposing numbers.
Coding Compliance
- Medical Coding: Transforming verbal descriptions into numbers to determine medical fee reimbursement.
- Payer Initial Claim Processing: Screens for basic errors in claim data or missing information.
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Claim Denials: can occur due to:
- Careless Errors
- Incorrect Diagnosis Codes
- Incorrect Procedure Codes
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Rejected Claims:
- Delay payment processing.
- Potential fines for providers.
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Errors Related to Coding Processes:
- Truncated coding: Not using the most specific diagnosis codes.
- Assumption coding: Reporting items or services not documented.
- Altering documentation after services are reported: illegal and unethical.
- Coding without documentation: must have documentation to support coding.
- Reporting services provided by unlicensed or unqualified personnel: illegal and unethical.
- Not satisfying conditions of coverage for a service: ensure that the service is covered by the payer.
- Payers not complying with required claim turnaround time: ensure the payer is adhering to their own policies.
- Intentionally upcoding: using a code that results in a higher reimbursement rate than the correct code, illegal and unethical.
- Not using acute and chronic coding designations correctly: important for accurate billing.
- Not coding multiple diagnoses using a combination code: using appropriate combination codes for multiple diagnoses.
- Unbundling: using multiple codes for a service that should be coded with a single code, illegal and unethical.
Errors Related to Billing Processes
- Billing Non-Covered Services: only bill for services covered by the payer.
- Billing Over Limit Services: ensure the service is within the allowed limits for the payer.
- Upcoding: using a procedure code that results in a higher reimbursement rate than the correct code, illegal and unethical.
- Downcoding: using a code that does not accurately reflect the level of service provided.
- Billing Without Signatures: ensure all necessary signatures are present on the billing forms.
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Description
Test your knowledge on medical coding conventions including NEC, NOS, and various code classifications. This quiz covers essential terms and guidelines vital for accurate coding in healthcare. Brush up on your understanding of inclusion and exclusion notes as well as punctuation rules in coding.
