medicare part A
The part of the Medicare program that pays for hospitalization, care in a skilled nursing facility, home health care, and hospice
... [Show More] care.
Medicare Part B
the part of medicare that helps cover madically necessary physician services outpatient care and other medical services full services not covered under medicare part a part B is an optional benefit for which the patient must pay a premium in which generally requires a yearly deductible and co insurance
Medicare Part C (Medicare Advantage)
combines benefits of part A and B, sometimes D.
Medicare—Part D
Prescription drug coverage
medical coding
The process of translating this written or dictated medical record into a series of numeric and alpha numeric codes
2 primary types of insurers
commercial insurance plans and government insurance plans
Medicare
provides coverage for people over the age of 65, bling or disabled individuals, and people with permanent kidney failure or end stage renal disease (ESRD)
Medicaid
a health insurance assistance program for low income people
Advanced Beneficiary Notice (ABN)
Document that informs covered patients that Medicare may not cover a certain service and the patient will be responsible for the bill
required before billing the patient if coverage is denied
HITECH
Health Information Technology for Economic and Clinical Health Act
- allows patients to request an audit trail of their disclosures of their health info made through the electronic health record
- requires that an individual be notified if their is an unauthorized disclosure of their health info
compliance plan
A written set of instructions outlining the process for coding and submitting accurate claims, and what to do if mistakes are found.
The AAPC was founded in what year?
1988
can a word have more than one root?
yes
blephar/o
eyelid
bucc/o
cheek
cholecyst/o
gallbladder
colp/o
vagina
cyst/o
A fluid sac or pouch, urinary bladder
derm/o
skin
encephal/o
brain
enter/o
intestine
hem/o, hemat/o
blood
my/o
muscle
myel/o
spinal cord, bone marrow
onych/o
nail
oste/o
bone
phleb/o
vein
pulm/o, pulmon/o
lungs
synov/i
synovial fluid, joint, or membrane
ab-
away from
ad-
toward, near
ante-
before
ec-, ecto-
out, outside
end/o
in, within
mon/o
one
poly-
many, much
post-
after, behind
-centesis
puncture, tap
-desis
binding, fusion
-ectomy
excision, surgical removal
-graphy
act of recording data
-pexy
surgical fixation
-plasty
surgical repair, plastic surgery, reconstruction
-tripsy
crushing
Anterior (ventral)
toward the front of the body
Posterior (dorsal)
toward the back of the body
Medial
Toward the midline of the body
Lateral
toward the side of the body
Proximal
nearer to the point of attachment or to a given reference point
Superior (cranial)
above; toward the head
Inferior (caudal)
below; toward the lower end of the spine
Superficial (external)
closer to the surface of the body
deep (internal)
closer to the center of the body
sagittal plane
cuts body into left and right side
frontal (coronal) plane
vertical plane dividing the body or structure into front (anterior) and back (posterior) portions
transverse plane (horizontal) (axial)
cuts horizontally through the body and separates the body into upper (superior) and lower (inferior) sections
Basic unit of all living things
cell
(4) connective tissue groups:
adipose tissue, cartilage, bone, blood
what does muscle tissue do?
causes movement
What are organs?
two or more kinds of tissue together performing special body functions
What are systems?
a group of organs working together to perform a complex body function
what is the cranial cavity?
space in the skull or cranium that contains the brain
what is the spinal (vertebral) cavity?
space inside the spinal column containing the spinal cord
what is the thoracic cavity?
Space containing the heart, lungs, esophagus, trachea, bronchi, and thymus.
what is the abdominal cavity?
The space containing the lowest portion of the esophagus, the stomach, intestines (excluding the sigmoid colon and rectum), kidneys, liver, gallbladder, pancreas, spleen, and ureters.
what is the pelvic cavity?
The space containing the urinary bladder, certain productive organs, part of the large intestine, and the rectum.
mucus membranes
Line the interior walls of the organs and tubes that open to the outside of the body, such as those of the digestive, respiratory, urinary, and reproductive systems.
serous membranes
line cavities, including the thoracic cavity and internal organs.
synovial membranes
• line joint cavities
• composed of connective tissue
• secrete synovial fluid into joint cavities
meninges
Composed of 3 connective tissue membranes found within the dorsal cavity and serve as a protective covering of the brain and spinal cord.
cutaneous membrane
another name for skin
largest organ system of the body?
integumentary system
the integumentary system is composed of?
skin, hair, nails
skin consists of ___ layers
2
epidermis and dermis
hair has ___ structures
2
follicle and shaft
Nails are composed of ___ parts
6
root, nail bed, nail plate, cuticle, perionychium, hyponychium
musculoskeletal system is composed of?
muscles, joints, tendons and joints
Bone Classification
long bones, short bones, flat bones, irregular bones, and sesamoid.
closed fracture
Does not involve a break in the skin
compound fracture
Projects through the skin with a possibility of infection
comminuted fracture
more than 2 pieces
transverse fracture
bone break with fracture line straight across shaft of bone across longitudinal axis.
greenstick fracture
only one side of the shaft is broken and the other is bent; common in children
spiral fracture
Spread along length of bone and produced by twisting stress
Colles fracture
fracture of the distal radius at the wrist
compression fracture
Occurs in vertebrae and is subject to extreme stress
epiphyseal fracture
Occurs where the matrix is undergoing calcification and chondrocytes are dying; usually seen in children
Cartilage
A connective tissue that is more flexible than bone and that protects the ends of bones and keeps them from rubbing together.
there are ___ types of joints
3
fibrous, cartilaginous, and synovial
skeletal muscle
striated and voluntary
smooth muscle
involuntary muscle found in hollow organs
cardiac muscle
wall of the heart
the human body contains ___ types of blood vessels
3
arteries, veins, and capillaries
the heart is composed of ___ layers
3
epicardium
myocardium
endocardium
what is the epicardium?
outer layer of the heart
What is the myocardium?
main muscle of the heart
what is the endocardium?
inner lining of the heart
what is the pericardial sac?
Double-layer sac covering the heart. prevents heart from rubbing against other organs or body structures.
lymphatic systems purpose is?
serves to collect excess fluid from the interstitial spaces and returns it to the heart
lymphatic vessels
transport lymph
Spleen
filters and destroys red blood cells that are no longer efficient
thymus
bi loved organ located in upper thorax and extends to lower neck.
• responsible for T-lymphocyte maturation, enabling them to function against specific pathogens in the immune response
tonsils
Partially encapsulated lymph nodules located in the pharynx.
the respiratory system includes:
nose, nasal cavity, pharynx, larynx, trachea, bronchi, lungs, and alveoli
Lungs
divided into lobes
right lung has 3 lobes
left lung has 2 lobes
urinary system structures
kidneys, ureters, urinary bladder, urethra
the eyeball has ___ layers
3
retina (innermost)
choroid (middle)
sclera (outermost)
adrenal glands
situated on each kidney
medulla - secretes epinephrine and norepinephrine
cortex - secretes several steroids
carotid body
A receptor in the common carotid artery sensitive to changing oxygen, carbon dioxide, and pH levels of the blood.
parathyroid gland
regulates calcium levels and phosphorus metabolism
pituitary gland (hypophysis cerebri)
approximately the size of a pea and located at the base of the brain. The pituitary is divided into two lobes. It is often referred to as the master gland because it produces hormones that stimulate the function of other endocrine glands
thymus gland
lymphoid organ in the mediastinum
regulates humoral immune functions
thyroid gland
regulates metabolism and serum calcium levels
Hematologic System
involves the blood
red cells, white cells, and platelets are produced in the marrow of the bone (especially the vertebrae, ribs, hips, skull, and sternum- and fight infection, carry oxygen, and help control bleeding)
what is the bodys primary defense against infection?
white blood cells, leukocytes
code first note
Instructs the coder to select a code to represent the etiology that caused the manifestation.
list etiology 1st and manifestation 2nd
eponym
a disease, structure, operation, or procedure named for the person who discovered or described it first
the main term is:
a term identifying disease or conditions
do not code a term when it is listed as: outpatient
probable, suspected, questionable, working, differential, consistent with, and rule out.
When a definitive diagnosis has not been determined: outpatient
Signs, symptoms, abnormal test results, and other reasons for the visit are acceptable for reporting purposes
true or false: in the inpatient settings report suspected or ruled out diagnoses as if the condition exists
true
which is sequenced first? acute or chronic
acute condition
confirmed cases of HIV should be coded to
Z21
treatment for HIV related illnesses should be coded to
B20
types of neoplasms excluded from the table of neoplasms
lipomas
melanomas
neuroendocrine tumors
Merkel cell carcinomas
for malignant neoplasms, code first
the site requiring care and then the other site
1st trimester of pregnancy
less than 14 weeks 0 days
2nd trimester of pregnancy
14 weeks to less than 28 weeks 0 days
3rd trimester of pregnancy
28 weeks until delivery
encounter for full term uncomplicated delivery is code
O80
when there are multiple burns, code:
code the deepest level of burn first
How to code poisoning
1. the first code is from the Table of Drugs and Chemicals identifies the drug
2. the second code indicates the conditions and manifestations that resulted from the poisoning
TRUE OR FALSE: codes for underdosing are NEVER used as the primary diagnosis?
True
MODIFIER 22 (Increased procedural services)
when the services provided is greater than usually required
MODIFIER 23 (unusual anesthesia)
when a procedure that usually requires local/no anesthesia must be performed under general anesthesia due to unusual circumstances
Modifier-26 Professional Component
use when the professional component is reported separately
Modifier -32 Mandated Services
mandatory consultation requested by insurance
MODIFIER 91 (repeat clinical diagnostic laboratory test)
used when its necessary to repeat the same lab test on the same day to obtain subsequent test results
autologous
Obtained from the patient
allograft
obtained from another human donor
xenograft
obtained from an animal
can external cause codes be a first listed diagnosis?
no
"articular" fracture refers to?
a movable joint
"extra-articular" fracture means?
the fracture does not does not extend into the joint
"intra-articular" fracture means?
the fracture extends into the joint
a bunion is AKA
hallux valgus deformity
the upper chambers of the heart are the?
atria
What do the atria do?
receive blood
the lower chambers of the heart are the?
ventricles
What do the ventricles do?
pump blood out of the heart [Show Less]