Coding Clinic - ANSWER-Valuable reference tool for coders that is published by AHA each quarter
CPT - ANSWER-Current Procedural Terminology
MS-DRGs
... [Show More] - ANSWER-Medicare Severity-Diagnosis Related Groups
CPT Assistant - ANSWER-Monthly publication by the AMA that provides coding advice for CPT coding scenarios
Encoder Nosology - ANSWER-Provides coding professionals from the encoder company that are available to help answer tough coding questions
History & Physical - ANSWER-Provides the initial chief complaint and initial impressions of the provider when the patient is first admitted. It also has a comprehensive physical review of the patient's body systems and vital signs, and provides the initial treatment plan, medications, and tests that are being ordered to treat the patient.
Progress Notes - ANSWER-Provide information about what is going on with the patient on a day-to-day basis; they should include the diagnoses that are being treated as well as any information about any changes in the patient's well-being and tests/procedures being performed.
Operative and Pathology Reports - ANSWER-Summarize the invasive procedures performed and any samples that are removed from the patient's body
Pathology report - ANSWER-Provides detailed information from the pathologist of the facility as to the status of the tissues or organs removed from the patient's body
Encoder - ANSWER-Specialty software used to facilitate the assignment of diagnostic and procedural codes according to the rules of the coding system
What is the value of utilizing coding software? - ANSWER-It facilitates accurate coding by providing links to coding resources, groups diagnosis and procedure codes to the correct MS-DRG, and provides edits with additional information for the coder to consider when placing codes into the encoder
Principal diagnosis - ANSWER-Diagnosis that, after study, is the reason for the patient's admission to the hospital.
Secondary diagnoses - ANSWER-Additional supporting information for the conditions the patient is being cared for
MCC - ANSWER-Major Complication or Comorbidity
CC - ANSWER-Complication or Comorbidity
CMI - ANSWER-Case Mix Index
LOS - ANSWER-Length of Stay
Complication - ANSWER-A condition arising during the hospital stay that prolongs the LOS by at least one day in approximately 75% of the cases
Comorbidity - ANSWER-A pre-existing condition which because of its presence with the principal diagnosis will increase the LOS by at least one day in 75% of the cases
Primary procedures - ANSWER-Procedure codes that best represent the procedure that has been performed
Secondary procedures - ANSWER-Do not typically impact the MS-DRG; however, they are important for capturing the details of the care the patient has received while in the hospital.
Coding conventions for ICD-10-CM - ANSWER-General rules for the use of the classification independent of the guidelines
Letter that ICD-10 utilizes as a placeholder for certain codes - ANSWER-X
Excludes1 - ANSWER-Indicates that the code excluded should never be used with the code above the Excludes1 note.
Excludes2 - ANSWER-Indicates that, when appropriate, it is acceptable to use both the code and the excluded code together.
Inclusion terms - ANSWER-List of terms that are included under some codes. They are the conditions for which the code should be used.
CMS - ANSWER-Centers for Medicare & Medicaid Services
Medicare patients are reimbursed by - ANSWER-MS-DRGs
Medicaid has it's rates set by - ANSWER-each individual state
PPS - ANSWER-Prospective Payment System
Prospective Payment System - ANSWER-Payment method based on a predetermined amount that results from a particular service
APR-DRG - ANSWER-All Patient Refined Diagnosis Related Groups
All Patient Refined DRGs - ANSWER-Incorporate severity of illness as a part of assigning DRGs to determine the complexity of the patient and the need for an increased utilization of resources as the patient moves to a higher level of severity of illness based on additional diagnoses.
APG - ANSWER-Ambulatory Patient Group
Ambulatory Patient Group - ANSWER-Provides fixed reimbursement to a facility for outpatient procedures or visits and includes data regarding the reason for the visit and patient data
Each individual MS-DRG has these components - ANSWER-title, geometric mean length of stay, arithmetic mean length of stay, relative weight, and ICD code range.
Formula used to calculate payment for a specific case - ANSWER-The hospital's payment rate per case X the weight of the MS-DRG to which the case is assigned = Payment
SOI - ANSWER-Severity of Illness
Severity of Illness - ANSWER-Extent of physiologic decomposition or organ system loss of function
ROM - ANSWER-Risk of Mortality
Risk of Mortality - ANSWER-The likelihood of dying
Levels of SOI and ROM - ANSWER-1=Minor, 2= Moderate, 3=Major, and 4= Extreme
OPPS - ANSWER-Hospital Outpatient Prospective Payment System
APCs - ANSWER-Ambulatory Payment Classifications
HH PPS - ANSWER-Home Health Prospective Payment System
OASIS - ANSWER-Outcome and Assessment Information Set
SNF PPS - ANSWER-Skilled Nursing Facility Prospective Payment System
MDS - ANSWER-Minimum Data Set
The Hospital Outpatient Prospective Payment System utilizes - ANSWER-Ambulatory Payment Classifications (APCs)
Home Health Prospective Payment System utilizes - ANSWER-A case-mix methodology based on data elements from OASIS
Skilled Nursing Facilitates Prospective Payment System utilizes - ANSWER-Minimum Data Set
Minimum Data Set - ANSWER-A standardized screening and assessment tool that gives a multidimensional view of the patients functional capability.
IRF PPS - ANSWER-Inpatient Rehabilitation Facility Prospective Payment System
Inpatient Rehabilitation Facility prospective payment system utilizes - ANSWER-The patient assessment instrument (PAI) to assign patients to case-mix groups according to their clinical status and resource requirements.
The final MS-DRG assignment is based on factors such as - ANSWER-Principal and secondary diagnoses, principal and secondary procedures, patient gender, and discharge status
Communication between the coders and the CDI specialist should be - ANSWER-Open and supportive
Level 1-CPT codes are maintained by - ANSWER-American Medical Association (AMA)
Level II National Codes are maintained by - ANSWER-CMS
The six sections within category one of Level 1 CPT are - ANSWER-Evaluation and Management, Anesthesia, Surgery, Radiology, Pathology/Laboratory, and Medicine
How many categories are under Level 1 CPT? - ANSWER-3
HCPCS - ANSWER- [Show Less]