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42 Cards in this Set
- Front
- Back
Define diagnosis. |
-Determination of the cause. -Being able to tell one disease to another. |
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What is morbidity? |
Deaths. |
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What information is contained in the introductory pages of the ICD-9 book? |
Basic foundation for coding guidelines. |
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What is an eponym? |
Disease, procedure, or syndrome. |
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What is an essential modifier? |
Main terms describing different sites. |
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How are non essential modifiers written? |
In parenthesis. |
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What is in Section 2 Volume 2 of ICD-9? |
Table of drugs and chemicals. |
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What are E codes? |
Codes used for coding external causes. |
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How would you look up: Acute depressive reaction? |
By the action word, which in this case is "reaction." |
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In what style are main terms typed? |
In bold face. |
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What does ICD-9-CM stand for? |
ICD - International Classification of Disease and Diagnosis 9 - 9th Edition CM - Clinical Modification |
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What kind of diagnosis do doctors and hospitals use? |
-Doctors use primary diagnosis. -Hospitals use principal diagnosis. |
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How often is ICD updated? |
Annually. |
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What are the two tables that are in the disease section? |
-Neoplasms -Hypertension |
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What are the three major tabular lists? |
-Drugs and chemicals -Neoplasms -Hypertension |
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What codes are used for external causes? |
E codes. |
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How does the chain of command go for ICD? |
-Categories -Subcategories -Sub classifications |
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What are V codes? |
Codes used for well visits/office visits, probable causes and vaccinations. |
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What happens if there is no code given for a patient's diagnosis? |
It will be coded based on signs and symptoms. |
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What do you call two or more diagnoses that are related? |
Combination codes. |
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Who administers Medicare and Medicaid? |
CMS (Centers for Medicare and Medicaid Services) |
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What are people who fall below the Federal Poverty Level (FPL) considered? |
Categorically needy. |
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What would you call a Medicaid claim with no other insurance? |
Medicaid simple claim. |
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What is Medicare? |
A program for individuals ages 65 years or older, disabled or have ESRD. |
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What is FICA? |
[Federal Insurance Contribution Act] Deductions that provides money to the elderly, disabled and survivors. |
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What are the four parts of Medicare? |
Part A - Hospital Insurance Part B - Physician visits Insurance Part C - Supplemental Insurance Part D - Prescription Insurance |
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When does the benefit period begin for Medicare Part A? |
Begins at the time that the patient is eligible. |
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In what year was Medicare Part D available? |
2006 |
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What type of payer is Medicaid? |
Secondary payer. Even with Medicare, Medicaid is always going to be the secondary payer. |
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What can a doctor do if he/she is not satisfied with a reimbursement? |
The doctor may file an appeal. |
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How many levels of appeals are there? |
Five. |
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What is EFT? |
[Electronic Funds Transfer] Medicare can use direct deposit to the doctor's accounts. |
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What is CLIA? |
[Clinical Laboratory Improvement Act] Used for lab testing. |
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What is TANF? |
A cash assistance program. |
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What established the Medicaid program? |
The Social Security Act. |
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What is SSI? |
Supplemental Security Income for the qualifying aged and the disabled poor.
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Do Medicaid and the 50 states have categorically needy citizens? |
Yes. |
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What is one way to check for Medicaid eligibility? |
AVR [Automated Voice Recognition] |
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What is the filing limit for Medicaid? |
1 year. |
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What is third party liability? |
When someone else is responsible for your bill. |
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Is Medicaid always the last payer? |
Yup. |
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What happened to Managed Care Organizations (MCO) in 1999? |
It evolved. |