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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.

What is morbidity?

Deaths.

What information is contained in the introductory pages of the ICD-9 book?

Basic foundation for coding guidelines.

What is an eponym?

Disease, procedure, or syndrome.

What is an essential modifier?

Main terms describing different sites.

How are non essential modifiers written?

In parenthesis.

What is in Section 2 Volume 2 of ICD-9?

Table of drugs and chemicals.

What are E codes?

Codes used for coding external causes.

How would you look up: Acute depressive reaction?

By the action word, which in this case is "reaction."

In what style are main terms typed?

In bold face.

What does ICD-9-CM stand for?

ICD - International Classification of Disease and Diagnosis


9 - 9th Edition


CM - Clinical Modification

What kind of diagnosis do doctors and hospitals use?

-Doctors use primary diagnosis.


-Hospitals use principal diagnosis.

How often is ICD updated?

Annually.

What are the two tables that are in the disease section?

-Neoplasms


-Hypertension

What are the three major tabular lists?

-Drugs and chemicals


-Neoplasms


-Hypertension

What codes are used for external causes?

E codes.

How does the chain of command go for ICD?

-Categories


-Subcategories


-Sub classifications

What are V codes?

Codes used for well visits/office visits, probable causes and vaccinations.

What happens if there is no code given for a patient's diagnosis?

It will be coded based on signs and symptoms.

What do you call two or more diagnoses that are related?

Combination codes.

Who administers Medicare and Medicaid?

CMS (Centers for Medicare and Medicaid Services)

What are people who fall below the Federal Poverty Level (FPL) considered?

Categorically needy.

What would you call a Medicaid claim with no other insurance?

Medicaid simple claim.

What is Medicare?

A program for individuals ages 65 years or older, disabled or have ESRD.

What is FICA?

[Federal Insurance Contribution Act]


Deductions that provides money to the elderly, disabled and survivors.

What are the four parts of Medicare?

Part A - Hospital Insurance


Part B - Physician visits Insurance


Part C - Supplemental Insurance


Part D - Prescription Insurance

When does the benefit period begin for Medicare Part A?

Begins at the time that the patient is eligible.

In what year was Medicare Part D available?

2006

What type of payer is Medicaid?

Secondary payer. Even with Medicare, Medicaid is always going to be the secondary payer.

What can a doctor do if he/she is not satisfied with a reimbursement?

The doctor may file an appeal.

How many levels of appeals are there?

Five.

What is EFT?

[Electronic Funds Transfer]


Medicare can use direct deposit to the doctor's accounts.

What is CLIA?

[Clinical Laboratory Improvement Act]


Used for lab testing.

What is TANF?

A cash assistance program.

What established the Medicaid program?

The Social Security Act.

What is SSI?

Supplemental Security Income for the qualifying aged and the disabled poor.


Do Medicaid and the 50 states have categorically needy citizens?

Yes.

What is one way to check for Medicaid eligibility?

AVR [Automated Voice Recognition]

What is the filing limit for Medicaid?

1 year.

What is third party liability?

When someone else is responsible for your bill.

Is Medicaid always the last payer?

Yup.

What happened to Managed Care Organizations (MCO) in 1999?

It evolved.