Mod H Unit 2 Terminology & Theory

Front 1

Primary Diagnoses

Back 1

what a physician and outpatient clinic use

Front 2

Principal Diagnosis

Back 2

used by hospitals and institutional facilities

Front 3

"CM" in ICD-9 CM, stands for

Back 3

Clinical modification

Front 4

2 tables in the Alphabetic Index to Disease

Back 4

Hypertension and Neoplasm

Front 5

3 types of codes in Volume 1 of the ICD-9

Back 5

3 digit category, 4 digit subcategory, 5 digit subclassification, however NOT 5 digit manifistation codes

Front 6

Appeal

Back 6

may be filed by a beneficiary who is not satisfied with a reimbursement

Front 7

AVR system

Back 7

common method for verifying Medicaid eligibility

Front 8

Benefit period

Back 8

period of time a Medicare beneficiary is eligible for part A benefits for inpatient hospital

Front 9

Categorically Needy

Back 9

eligible in all states for Medicaid assistance

Front 10

Categorically Needy

Back 10

receive medical assistancebecause their income falls within poverty of FPL guidelines or SSI

Front 11

Boldface typeface

Back 11

used for main terms in Volume 2

Front 12

CLIA

Back 12

estabilished quality standards for all laboratory testing to ensure safety, accuracy, reliability and timeliness

Front 13

CMS

Back 13

administers the Medicaid program

Front 14

coding

Back 14

transforming verbal descriptions of a diagnosis into numbers or alphanumeric characters

Front 15

color coding

Back 15

used in Volume 1 of the ICD-9 -CM manual to alert for special edits and important issues

Front 16

Combination codes

Back 16

assigned when more than one otherwise individually classified disease is combinmed with another

Front 17

Diagnosis

Back 17

presence of an illness or disease and the art of distinguishing one disease from another

Front 18

Diagnosis

Back 18

the determination of the nature of the cause of the disease

Front 19

Diagnostic Services

Back 19

qualifies under federal ly approved optional services for federal funding

Front 20

E Codes

Back 20

represent external causes of injury and poisoning

Front 21

Electroni Funds Transfer

Back 21

Can be used to automatically deposit Medicare payments into a providers bank account

Front 22

Eponym

Back 22

Disease, procedure, or syndrome named for the individuals who discovered them

Front 23

Essential modifiers

Back 23

Modifies main terms describing different sites, the cause or origin of disease, and different clinical types

Front 24

FICA

Back 24

act that provides for a federal system of old age, survivors, disability,a nd hospital insurance

Front 25

Filing medicaid claims

Back 25

time limit is variable by state

Front 26

How many parts to the medicare program

Back 26

four

Front 27

ICD-9 introductory pages

Back 27

serves as a basic foundation for diagnostic coding and aods in assigning codes correctly

Front 28

ICD-9, section 2 and volume 2

Back 28

table of drugs and chemicals

Front 29

if a code has instructions to "use additional code to identify"

Back 29

then an additional code should be used for better clarification

Front 30

if no specific diagnosis for a patient

Back 30

must code for signs and symptoms

Front 31

In acute depressive reaction

Back 31

the main term is reaction

Front 32

Managed care organization

Back 32

included in private plans due to the balanced budget act of 1997

Front 33

Medicaid

Back 33

is always the last payer of resort

Front 34

Medicaid

Back 34

Not an insurance that is typically primary to Medicare

Front 35

Medicaid Simple Claim

Back 35

Submitted when a Medicaid beneficiary has no other health care coverage

Front 36

Medicare appeals process

Back 36

has five levels

Front 37

Medicare

Back 37

federal insurance program for people 65 years and older, established in 1699

Front 38

Medicare Part D begin in

Back 38

2006

Front 39

Mortality

Back 39

the deaths that occur from disease

Front 40

nonessential modifiers

Back 40

terms in parentheses following the main terms

Front 41

Part B Medicare

Back 41

helps pay for physician and outpatient charges

Front 42

Part D of Medicare

Back 42

helps pay for prescription drugs

Front 43

Social security act

Back 43

federal act that established Medicaid

Front 44

SSi program

Back 44

Provides assistance to the aged and disabled poor

Front 45

Table of drugs and chemicals

Back 45

list external causes of adverse effects resulting from ingestion or exposure to drugs or other chemicals

Front 46

TANF

Back 46

federal state cash assistance program for poor families, typically headed by a single parent

Front 47

Third party liability

Back 47

legal obligation of other insurance policies to pay all or part of the expenditures for medicaid patients

Front 48

updated ICD-9 is published

Back 48

annually

Front 49

V code

Back 49

needed for after care, examinations, and problem with

Front 50

v codes

Back 50

for when an individual who is not sick visits a medical facility for a specific purpose (such as a vaccination)