Ch Medical Coding and Claims. A bill sent to the insurance carrier for payment related to patient care

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1 A bill sent to the insurance carrier for payment related to patient care A claim held or rejected by the insurance carrier due to problems or errors A coding system published by the US department of Health and Human Services to classify diseases and injuries. A condition that exists along with the condition for which the patient is receiving treatment and may increase patient s length of stay (LOS( if hospitalized A crosswalk between the ICD-9 and the ICD-10 A method developed by the Health Care Finance Administration for coding procedures and other services delivered to Medicare patients A neoplasm with invasive and metastatic properties A nonmalignant lesion that is not invasive or metastatic A pathologic reaction to a drug that occurs when appropriate doses are given A patient s statement describing symptoms and conditions that are the reason for seeking health care services

2 A person who has not received care from the physician or another physician of the same specialty in the same group practice within 3 or more years A person who has received care from the physician or another physician of the same specialty in the same group practice within 3 years A residual condition occurring after the acute phase is over A resort to a higher authority for a decision A supplementary classification of ICD-9 coding that denotes the external cause of an injury rather than a disease; explains the mechanism of injury; includes drug events such as poisonings and adverse effects A term used in ICD-9 coding for unspecified diagnosis A term used in ICD-9 coding when information is not available to code the term in a more specific category Also called an encounter form; a charge form custom-designed for the specific medical practice; lists the ICD-9 and CPT codes common to the services of that practice An unreasonable and generally unacceptable departure from precedent and custom with one person taking advantage of another person or set of circumstances; abuse may or may not be unlawful Billing for individual visits when not all the patients present during the visit received services

3 Billing for services or supplies not provided Billing for several visits when services were performed during one visit Coding system first published by the American Medical Association in 1966; a manual, updated annually, that contains the codes for procedures and services performed by doctors and other select medical personnel Completed insurance claim form submitted to a carrier without deficiencies or errors Deliberately using an incorrect code to bill at a higher rate Diagnostic coding system developed for use in the US by the CDC; consists of three to seven alphanumeric digits Discussion with patient or family concerning diagnosis, recommendations, risks, benefits, prognosis, options, and necessary conditions-related education; definition used for the coding of professional services Facility where the health care service took place (e.g., physician s office, emergency dept) ICD-9 codes identifying health care visits for reasons other than illness Intensive care in acute life-threatening conditions requiring constant bedside attention by the physician; definition used for the coding of professional services

4 Intentional and unlawful deception for gain that results in harm to another person or organization Neoplasm confined to the site of origin Procedural coding system developed for use in the US by the CDC; consists of seven alphanumeric digits Scheduling the patient for unnecessary follow-up visits Services rendered by a physician whose opinion or advice ins requested by another physician or agency in the evaluation or treatment of a patient s illness or suspected problem Similar services provided to the same patient on the same day by a different physician The cause of disease The definitive diagnosis, obtained generally through hospitalization The name of a disease or procedure derived from the name of a place or person The symptoms, conditions, and initial impressions diagnosed as the cause for the patient seeking health care services

5 Universal health insurance claim form used in the physician s office, originally designed Unnecessary or excessive referrals of patients to other providers and back to primary office Using several CPT codes to identify procedures normally covered by a single code

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