Ch 10 Key Terms POHR
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Austin Community College District *
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Course
1345
Subject
Health Science
Date
Feb 20, 2024
Type
Pages
3
Uploaded by esinamharriet
1.
AHA Coding Clinic for HCPCS: Newsletter that provides official coding guidance
for users of Healthcare Common Procedure Coding System (HCPCS) Level II
procedure, service, and supply codes.
2.
AHA Coding Clinic for ICD-10-CM and ICD-10-PCS: A publication issued
quarterly by the American Hospital Association and approved by the Centers for
Medicare and Medicaid Services (CMS) to give coding advice and direction for
International Classification of Diseases, Tenth Revision, Clinical Modification
(ICD-10-CM) and International Classification of Diseases, Tenth Revision,
Procedure Coding System (ICD-10-PCS).
3.
Category I CPT code: A Current Procedural Terminology CPT code that
represents a procedure or service that is consistent with contemporary medical
practice and that is performed by many physicians in clinical practice in multiple
locations.
4.
Category II CPT code: A Current Procedural Terminology (CPT) code that
represents services or test results contributing to positive health outcomes and
high-quality patient care.
5.
Category III CPT code: A Current Procedural Terminology (CPT) code that
represents emerging technologies for which a Category I code has yet to be
established.
6.
Charge: Price assigned to a unit of medical or health service, such as a visit to a
physician or a day in a hospital.
7.
Charge capture: The accounting for all reportable services and supplies rendered
to a patient.
8.
Charge code: Hospital-specific internally assigned code used to identify an item
or service within the charge description master. Alternative terms are service
code, charge description number, item code, or charge identifier.
9.
Charge description: Hospital-specific explanatory phrase that is assigned to
describe a procedure, service, or supply in the charge description master.
10. Charge description master (CDM): Data table used by healthcare facilities to
manage required billing elements for all services provided to patients.
11. Charge status indicator: Identifier used to indicate whether a charge description
master line item charge is currently active or inactive
12. Classification system: (1) A system for grouping similar diseases and procedures
and organizing related information for easy retrieval. (2) A system for assigning
numeric or alphanumeric code numbers to represent specific diseases and
procedures.
13. CPT Assistant: Official monthly newsletter for Current Procedural Terminology
(CPT) coding issues and guidance.
14. Current Procedural Terminology (CPT): Coding system created and maintained
by the American Medical Association that is used to report diagnostic and
surgical services and procedures.
15. Department code: Hospital-specific number that is assigned to each clinical or
ancillary department that provides services to patients and has at least one
charge item in the charge description master. Alternative terminology for this data
element is general ledger number.
16. Hard coding: Use of the charge description master to code repetitive or non
complex services.
17. Health Insurance Portability and Accountability Act of 1996 (HIPAA): Significant
piece of legislation aimed at improving healthcare data transmission among
providers and insurers; designated code sets to be used for electronic
transmission of claims.
18. Healthcare Common Procedure Coding System (HCPCS): Coding system
created and maintained by the Centers for Medicare and Medicaid Services
(CMS) that provides codes for procedures, services, and supplies not
represented by a Current Procedural Terminology (CPT) code.
19. HCPCS code: A code that is part of the Healthcare Common Procedure Coding
System.
20. ICD-10-CM/PCS Coordination and Maintenance Committee: Committee
composed of representatives from the National Center for Health Statistics
(NCHS) and the Centers for Medicare and Medicaid Services (CMS) that is
responsible for maintaining the US clinical modification version of the
International Classification of Diseases, Tenth Revision, Clinical Modification.
21. International Classification of Diseases, Tenth Revision, Clinical Modification
(ICD-10-CM): Coding and classification system used to report diagnoses in all
healthcare settings.
22. International Classification of Diseases, Tenth Revision, Procedure Coding
System (ICD-10-PCS): Coding and classification system used to report inpatient
procedures and services.
23. Line item: Individual line of a charge description master that includes all the
required data elements, such as charge code, description, revenue code, and
charge.
24. Medicare Claims Processing Manual: Online publication that provides guidance
for producing claims for all healthcare settings. Includes billing regulations, as
well as service area-specific requirements.
25. Modifier: Two-digit alpha, alphanumeric, or numeric code that provides the
means by which a physician or facility can indicate that a service provided to the
patient has been altered by some special circumstance(s), but for which the basic
code description itself has not changed.
26. National Center for Health Statistics (NCHS): Organization that developed the
clinical modification to the International Classification of Diseases, Tenth Revision
(ICD-10); responsible for maintaining and updating the diagnosis portion of the
International Classification of Diseases, Tenth revision, Clinical Modification
(ICD-10-CM).
27. Payer identifier: Code that is used in the charge description master to
differentiate among payers that have specific or special billing protocol in place.
28. Revenue code: Four-digit billing code that categorizes charges based on type of
service, supply, procedure, or location of service.
29. Single path coding: Process where one coding professional assigns the codes
required for both facility and professional claims during the same coding session.
30. Soft coding: Process in which all diagnoses and procedures are identified,
coded, and then abstracted into the HIM coding system.
31. World Health Organization (WHO): Organization that created and maintains the
International Classification of Diseases (ICD) used throughout the world to collect
morbidity and mortality information.
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