Health insurance today chapter 14
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Health insurance today chapter 14
14.1
1.
A recognized process of transforming descriptions of a patient’s disease process, disorder, or injury into universal numerical or alphanumerical formats is referred to as: codes
2.
The reason (sore throat or chest pain) that brings a patient to the healthcare facility Is commonly referred to as a(n): diagnosis
3.
The first ICD system (ICD-1) was put into use in: 1900
4.
Diagnosis codes in the outdated ICD-9-CM system consisted of ____
3-5_____ digits or characters.
5.
Diagnosis codes in the ICD-10-CM system consist of ____
3-7___ digits or characters.
6.
Diagnosis codes in the ICD-10 lists all diagnostic terms:
7.
Which of these is not a covered entity as defined by HIPPA rules? A covered entity under the HIPPA privacy rule refers to health plans, healthcare clearinghouses, and healthcare providers that transmit health information electronically
8.
Part III (Tabular List of Diseases and Injuries) of the ICD-10-CM coding manual is composed of ____
21____ chapters.
9.
Common uses of coding include all of these except: • Measuring the quality, safety, and effectiveness of care
• Designing payment systems and processing claims for reimbursement
• Conducting research, epidemiological studies, and clinical trials
• Setting healthcare policies
• Facilitating operational and strategic planning and the designing of healthcare delivery systems
• Monitoring resource use
• Improving clinical, financial, and administrative performance
• Preventing and detecting healthcare fraud and abuse
• Tracking public concerns and assessing the risks of adverse public health events
10.
Valid reasons for converting to the ICD-10-CM system include all except: a single code can report a disease and its current manifestation (signs and symptoms). Differentiates various outcomes with 7
th
character, laterality, ICD-9 running out of available codes, use of full code titles reflecting advances in medical knowledge, 11.
In the current diagnostic coding system, the manual used for coding inpatient procedures is: ICD-10-PCS
12.
Diagnosis codes in ICD-10-CM are used in: physicians’ offices and outpatient settings
13.
In fracture care, a seventh character A indicates: initial encounter
14.
After the diagnosis has been determined, the ___
main term____ in the diagnosis should be identified.
15.
When diseases, procedures, or syndromes are named after the individual who discovered or first used them, they are commonly referred to as: eponym
16.
Identify the main term in the diagnosis of premature atrial contraction (PAC): contraction
17.
Some categories, mainly those to notes liking them with other categories, require multiple indexing steps. To avoid repeating multiple steps for each of the additional terms involved, a ___
cross-reference_____ is used.
18.
After the provisional code is located in the ____
Index_____, the coder should verify the code by locating it in the ____
Tabular list_______ to ensure that the diagnosis has been coded to the optimal specificity.
19.
Codes are arranged in the tabular list and divided into chapters based on ___
body system or condition (anatomic site, or etiology) ______.
20.
In ICD-10 diagnostic coding, the letter “x”: placeholder
21.
The index to diseases in the ICD-10-CM coding manual is organized: alphabetically 22.
Diseases, procedures, or syndromes named for individuals who discovered or first used them are called: eponym
23.
Essential modifiers describe: different sites, the etiology, and clinical types
24.
Terms enclosed in parentheses after main terms are called: nonessential modifiers
25.
If a patient’s condition has not been specifically diagnosed, the health insurance professional must code the: signs and symptoms 26.
Which of these is considered a “main term”
27.
The ___
default____ code represents the condition that is most commonly associated with the main term or is the unspecified code for the condition.
28.
The main term for acute depressive reaction is:
29.
In the ICD-10-CM system, all letters of the alphabet are used except: U
30.
When a term has many modifiers that might be listed beneath more than one term, what cross reference is used? See also
31.
In most ICD-10-CM manuals, main terms in the index appear in: boldface type
32.
The “placeholder character” in ICD-10-CM utilizes the: “x”
33.
In ICD, rules and guidelines used in coding are commonly referred to as: conventions
34.
Identify the symbol that typically is used in the tabular list when an addition digit (or digits) is needed to code a diagnosis to its greatest specificity: (-)
35.
Which of these are not used in ICD-10-CM?
36.
NEC in the ICD-10-CM system represents: not elsewhere classified 37.
In ICD-10, when a code appears with a Type 1 Excludes not, it means: use a different code 38.
In medicine, _____
manifestation______ is a sign or symptom of a disease.
39.
A ____
combination____ code is a single code used to classify two diagnoses or a diagnosis with an associated secondary process (manifestation).
40.
In medicine, the study of the form and structure or organisms and their specific structural features is: morphology
41.
A code listed next to a main term in the ICD-10-CM index is referred to as a: Default code
42.
Sequelae are the ____
late effects__ of injury or illness.
43.
Which character in an ICD-10-CM code indicates laterality for bilateral sites? 6
th
44.
The coder should always begin the search for the correct code assignment in the: Index
45.
Examples of adverse effects include all of these except: Tachycardia, gastrointestinal hemorrhaging, vomiting, hypokalemia, respiratory failure.
46.
Under HIPPA, a ___
code set___ is any set of codes used for encoding data elements, such as tables of terms, medical concepts, or medical diagnosis codes.
47.
What must be coded if a patient’s condition has not been specifically diagnosed? Signs and or symptoms that brought the patient to the healthcare facility
48.
Identify what must be coded first if the patient’s diagnosis is diabetic ulcer of the heel:
49.
If a patient has both scarlet fever and strep throat:
50.
Which of these is not considered a code set by HIPPA rules? HCPCS, CPT, CDT, ICD-10, NDC
14.2 True/False
1.
A diagnosis should never be coded from the alphabetic list alone. True
2.
A diagnosis must be determined by the healthcare professional providing the medical care. True
3.
When the healthcare insurance professional generates an insurance claim for payment of the provider’s services, the written diagnosis must appear on the claim. False
4.
The US healthcare system currently uses six major coding structures. False
5.
A covered entity under the HIPPA privacy rule refers to health plans, healthcare clearinghouses, and healthcare providers that transmit health information electronically.
True
6.
One of the primary concerns with the former ICD-9 system was the lack of specificity expressed in the codes. True
7.
All publishers must format and arrange the ICD-10 codes identically. False
8.
The tabular list lists all diagnostic codes in alphanumerical order. True
9.
Anatomic sites are often listed as main terms in ICD-10-CM False
10.
Essential modifiers must be a part of the diagnosis documented in the health record. True
11.
Nonessential modifiers frequently are not a part of the diagnostic statement but are provided to assist the coder in locating the correct code. True
12.
Main terms cannot be anatomic sites. True
13.
If a patient has a diagnosis of deviated nasal septum, the main term is nasal. False
14.
See or see also tells the coder to continue the search under another main term. True
15.
The alphabetic index to disease contains a hypertension table and a neoplasm table. False
16.
In the tabular list, a bullet symbol preceding the code indicates the code is no longer in use. False
17.
The table of drugs and chemicals contains a classification of drugs and other chemicals substances to identify poisoning states and external causes of adverse effects. True
18.
In ICD-10, an unspecified side code should be used if laterality is not identified in the diagnostic statement. True
19.
In ICD-10-CM, any poisoning that was intentional is classified as “poisoning, intentional, self-harm”. True
20.
Bold type is used in ICD-10 for all exclusion notes and to identify codes that should not be used for describing the first listed diagnosis. False
21.
When the notation “code first underlying disease” is seen, the etiology is coded before the manifestation. True
22.
Colons are used in the tabular list after an incomplete term that needs one or more of the (non or essential) modifiers after the colon to make it assignable to a given category. True
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23.
ICD-10-CM codes may consist of up to seven characters, with the seventh character extensions representing visit encounter or sequela for injuries and external causes. True
24.
The first character of an ICD-10-CM code is always an alphabetic letter. True
25.
All alpha characters in the ICD-10-CM coding system are case sensitive. False
26.
In ICD-10-CM, codes longer than three characters always have a decimal point after the first three characters. True
27.
Categories of injuries are arranged alphabetically under the main term “injury” rather than by type of injury, such as dislocation. True
28.
Indented subterms are never used in combination with the main term. False
29.
In ICD-10-CM, if a code has only three characters, the coder can generally assume that the category has not been further subdivided. True
30.
If a code that requires a seventh character is not six characters long, the placeholder “x” must be used to fill the empty characters. True
14.3
1.
Define diagnosis in your own words. What is going on with the patient, the reason they came to the healthcare facility
2.
ICD-10-CM stands for International Classification of Diseases, 10
th
revision, Clinical modification
3.
Provide a brief explanation of the diagnostic coding process.
4.
Explain where the diagnosis can be found in the patient’s record. Clinical notes, laboratory tests, radiological results, and other sources.
5.
List the seven essential steps to ICD-10 diagnostic coding. Locate the diagnosis in the health record, determine the main term of the stated diagnosis, find the main term in the index, read and apply any notes, scan the main term entry for any modifiers or cross-referencing, locate code in tabular, ensure code is to its fullest numerical value.
6.
Why is it important for the health insurance professional to use the most recent diagnostic coding manual? Because they are updated so frequently to assure that documentation is accurate and full
7.
List the four ways main terms appear in the alphabetic index to disease, and give an example of each.
8.
The first character in an ICD-10-CM diagnosis code is always a(n) ___
alphabetic letter____, and all letters of the alphabet are used except the letter ___
U____.
9.
The second section of the ICD-10-CM manual is the tabular list. Explain what this section contains and how the information is arranged
. 21 chapters containing a list of codes arranged alphanumerically and divided into chapters based on body system or condition
10.
The ICD-10-CM, if no bilateral code is provided and the condition is bilateral, what should the coder do? Code both left and right codes
11.
Explain the two uses of the “placeholder” character in ICD-10 coding: used in certain codes to allow for future expansion and to fill out empty characters when a code contains fewer than six characters and a 7
th
character applies.
12.
Explain the difference between etiology and manifestation. Etiology is the cause or origin of a disease or condition. Manifestation is signs and symptoms of a disease.
14.4 Main terms, ICD codes, Explain conventions and Symbols
1.
Breast mass mass
2.
Deviated nasal septum deviated
3.
Heel spurs spurs
4.
Excessive eye strain strain
5.
Tension headache headache
6.
Bronchial croup croup
7.
Senile cataract cataract
8.
Paranoid delusions Paranoid
9.
Acute hemorrhagic otitis media with effusion otitis
10.
Coronary insufficiency insufficiency
11.
Angina pectoris, unspecified, ____
angina_____: ICD-10 code: I20.9
12.
Asthma, unspecified (uncomplicated), _____
asthma_____: ICD-10 code: J45.909
13.
Excessive and frequent menstruation w/ irregular cycle, ____
menstruation_____: ICD-10 code: N92.1
14.
Parkinson disease, ____
disease______: ICD-10 code: G20.A1
15.
Urethral abscess, _____
abscess____: ICD-10 code: N34.0
16.
NOS: (
not otherwise specified) unspecified, a more specific code is unavailable
17.
NEC: (
not elsewhere classifiable) “other specified”
18.
– (dash): indicate that the code is incomplete used in index and tabular
19.
.- (point dash): indicate that the code is incomplete in the tabular 20. AND: narrative statement, represents and/or
21. With: sequenced immediately after the main term, not in alphabetic order 22.
Other and other specified: used when the information in the medical record provides detail for which a specific code does not exist has an 8 as the 4
th
character.
23. Unspecified: used when info in med record is insufficient to assign a more specific code. (usually has a 4
th
digit 9 or 5
th
digit 0)
24.
Code first: sequence first etiology
25.
Code also: two code may be required to describe the condition fully
26. Incudes: appears immediately under a three-digit code title to define further, or give examples of, the content of the category
27.
Excludes: ____
two types____, Excludes 1: _____
not coded here________, Excludes 2:______
not included here______
28.
Use additional code: when a manifestation code and an etiology code need to be used
29.
Code first underlying disease: etiology code first before manifestation code
14.5
1.
Hypertension, essential, benign: ______
hypertension______, ICD-10: I10
2.
Shortness of breath, chest discomfort, nausea, and profuse sweating ICD-10:
3.
Health maintenance examination, 51 year old mail:___________, ICD-10: __________, Tobacco dependence:__________, ICD-10:___________, Gastroesophageal reflux disease: ___________, ICD-10:___________, arthritis of spine (degenerative):_________, ICD-
10:____________.
4.
D. archie Simpson, a 14-year-old boy, presents to the clinic with an insect bite to the right hand, etiology unknown. What is the correct ICD-10-CM codes? (2)
5.
E. Katie Oliver, a 6 year old, comes to the clinic with complaints of fever of 101.5F, chills, sweats, mild earache, stuffy nose, sinus pain and pressure, an episodic cough that is worse in
the evening, wheezing, and dyspnea that started approximately 5 days ago. The diagnosis documented in Katie’s health record is acute upper respiratory infection with mild sinusitis, possibly allergy related. How many diagnostic codes would you list on the claim form?
6.
David Scott presented to the clinic as a new patient on 08/05/20XX. The documentation in his health record states a diagnosis of ulcer of the left midfoot on this first visit. _____________. Over the next 2 years, Mr. Scott continues to come to the clinic for follow up visits for treatment of his foot ulcer, which tends to heal and then recure. Would the ICD-
10-CM code be the same for this patient follow up visit 2 years later? ________________. If not, what is the correct ICD-10 code for this follow up visit? _________.
7.
Marcie Emerson, a 22 year old female, presents to the clinic with chief complaint of sore throat, mild discomfort with swallowing, hoarseness in her voice, nasal congestion with a greenish nasal discharge, and slight postnasal dyspnea. That patient is afebrile. Impression: Acute pharyngitis. How many diagnosis codes are needed for this patient’s claim form? __________. State the diagnosis(es): ____________. Using the steps learned form the text, assign the correct ICD-10 code(s). _______________
14.6
1.
Acute gastritis without bleeding K29.00
2.
Right upper quadrant abdominal tenderness R10.811
3.
Foreign body in left ear T16.2xxA
4.
Chronic hypertrophy of tonsils and adenoids J35.3
5.
Fibrocystic disease of breast (female) N60.19
6.
Acute suppurative mastoiditis with sub periosteal abscess H70.019
7.
Recurrent direct left inguinal hernia with gangrene K40.41
8.
Acute upper respiratory infection with influenza J11.1
9.
Benign cyst of right breast N60.01
10.
Bunion of right great toe M20.5X1
11.
Nondisplaced abduction fracture anterior acetabulum, subsequent encounter with routine healing S32.449D
12.
Bronchiectasis with acute bronchitis J47.0
13.
Acute bleeding peptic ulcer K27.0
14.
Influenza with gastroenteritis J11.2
15.
Acute cholecystitis with cholelithiasis and choledocholithiasis K80.63
16.
Meningitis due to salmonella infection A02.21
17.
Dysphagia following unspecified cerebrovascular disease I69.991
18.
Alcohol abuse with alcohol-induced sleep disorder F10.182
19.
Displacement of heart valve prosthesis, initial encounter T82.02XA
20.
Intraoperative hemorrhage and hematoma of spleen complicating a procedure on the spleen
D78.01
21.
Arteriosclerotic heart disease of native coronary artery w/ unstable angina pectoris I25.110
22.
Crohn’s disease of small intestine with fistula K50.013
23.
Toxic liver disease with chronic active hepatitis with ascites K71.51
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24.
Poisoning by aspirin, accidental (unintentional) T39.011A
25.
Poisoning by aspirin, intentional self-harm T39.012A
14.7
1.
Poisoning by aspirin, undetermined T39.014A
2.
Malignant neoplasm of upper inner quadrant of left female breast C50.212
3.
Dermatochalasis of left lower eyelid H02.835
4.
Phlebitis and thrombophlebitis of superficial vessels of right lower extremity I80.01
5.
Webbed fingers, bilateral Q70.13
6.
Pressure ulcer of right hip, stage III L89.213
7.
Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene E09.52
8.
Perforation due to foreign body accidently left in body after surgical operation T81.530A
9.
Laceration with foreign body of abdominal wall, right lower quadrant, with penetration into peritoneal cavity, initial encounter S31.623A
10.
Displaced transverse fracture of shaft of humerus, right arm, initial encounter for closed fracture S42.321A
11.
Bilateral inguinal hernia, with obstruction, without gangrene, recurrent K40.01
12.
Difficulty in walking, NEC R26.2
13.
Pain, unspecified R52
14.
Flaccid hemiplegia due to old cerebral infarction I69.359
15.
Residuals of previous severe burn, left wrist T23.072S
16. Palpitations R00.2
17.
Cocaine dependence, uncomplicated F14.20
18.
Right upper quadrant pain R10.11
19.
Anorexia nervosa, unspecified F50.00
20.
Calculus of kidney N20.0
21. Presbyopia H52.4
22.
Type 1 diabetes mellitus without complication E10.9
23.
Mitral stenosis, congenital Q23.2
24.
Chronic obstructive pulmonary disease with acute exacerbation J44.1
25. Dehydration E86.0
14.8
1.
Locate and identify subterms main terms category subcategory code placements in the manual
14.9 identify main term and ICD-10 code
1.
Allergy to eggs Z91.012
2.
Family history of asthma Z82.5
3.
Supervision of high risk pregnancy w/ history of infertility O09.00
4.
Routine health checkup (18 y/o male) Z00.00
5.
Dietary counseling and surveillance Z71.3
6.
HIV screening Z11.4
7.
Injury sustained by a pedestrian hit by a car (initial encounter) V03.90XA
8.
Patient injury due to fall from a snowmobile (driver)(subsequent encounter) V86.52XD
9.
Injury sustained due to (rider) being thrown from a horse (sequelae) V80.010S
10.
Diabetes mellitus screening in asymptomatic patient Z13.1
11.
Urinary incontinence R32
12.
Vesicovaginal fistula N82.0
13.
Carcinoma in situ of prostate D07.5
14.
Gastric ulcer w/o perforation or bleeding K25.3
15.
Hypertension, benign essential I10
16.
Rectal polyp K62.1
17.
Acute tonsillitis J03.90
18.
Acute cephalgia G44.001
19.
Nasal laceration w/o foreign body (first visit) S01.21XA
20.
Deviated septum J34.2
21. Drowsiness R40.0
22.
Low self-esteem R45.81
23.
Fever w/ chills R50.9
24.
Elevated blood glucose level R73
25. Anorexia R63.0
26.
Severe sepsis w/ septic shock R65.21
27.
Heart murmur R01.1
28. Aphagia R13.0
29. Petechiae R23.3
30.
Facial droop R29.810