Medical Insurance: An Integrated Claims Process: Medical Insurance Chap. 4 Flashcards


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1

ICD-10-CM

HIPAA-mandated diagnosis code set as of October 1, 2014

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code

three- to seven-character alphanumeric representation of a disease or condition

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Alphabetical indexes

part of the ICD-10-CM listing diseases and injuries alphabetically with corresponding diagnosis codes

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Tabular List

part of the ICD-10-CM listing diagnosis codes in chapters alphanumerically

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Neoplasm Table

summary table of code numbers for neoplasms by anatomical site and divided by the description of the neoplasm

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Table of Drugs and Chemicals

index in a table format of drugs and chemicals that are listed in the Tabular List

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Index of External Causes

index of all external causes of disease and injuries classified in the Tabular List

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diagnosis statement

physician's description of the main reason for a patient's encounter

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convention

typographic technique that provides visual guidance for understanding information

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main term

word the identifies a disease of condition in the Alphabetic table

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default code

ICD-10-CM code listed next to the main term in the Alphabetic index that is most often associated with a particular disease or condition

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subterm

word of phrase that describes a main term in the Alphabetical index

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etiology

cause or origin of a disease of condition

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nonessential modifyer

supplementary word of phrase that helps define a code in ICD-10-CM

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eponym

name of phrase formed from or based on a person's name

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NEC (not elsewhere classifiable)

abbreviation indication the coded to use when a disease of condition cannot be placed in any other category

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NOS (not otherwise specified)

term that indicates the coded to used when no information is available for assigning the disease of condition a more specific code; unspecified

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manifestation

characteristic sign of symptom of a disease

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first-listed code

code for diagnosis that is the patient's main condition; in cases involving an underlying condition and a manifestation, the underlying condition is the first-listed code

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combination code

single code describing both the etiology and the manifestation(s) of a particular condition

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placeholder character (x)

character "x" inserted in a code to fill a blank space

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seventh-character extention

necessary assignment of a seventh character to a code; often for the sequence of an encounter

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category

three-character code for classifying a disease of condition

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subcategory

four- or five- character code number

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inclusion notes

Tabular List entries addressing the applicability of certain codes to specified conditions

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exclusion notes

Tabular List entries limiting applicability of particular codes to specified conditions

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excludes 1

exclusion note used when two conditions could not exist together, such as an acquired and a congenital condition; means "not coded here"

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excludes 2

exclusion note meaning that a particular condition is not included here, but a patient could have both conditions at the same time

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laterality

use of ICD-10-CM classification system to capture the side of the body that is documented; the fourth, fifth, and sixth characters of a code specify the affected side(s)

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ICD-10-CM Official Guidelines for Coding and Reporting

general rules, inpatient (hospital) coding guidance, and outpatient (physician's office/clinic) coding guidance from the four cooperating parties (CMS advisers and partiipants from the AHA, AHIMA, and NCHS)

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primary diagnosis

first-listed diagnosis

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coexisting condition

additional illness that either has an effect on the patient's primary illness or is also treated during the encounter

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acute

illness or condition with severe symptoms and a short duration

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chronic

illness or condition with a long duration

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sequelae

conditions that remain after an acute illness or injury has been treated and resolved

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principal diagnosis

in inpatient coding, the condition is established after study to be chiefly responsible for the admission of the patient

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external cause code

ICD-10-CM code for an external cause of a disease or injury

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Z code

abbreviation for codes from the 21st chapter of the ICD-10-CM that identify factors that influence health status and encounters that are not due to illness or injury

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chief complaint (CC)

patient's description of the symptoms or other reasons for seeking medical care

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ICD-9-CM

previous HIPAA mandated diagnosis code set

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GEMs

acronym for general equivalence mappings, reference tables or related ICD-10-CM and ICD-9-CM codes