Billing And Coding Flashcards
(42 cards)
What do ICD (international classification of diseases) codes correspond to
Patients injury sickness
What do CPT (current procedure terminology) relate to?
What functions and services the HCP performed on or for the patient
What is ICD-10 CM
Clinical modification of the WHO standards of diagnosis
*diagnosis coding for all US health care settings
What is ICD 10 PCS
Inpatient procedure coding system for all US hospital settings
How are the ICD codes made
The codes have 3 to 7 characters
1. Digit 1 is alpha
2. Digit 2 is numeric
3. Digit 3-7 are alpha or numeric
*a decimal is used after the third character
What is the ICD-10-CM code structure
- Category (first three characters)
- Etiology, anatomical site, severity (fourth, fifth, sixth characters)
- Extension (seventh character)
What is a claim
Provider will select the most appropriate ICD code and take the information from the codes and bill the insurance company
What is the coding part
Select the ICD 10 code that best and accurately defines the diagnosis
What is the billing part
Select the best CPT E/M code based on the criteria given and supplied by the documentation
What is the evaluation and management coding (E/M or E&M coding) used for
It is a subset of CPT
1. A unique 5 digit code for procedures/services including office visits
*medical providers use to bill payers for reimbursement of services provided
What did the 2021 E/M coding changes apply to
New and established office patients
What classifies as a new office patient
Someone who has not been seen by you or someone in the exact same specialty in your group within the past three years
What classifies as an established office patient
Someone who has been seen by you or someone in the exact same specialty in your group within the three years
When did the new E/M (evaluation and management) guidelines take place
January 1 2021
What were the components of the Old EM guidelines
- History
- Physical exam
- Medical decision making
*new = 3/3 key components needed
*established = 2/3 key comments needed
How are the patients billed now according to the new 2021 EM guidelines
- Medically appropriate history and or examination
- Billing based solely on MDM or time
What else goes into consideration according to the new EM guidelines
- Total time includes face to face time plus non face to face time spent on the date of the encounter
What were the old rules based on time and what are the new rules based on time
Old = face to face time only
New = include face to face time, and non face to face time before and after the visit on the date of the encounter
What is including when adding up time spent on a patient
- Reviewing labs
- Counseling education
- Ordering medications, tests, or procedures
- Referring
*do not count travel time or teaching time
How many boxes are needed to qualify for any given level of MDM
2 out of 3
What is new in 2023 with initial hospital care
No more history or exam category
*replaced with medically appropriate history and or examination
*used for both inpatient and observation admission
What is new in 2023 with subsequent hospital care
Used for hospital progress notes for both inpatient/observation
* No more history or exam category
*replaced with medically appropriate history and or examination
What is new in 2023 with initial admission and discharge services
Used for both inpatients and observation patients
* No more history or exam category
*replaced with medically appropriate history and or examination
What is new in 2023 for outpatient consults and inpatient consults
- No more history or exam category
*replaced with medically appropriate history and or examination
