Mandated transaction code sets Flashcards
(24 cards)
ICD – 10 code
International classification of disease used with
Diagnostics and inpatient procedures coding of claims
POA
Present on admission indicators
Used with inpatient claims. (ER uses these)
CPT –4. (fourth revision)
Current procedural terminology
Used with outpatient procedure procedures
HCPCS
Healthcare common procedural coding system
Used outpatient procedures
NPI
National provider identification
Provider identification, as indicated by CMS administrative identifier standards can be hospital or physician
Tax ID
Taxonomy code
Used with administrative codes to identify practitioner type and specialty for healthcare practitioners 
Level I of the HCPCS
CPT codes in a system of descriptive, five digit, Numer codes used to identify medical services and procedures by physicians in a healthcare setting 
level II of the HCPCS
Five digit numeric codes with alpha prefixes A through V assigned by CMS identifying products, supplies and services not included in the CPT codes examples ambulance, durable medical equipment, prosthetics orthotics and supplies 
Level III of the HCPCS
Used at the state level by Medicaid and pays to designate additional services often called local codes. These codes are prohibited under HIPAA but still required by some state programs.
One range of CPT codes applies to what
Evaluation and management for an. (E & M)
Which one is not a component of the E&M
History
Examination
Medical codes used
Compliance
Medical codes used – should be medical decision-making
Compliance – should be counseling 
Which one is not a component of the E&M levels
Counseling
Coordination of benefits
Nature of prior issues
Time spent
Coordination of benefits exclamation should be coordination of CARE.
Nature of prior issues should be nature of presenting problems 
True or false
providers must ensure medical record documentation supports the level of service being built
True
What are the top three components in selecting a level of E& M service.
History
Examination
Medical decision-making 
What coating system is used for examining a patient and formulating a treatment plan
E&M range of CPT codes 
What is the Medicare learning network document called?
Evaluation and management services. ICN006764.

Name the method whereby HCPCS as well CPT codes can be Idefined to another level of specificity
By a pending a two digit numeric or alpha code known as the MIDIFIER
What is the modifier?
A two digit alpha numeric or numeric a pending code to the CPT or HCPCS 
Why are modifiers often
to clarify an atomic site of a procedure to avoid the appearance of duplicate billing if a procedure performed multiple times on the same day
What is the taxonomy codes?
Taxonomy codes are administrative codes to identify practitioner type and specialty for healthcare practitioners
What is an NPI number?
An NPI a unique 10 digit identifier issued to healthcare providers in the United States by CMS
